High percentage of uncomplicated UTI not susceptible to initial treatment
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New antimicrobial dispensing within 28 days of initial treatment was associated with uncomplicated UTIs where the uropathogen was not susceptible to initial treatment, according to a recent study.
“Uncomplicated urinary tract infection (uUTI) is typically treated without a culture to guide antibiotic choice. However, high rates of antimicrobial resistance in the community setting increase the likelihood of treatment failure,” Barbara W. Trautner, MD, PhD, investigator with the Michael E. DeBakey VA Medical Center Behavioral Health Program and infectious diseases clinician-investigator at Baylor College of Medicine, told Healio. “We wanted to examine whether women whose UTI was caused by an organism resistant to the original antibiotic prescribed had worse clinical outcomes than those whose UTI was caused by an organism susceptible to the antibiotic given.”
Trautner and colleagues performed a retrospective cohort study using data from female outpatients aged 12 years and older, with a positive urine culture and dispensing of an oral antibiotic 1 day or more from the index culture.
According to the study, isolate susceptibility to the antimicrobial initially dispensed, patient age and history of antimicrobial exposure, resistance and all-cause hospitalization within 12 months of index culture were evaluated for associations with adverse outcomes during 28-day follow-up.
Of 2,366 uUTIs assessed in the study, 1,908 (80.6%) were caused by isolates susceptible and 458 (19.4%) by isolates not susceptible to initial antimicrobial treatment. Of those cases caused by a nonsusceptible isolate, patients were 60% more likely to receive a new antimicrobial within 28 days compared with those with susceptible isolates (29% vs. 18.1%; 95% CI, 1.3-2.1), which Trautner said implies ”clinical failure of the initial course of treatment.”
According to the study, other variables associated with new antibiotic dispenses within 28 days were older age, prior antimicrobial exposure or prior nitrofurantoin-nonsusceptible uropathogens (P < .05). Additionally, older age, previous antimicrobial-resistant urine isolates and previous hospitalization were associated with all-cause hospitalization (P < .05).
“Antibiotic resistance in urinary organisms is real, prevalent, and adversely impacts clinical outcomes, even for an uncomplicated outpatient UTI,” Trautner concluded.
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