Prior cultures predict antibiotic susceptibility for patients with recurrent UTIs
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Prior urine culture susceptibility may help predict future antibiotic resistance in patients with recurrent UTIs, according to data presented at the Society for Healthcare Epidemiology of America Spring Meeting.
Researchers observed a high incidence of antimicrobial resistance among patients with recurrent UTIs (rUTI) in a study conducted in the urology and primary care practices at a Houston hospital.
“Recurrent UTI is commonly seen in clinical practice, as studies have identified that 24% to 44% of females and 14% of older males go on to develop rUTI,” Marissa Valentine-King, PhD, MPH, RN, a postdoctoral fellow at Baylor College of Medicine, said during her presentation.
“As patients with rUTI are often exposed to multiple rounds of antibiotics, studies have identified that patients with rUTIs have significantly higher levels of antimicrobial resistance than those with sporadic UTI,” Valentine-King said.
She said prior studies have not evaluated the predictability of a prior culture from patients with rUTI or antibiotic resistance among these patients in U.S. outpatient settings.
For their study, Valentine-King and colleagues constructed an antibiogram and evaluated the sensitivity, specificity, positive predictive values (PPVs) and negative predictive values (NPVs) of a prior culture on predicting resistance or susceptibility of a future culture.
They retrospectively assessed the electronic health records of outpatients seen in the two practices who had cystitis twice in 6 months or three times in 12 months between Nov. 1, 2016, and Dec. 31, 2018.
The study included 597 visits from 232 patients. Among 310 rUTI episodes with available urine culture, at least one uropathogen was isolated from 189 (61%), with Escherichia coli being the most common (130 of 196; 66%).
More than 20% of E. coli isolates were resistant to 10 of 18 antibiotics, with resistance to ciprofloxacin, nitrofurantoin and trimethoprim-sulfamethoxazole being 27.9%, 5.5%, and 38%, respectively.
The PPVs for predicting resistance were highest for ceftriaxone (0.86; 95% CI, 0.6-0.96), ciprofloxacin (0.84; 95% CI, 0.63-0.94) and levofloxacin (0.84; 95% CI, 0.63-0.94), whereas NPVs of resistance were highest for gentamicin (0.97; 95% CI, 0.83-1), ceftriaxone (0.94; 95% CI, 0.86-0.98) and cefepime (0.94; 95% CI, 0.84-0.98).
The researchers said NPVs for cefuroxime, ciprofloxacin, levofloxacin and nitrofurantoin were all greater than 0.83.
“Relaying on a prior culture may help improve antibiotic prescribing in the midst of rising antibiotic resistance,” Valentine-King concluded.
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Valentine-King M, et al. Abstract 104. Presented at: Society for Healthcare Epidemiology of America Spring Meeting; April 12-14, 2022
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