Risk Factors for Amoxicillin-Clavulanate Resistance in Community-Onset Urinary Tract Infections Caused by Escherichia coli or Klebsiella pneumoniae : The Role of Prior Exposure to Fluoroquinolones
Martínez-Casanova, Javier (Institut Hospital del Mar d'Investigacions Mèdiques)
Gómez-Zorrilla, Silvia (Institut Hospital del Mar d'Investigacions Mèdiques)
Prim, Núria (Institut Hospital del Mar d'Investigacions Mèdiques)
Dal Molin, Agustina (Institut Hospital del Mar d'Investigacions Mèdiques)
Echeverría-Esnal, Daniel (Institut Hospital del Mar d'Investigacions Mèdiques)
Gracia-Arnillas, María Pilar (Institut Hospital del Mar d'Investigacions Mèdiques)
Sendra, Elena (Institut Hospital del Mar d'Investigacions Mèdiques)
Güerri-Fernández, Robert (Institut Hospital del Mar d'Investigacions Mèdiques)
Duran-Jordà, Xavier (Institut Hospital del Mar d'Investigacions Mèdiques)
Padilla León, Eduardo (Institut Hospital del Mar d'Investigacions Mèdiques)
Horcajada, Juan Pablo (Institut Hospital del Mar d'Investigacions Mèdiques)
Grau, Santiago (Institut Hospital del Mar d'Investigacions Mèdiques)
Universitat Autònoma de Barcelona

Data:	2021
Resum:	Background: High rates of amoxicillin-clavulanate (AMC) resistance among Enterobacterales isolated from urinary tract infections (UTIs) were observed in our area. The aim of this study was to identify risk factors associated with AMC resistance in patients with community-onset UTI in emergency departments (EDs). Methods: A retrospective study was performed of all ED patients with positive urine cultures for Escherichia coli or Klebsiella pneumoniae in a Spanish tertiary-care hospital. Results: 330 urine cultures in all were included: 261 (79. 1%) for E. coli and 69 (20. 90%) for K. pneumonia. Rates of AMC resistance were 14. 94% and 34. 78%, respectively. UTI was clinically confirmed in 212 (64. 24%) cases. Previous antimicrobial exposure was independently associated with AMC resistance development in E. coli and K. pneumoniae urinary isolates (OR = 2. 94, 95% CI = 1. 55-5. 58). Analyses of infected patients revealed that previous exposure to fluoroquinolones (OR = 3. 33, 95% CI = 1. 10-10. 12, p = 0. 034) and to AMC (OR = 5. 68, 95% CI = 1. 97-16. 44, p = 0. 001) was significantly associated with isolation of AMC-resistant strains. Conclusions: Prior antibiotic exposure, particularly to AMC or fluoroquinolones, was the only independent risk factor associated with development of AMC resistance in E. coli and K. pneumoniae urinary isolates from patients attending the ED.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Amoxicillin/clavulanate ; Urinary tract infection (UTI) ; Enterobacterales ; Antimicrobial resistance ; Fluoroquinolones ; Emergency department
Publicat a:	Antibiotics, Vol. 10 (may 2021) , ISSN 2079-6382

DOI: 10.3390/antibiotics10050582
PMID: 34069184

11 p, 264.6 KB

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