Secular Trends in Gram-Negative Resistance among Urinary Tract Infection Hospitalizations in the United States, 2000–2009

2013 ◽  
Vol 34 (9) ◽  
pp. 940-946 ◽  
Author(s):  
Marya D. Zilberberg ◽  
Andrew F. Shorr
Keyword(s):  
United States ◽  
Urinary Tract ◽  
The United States ◽  
Secular Trends ◽  
Hospitalized Patients ◽  
Resistance Pattern ◽  
Surveillance Network ◽  
Gram Negative ◽  
Nationwide Inpatient Sample Database ◽  
Tract Infections

Objective.Urinary tract infections (UTIs) are common among hospitalized patients. Selection of an appropriate antibiotic for this infection requires knowledge of both its general microbiology and the epidemiology of drug-resistant organisms. We sought to determine secular trends in UTI hospitalizations that involve gram-negative (GN) multidrug-resistant Pseudomonas aeruginosa (MDR-PA), extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (EC) and Klebsiella pneumoniae(KP), and carbapenem-resistant Enterobacteriaceae (CRE).Design.Survey.Patients.Patients with UTI in US hospitals between 2000 and 2009.Methods.We first derived the total number of UTI hospitalizations in the United States from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database years 2000–2009. Based on a literature review, we then determined what proportion of all UTIs arise due to each of the organisms of interest, irrespective of resistance pattern. Finally, we assessed the prevalence of resistance within each pathogen based on the Eurofins Surveillance Network database 2000–2009. Susceptibility patterns served as phenotypic surrogates for resistance.Results.Between 2000 and 2009, the frequency of UTI hospitalizations increased by approximately 50%, from 53 to 77 cases per 1,000 hospitalizations. Infections due to all GN bacteria followed a similar trajectory, whereas those caused by resistant GN pathogens increased by approximately 50% (MDR-PA) to approximately 300% (ESBL). CRE emerged and reached 0.5 cases per 1,000 hospitalizations in this 10-year period.Conclusions.The epidemiology and microbiology of GN UTI hospitalizations has shifted over the past decade. The proportion of all hospitalizations involving this infection has climbed. Resistant GN bacteria are becoming more prevalent and are implicated in an increasing proportion of UTIs among hospitalized patients.

scholarly journals Colistin- and Carbapenem-Resistant Escherichia coli Harboring mcr-1 and bla NDM-5 , Causing a Complicated Urinary Tract Infection in a Patient from the United States: TABLE 1 

mBio ◽  
2016 ◽  
Vol 7 (4) ◽  
Author(s):  
José R. Mediavilla ◽  
Amee Patrawalla ◽  
Liang Chen ◽  
Kalyan D. Chavda ◽  
Barun Mathema ◽  
...  
Keyword(s):  
United States ◽  
Escherichia Coli ◽  
Urinary Tract ◽  
The United States ◽  
Clinical Samples ◽  
Isolation And Identification ◽  
Gram Negative ◽  
E Coli ◽  
Carbapenem Resistant ◽  
Tract Infections

ABSTRACT Colistin is increasingly used as an antibiotic of last resort for the treatment of carbapenem-resistant Gram-negative infections. The plasmid-borne colistin resistance gene mcr-1 was initially identified in animal and clinical samples from China and subsequently reported worldwide, including in the United States. Of particular concern is the spread of mcr-1 into carbapenem-resistant bacteria, thereby creating strains that approach pan-resistance. While several reports of mcr-1 have involved carbapenem-resistant strains, no such isolates have been described in the United States. Here, we report the isolation and identification of an Escherichia coli strain harboring both mcr-1 and carbapenemase gene bla NDM-5 from a urine sample in a patient without recent travel outside the United States. The isolate exhibited resistance to both colistin and carbapenems, but was susceptible to amikacin, aztreonam, gentamicin, nitrofurantoin, tigecycline, and trimethoprim-sulfamethoxazole. The mcr-1 - and bla NDM-5 -harboring plasmids were completely sequenced and shown to be highly similar to plasmids previously reported from China. The strain in this report was first isolated in August 2014, highlighting an earlier presence of mcr-1 within the United States than previously recognized. IMPORTANCE Colistin has become the last line of defense for the treatment of infections caused by Gram-negative bacteria resistant to multiple classes of antibiotics, in particular carbapenem-resistant Enterobacteriaceae (CRE). Resistance to colistin, encoded by the plasmid-borne gene mcr-1 , was first identified in animal and clinical samples from China in November 2015 and has subsequently been reported from numerous other countries. In April 2016, mcr-1 was identified in a carbapenem-susceptible Escherichia coli strain from a clinical sample in the United States, followed by a second report from a carbapenem-susceptible E. coli strain originally isolated in May 2015. We report the isolation and identification of an E. coli strain harboring both colistin ( mcr-1 ) and carbapenem ( bla NDM-5 ) resistance genes, originally isolated in August 2014 from urine of a patient with recurrent urinary tract infections. To our knowledge, this is the first report in the United States of a clinical bacterial isolate with both colistin and carbapenem resistance, highlighting the importance of active surveillance efforts for colistin- and carbapenem-resistant organisms.

scholarly journals 1675. Epidemiology of Urinary Tract Infections in the United States, 2009 - 2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S823-S823
Author(s):  
Kendra Foster ◽  
Linnea A Polgreen ◽  
Brett Faine ◽  
Philip M Polgreen
Keyword(s):  
United States ◽  
Urinary Tract ◽  
Klebsiella Pneumoniae ◽  
Urinary Tract Infections ◽  
Proteus Mirabilis ◽  
Antibiotic Use ◽  
The United States ◽  
Drug Resistant ◽  
E Coli ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are one of the most common bacterial infections. There is a lack of large epidemiologic studies evaluating the etiologies of UTIs in the United States. This study aimed to determine the prevalence of different UTI-causing organisms and their antimicrobial susceptibility profiles among patients being treated in a hospital setting. Methods We used the Premier Healthcare Database. Patients with a primary diagnosis code of cystitis, pyelonephritis, or urinary tract infection and had a urine culture from 2009- 2018 were included in the study. Both inpatients and patients who were only treated in the emergency department (ED) were included. We calculated descriptive statistics for uropathogens and their susceptibilities. Multi-drug-resistant pathogens are defined as pathogens resistant to 3 or more antibiotics. Resistance patterns are also described for specific drug classes, like resistance to fluoroquinolones. We also evaluated antibiotic use in this patient population and how antibiotic use varied during the hospitalization. Results There were 640,285 individuals who met the inclusion criteria. Females make up 82% of the study population and 45% were age 65 or older. The most common uropathogen was Escherichia Coli (64.9%) followed by Klebsiella pneumoniae (8.3%), and Proteus mirabilis (5.7%). 22.2% of patients were infected with a multi-drug-resistant pathogen. We found that E. Coli was multi-drug resistant 23.8% of the time; Klebsiella pneumoniae was multi-drug resistant 7.4%; and Proteus mirabilis was multi-drug resistant 2.8%. The most common antibiotics prescribed were ceftriaxone, levofloxacin, and ciprofloxacin. Among patients that were prescribed ceftriaxone, 31.7% of them switched to a different antibiotic during their hospitalization. Patients that were prescribed levofloxacin and ciprofloxacin switched to a different antibiotic 42.8% and 41.5% of the time, respectively. Conclusion E. Coli showed significant multidrug resistance in this population of UTI patients that were hospitalized or treated within the ED, and antibiotic switching is common. Disclosures All Authors: No reported disclosures

Trends in Catheter-Associated Urinary Tract Infections in Adult Intensive Care Units—United States, 1990–2007

2011 ◽  
Vol 32 (8) ◽  
pp. 748-756 ◽  
Author(s):  
Deron C. Burton ◽  
Jonathan R. Edwards ◽  
Arjun Srinivasan ◽  
Scott K. Fridkin ◽  
Carolyn V. Gould
Keyword(s):  
United States ◽  
Intensive Care ◽  
Urinary Tract ◽  
Intensive Care Units ◽  
Urinary Tract Infections ◽  
Asymptomatic Bacteriuria ◽  
The United States ◽  
Symptomatic Urinary Tract Infection ◽  
Prevention Guidelines ◽  
Tract Infections

Background.Over the past 2 decades, multiple interventions have been developed to prevent catheter-associated urinary tract infections (CAUTIs). The CAUTI prevention guidelines of the Healthcare Infection Control Practices Advisory Committee were recently revised.Objective.To examine changes in rates of CAUTI events in adult intensive care units (ICUs) in the United States from 1990 through 2007.Methods.Data were reported to the Centers for Disease Control and Prevention (CDC) through the National Nosocomial Infections Surveillance System from 1990 through 2004 and the National Healthcare Safety Network from 2006 through 2007. Infection preventionists in participating hospitals used standard methods to identify all CAUTI events (categorized as symptomatic urinary tract infection [SUTI] or asymptomatic bacteriuria [ASB]) and urinary catheter–days (UC-days) in months selected for surveillance. Data from all facilities were aggregated to calculate pooled mean annual SUTI and ASB rates (in events per 1,000 UC-days) by ICU type. Poisson regression was used to estimate percent changes in rates over time.Results.Overall, 36,282 SUTIs and 22,973 ASB episodes were reported from 367 facilities representing 1,223 adult ICUs, including combined medical/surgical (505), medical (212), surgical (224), coronary (173), and cardiothoracic (109) ICUs. All ICU types experienced significant declines of 19%–67% in SUTI rates and 29%–72% in ASB rates from 1990 through 2007. Between 2000 and 2007, significant reductions in SUTI rates occurred in all ICU types except cardiothoracic ICUs.Conclusions.Since 1990, CAUTI rates have declined significantly in all major adult ICU types in facilities reporting to the CDC. Further efforts are needed to assess prevention strategies that might have led to these decreases and to implement new CAUTI prevention guidelines.

scholarly journals Urinary Tract Infection Due to Non-fermentative Gram-Negative Bacilli in Tribhuvan University Teaching Hospital, Kathmandu, Nepal

NUTA Journal ◽  
2020 ◽  
Vol 7 (1-2) ◽  
pp. 71-78
Author(s):  
Santosh Kumar Yadav ◽  
Uday Kant Jha ◽  
Jeevan Bahadur Sherchan
Keyword(s):  
Urinary Tract ◽  
Teaching Hospital ◽  
Antibiotic Susceptibility ◽  
Hospitalized Patients ◽  
The Body ◽  
University Teaching ◽  
Burkholderia Cepacia Complex ◽  
Acinetobacter Species ◽  
Gram Negative ◽  
Tract Infections

Urinary tract infections (UTIs) are the second most common type of bacterial infection of the body affecting humans throughout their lifetime. They are a frequent cause of nosocomial in fection in many hospitals. Therefore, this study was designed to isolate and identify the non-fermentative Gram-negative bacilli (NFGNB) causing UTI in hospitalized patients and determine their antibiotic susceptibility profile. This study was carried in Tribhuvan University Teaching Hospital, Nepal among hospitalized patients. The urine sample was cultured and the antibiotic susceptibility profile of isolated NFGNB was determined by standard microbiological procedures. Among the total of 49 NFGNB isolates, Acinetobacter species (n=21, 42.9%) and Pseudomonas aeruginosa (n=21, 42.9%) were the major isolates and the remaining was Burkholderia cepacia complex (n=7, 14.3%). These isolates were found resistant to commonly used antibiotics. From the present study, it is clear that NFGNB are an important bacterial pathogen capable of producing UTI in hospitalized patients.

scholarly journals 1686. Microbiology of Community-Onset Urinary Tract Infections in the United States, 2012-2017

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S826-S827
Author(s):  
Leigh Ellyn Preston ◽  
Clifford McDonald ◽  
Babatunde Olubajo ◽  
Natalie McCarthy ◽  
Sujan Reddy ◽  
...  
Keyword(s):  
United States ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Relative Frequency ◽  
The United States ◽  
Antibiotic Prescribing ◽  
Factors Associated ◽  
Tract Infections ◽  
Community Onset

Abstract Background Community-onset urinary tract infections (coUTIs) are one of the most common indications for antibiotic prescribing. It is important to understand patient demographic factors associated with microorganisms causing coUTI and their antibiotic resistance profiles, to tailor antibiotic prescribing practices. We analyzed microbiology data to understand factors associated with coUTI in the United States (US). Methods CoUTIs were identified in the Premier Healthcare Database and Cerner Health Facts among patients treated at participating healthcare facilities in the US between 2012-2017. Cases were defined by urine cultures yielding a bacterial organism and were collected in outpatient settings or within three days of hospitalization. Only the first specimen for each encounter was included in the analysis. Data on the organisms isolated, patient’s age, sex, and US census regions of the submitting facilities were described and compared using chi-square tests for associations. Encounters were classified as inpatient (INPT), observation (OBS), emergency department (ED), and outpatient (OTPT) based on the setting in which the culture was submitted. Results Using data from 637 acute care hospitals, urine samples from 3,291,561 encounters were included, with 776,653 (25.7%) INPT, 1,063,219 (34.8%) ED, 107,760 (3.5%) OBS, and 1,092,658 (35.8%) OTPT. The pathogens most frequently associated with coUTIs were Escherichia coli (57.3%), Klebsiella pneumoniae (9.7%), Enterococcus faecalis (5.1%), Proteus mirabilis (4.9%), and Pseudomonas aeruginosa (2.9%). Female sex, age < 65y and OTPT and ED settings were associated with higher relative frequency of E. coli (all p < 0.0001). Male sex, INPT setting and age >65 y were associated with higher relative frequency of P. aeruginosa, P. mirabilis and E. faecalis (all p < 0.0001, Figure). K. pneumoniae was found at higher relative frequency in those >45y, and in INPT and OBS settings (all p < 0.0001). Figure. Distribution of pathogens most frequently associated with community onset urinary tract infections Conclusion Understanding patient factors associated with the microbiology of coUTIs is an important step in developing treatment recommendations and antibiotic stewardship efforts. Further analyses will include assessing the impact of major antibiotic resistance phenotypes, geographic and healthcare settings. Disclosures All Authors: No reported disclosures

Antibiogram of Gram Negative Uropathogens in a Tertiary Care Hospital

2021 ◽  
Vol 8 (2) ◽  
pp. 80-84
Author(s):  
Milind Davane ◽  
Sanjivani Mundhe
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Susceptibility ◽  
Hospitalized Patients ◽  
Health Concern ◽  
Diffusion Method ◽  
Susceptibility Pattern ◽  
Gram Negative ◽  
Antimicrobial Susceptibility Pattern ◽  
Tract Infections ◽  
Klebsiella Spp

Background: Globally, urinary tract infection (UTI) is considered a major public health concern and the second most common bacterial infection affecting individuals of different ages worldwide. Urinary tract infections (UTIs) are caused by multiplicity of microorganisms. The chronicity of different bacterial isolates and their propensity to various antibiotics may differ widely, particularly in hospitalized patients, that makes the study of susceptibility pattern mandatory for a proper selection of antibiotics. Objective: To evaluate antimicrobial susceptibility pattern of the Gram negative organisms isolated from urine cultures of hospitalized patients. Material and Methods: A total of 500 urine samples from hospitalized patients which showed significant bacteriuria were studied. Samples were inoculated on Blood agar and MacConckey agar. Further identification and study of organisms was done by standard Microbiological methods. Antimicrobial Susceptibility pattern was studied by Modified Kirby- Bauer’s disc diffusion method with the panel of 15 drugs as per Clinical Laboratories Standard Institute (CLSI) guidelines. Results: UTIs were found more common in females 290 (58%). Commonest organism found was Escherichia coli 260 (52%) followed by Klebsiella spp. 120 (24%), Pseudomonas spp. 40 (8%), Proteus spp. 38 (7.6%), Citrobacter spp. 25 (5%) and Acinetobacter spp. 17 (3.4%). Majority of the strains were found sensitive to nitrofurantoin followed by amikacin, piperacillin-tazobactam and cotrimoxazole. Commonly prescribed fluroquinolones were found least effective for treatment of UTI. All the strains were found sensitive to imipenem. Extended spectrum beta lactamase (ESBL) was noted in E.coli and in Klebsiella spp. Conclusion: To discourage the indiscriminate use of antibiotics and to prevent further development of bacterial drug resistance, proper knowledge of susceptibility pattern of uropathogens in particular area is very important before prescribing any empirical antibiotic therapy.

Temporal Trends in the Microbiological Characteristics of Sepsis in the United States: A Population Based Study

2021 ◽  
pp. 088506662110537
Author(s):  
Po-Yang Tsou ◽  
Chia-Hung Yo ◽  
Yenh-Chen Hsein ◽  
Gregory Yungtum ◽  
Wan-Ting Hsu ◽  
...  
Keyword(s):  
United States ◽  
Temporal Trends ◽  
Population Level ◽  
The United States ◽  
Population Based ◽  
Epidemiologic Studies ◽  
Annual Increase ◽  
Gram Negative ◽  
Nationwide Inpatient Sample Database ◽  
Incidence And Mortality

Background Epidemiologic studies are needed for monitoring population-level trends in sepsis. This study examines sepsis-causing microorganisms from 2006 to 2014 in the United States using data from the Nationwide Inpatient Sample database. Methods 7 860 686 adults hospitalized with sepsis were identified using a validated ICD-9 coding approach. Associated microorganisms were identified by ICD-9 code and classified by major groups (Gram-positive, Gram-negative, fungi, anaerobes) and specific species for analysis of their incidence and mortality. Results The rate of sepsis incidence has increased for all four major categories of pathogens, while the mortality rate decreased. In 2014, Gram-negative pathogens had a higher incidence than Gram-positives. Anaerobes increased the fastest with an average annual increase of 20.17% (p < 0.001). Fungi had the highest mortality (19.28%) and the slowest annual decrease of mortality (−2.31%, p = 0.006) in 2013, while anaerobic sepsis had the highest hazard of mortality (adjusted HR 1.60, 95% CI 1.53-1.66). Conclusions Gram-negative pathogens have replaced Gram-positives as the leading cause of sepsis in the United States in 2014 during the study period (2006-2014). The incidence of anaerobic sepsis has an annual increase of 20%, while the mortality of fungal sepsis has not decreased at the same rate as other microorganisms. These findings should inform the diagnosis and management of septic patients, as well as the implementation of public health programs.

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