Fluoroquinolone-Resistant and Extended-Spectrum β-Lactamase–ProducingEscherichia coliInfections in Patients with Pyelonephritis, United States1

Abstract

Prevalence of fluoroquinolone resistance now exceeds treatment guideline thresholds for alternative antimicrobial drug strategies.

Escherichia coli Sequence Type 131 H 30 Is the Main Driver of Emerging Extended-Spectrum-β-Lactamase-Producing E. coli at a Tertiary Care Center

“…This suggests that efforts to reduce fluoroquinolone resistance-related morbidity and costs should include attention to this strain. The clinical importance of the combined ESBL production and fluoroquinolone resistance phenotype, which here was strongly associated with ST131- H 30 and H 30Rx, has been noted recently for patients with acute pyelonephritis (3). …”

“…It poses increasing clinical challenges due to emerging antimicrobial resistance, most notably to fluoroquinolones and extended-spectrum cephalosporins (ESCs), with the latter mediated mainly by extended-spectrum beta-lactamases (ESBLs), such as CTX-M-15 (2, 3). The dissemination of specific drug-resistant clonal groups accounts for much of this problem (4, 5).…”

The Pandemic H30 Subclone of Sequence Type 131 (ST131) as the Leading Cause of Multidrug-Resistant Escherichia coli Infections in the United States (2011–2012)

“…Emerging antimicrobial resistance increasingly complicates their management [2, 3]. Better understanding of the growing E. coli resistance problem is sorely needed.…”

EMERGEncy ID NET: Review of a 20-Year Multisite Emergency Department Emerging Infections Research Network

“…Of note, about one-half of all patients in this study were treated with oral antibiotics as outpatients. At present, no oral antimicrobials are available with consistent in vitro activity to empirically treat acute pyelonephritis due to ESBL-producing E. coli , highlighting the importance of emerging antimicrobial resistance and the need for research into new treatments for resistant infections [11]. These findings indicate that ED providers should make treatment decisions on the basis of their local antibiogram, including consideration of empirical treatment with a carbapenem or another agent found to be consistently active, for persons at high risk for both antimicrobial drug resistance and severe sepsis.…”