Department of Emergency Medicine, Department of Medicine, Divsion of Infectious Diseases, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Department of Emergency Medicine, Mills Peninsula Medical Center, Burlingame, CA.
Ann Emerg Med. 2021 Jan;77(1):32-43. doi: 10.1016/j.annemergmed.2020.08.022. Epub 2020 Oct 31.
Enterobacteriaceae resistant to ceftriaxone, mediated through extended-spectrum β-lactamases (ESBLs), commonly cause urinary tract infections worldwide, but have been less prevalent in North America. Current US rates are unknown. We determine Enterobacteriaceae antimicrobial resistance rates among US emergency department (ED) patients hospitalized for urinary tract infection.
We prospectively enrolled adults hospitalized for urinary tract infection from 11 geographically diverse university-affiliated hospital EDs during 2018 to 2019. Among participants with culture-confirmed infection, we evaluated prevalence of antimicrobial resistance, including that caused by ESBL-producing Enterobacteriaceae, resistance risk factors, and time to in vitro-active antibiotics.
Of 527 total participants, 444 (84%) had cultures that grew Enterobacteriaceae; 89 of 435 participants (20.5%; 95% confidence interval 16.9% to 24.5%; 4.6% to 45.4% by site) whose isolates had confirmatory testing had bacteria that were ESBL producing. The overall prevalence of ESBL-producing Enterobacteriaceae infection among all participants with urinary tract infection was 17.2% (95% confidence interval 14.0% to 20.7%). ESBL-producing Enterobacteriaceae infection risk factors were hospital, long-term care, antibiotic exposure within 90 days, and a fluoroquinolone- or ceftriaxone-resistant isolate within 1 year. Enterobacteriaceae resistance rates for other antimicrobials were fluoroquinolone 32.3%, gentamicin 13.7%, amikacin 1.3%, and meropenem 0.3%. Ceftriaxone was the most common empirical antibiotic. In vitro-active antibiotics were not administered within 12 hours of presentation to 48 participants (53.9%) with ESBL-producing Enterobacteriaceae infection, including 17 (58.6%) with sepsis. Compared with other Enterobacteriaceae infections, ESBL infections were associated with longer time to in vitro-active treatment (17.3 versus 3.5 hours).
Among adults hospitalized for urinary tract infection in many US locations, ESBL-producing Enterobacteriaceae have emerged as a common cause of infection that is often not initially treated with an in vitro-active antibiotic.
通过扩展型β-内酰胺酶（ESBLs）介导的对头孢曲松耐药的肠杆菌科细菌，通常会在全球范围内引起尿路感染，但在北美却较少见。目前美国的流行率尚不清楚。我们确定了美国急诊部（ED）因尿路感染住院的患者中肠杆菌科的抗菌药物耐药率。
我们前瞻性地招募了 2018 年至 2019 年期间来自 11 个地理位置不同的大学附属医院 ED 因尿路感染住院的成年人。在培养确认感染的参与者中，我们评估了抗菌药物耐药率，包括由产 ESBL 的肠杆菌科引起的耐药率、耐药风险因素以及获得体外活性抗生素的时间。
在 527 名总参与者中，444 名（84%）的培养物中生长有肠杆菌科；在 435 名有确认性检测的参与者中，89 名（20.5%；95%置信区间 16.9%至 24.5%；4.6%至 45.4%，按地点划分）其分离物为产 ESBL 的细菌。所有尿路感染参与者中，产 ESBL 的肠杆菌科感染的总体流行率为 17.2%（95%置信区间 14.0%至 20.7%）。产 ESBL 的肠杆菌科感染的风险因素包括医院、长期护理、90 天内使用抗生素以及 1 年内氟喹诺酮类或头孢曲松耐药的分离物。其他抗菌药物的肠杆菌科耐药率为：氟喹诺酮 32.3%、庆大霉素 13.7%、阿米卡星 1.3%、美罗培南 0.3%。头孢曲松是最常用的经验性抗生素。48 名（53.9%）产 ESBL 的肠杆菌科感染患者在出现症状后 12 小时内未给予体外活性抗生素，其中 17 名（58.6%）患有败血症。与其他肠杆菌科感染相比，产 ESBL 感染与获得体外活性治疗的时间更长（17.3 小时 vs. 3.5 小时）。
在许多美国地区因尿路感染住院的成年人中，产 ESBL 的肠杆菌科已成为一种常见的感染原因，而这些感染通常最初未用体外活性抗生素治疗。
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