Prediction of Sulfamethoxazole/Trimethoprim Resistance in Community-Onset Urinary Tract Infections.
J Glob Antimicrob Resist. 2019 Nov 01;:
Authors: DeMarsh M, Brandon Bookstaver P, Gordon C, Lim J, Griffith N, Bookstaver NK, Justo JA, Kohn J, Al-Hasan MN, Prisma Health Antimicrobial Stewardship and Support Team (PHASST)
OBJECTIVE: The study aims to predict resistance to sulfamethoxazole/trimethoprim (SXT) in patients with community-onset urinary tract infections (UTIs) due to Enterobacteriaceae based on patient-specific risk factors.
DESIGN: Retrospective case-control study.
SETTING: Prisma Health facilities in central South Carolina, USA, including three community hospitals, affiliated emergency departments, and ambulatory clinics.
PATIENTS: Adult patients with community-onset UTIs due to Enterobacteriaceae from April 1, 2015 to February 29, 2016.
METHODS: Multivariate logistic regression was used to examine risk factors for SXT resistance.
RESULTS: Among 351 unique patients with community-onset UTIs, 71 (20%) had Enterobacteriaceae urinary isolates that were SXT-resistant (SXT-R). Overall, median age was 64 years and 252 (72%) were women. Multivariate model identified prior urinary infections or colonization with SXT-R Enterobacteriaceae (odds ratio [OR] 8.58, 95% confidence intervals [CI] 3.92-18.81, p < 0.001) and SXT use within past 12 months (OR 2.58, 95% CI 1.13-5.89, p = 0.02) as predictors of SXT resistance among urinary isolates. Most patients with UTIs (285; 81%) had no risk factors for SXT resistance. SXT resistance rates increased from 13% in the absence of risk factors to 31% in patients with prior SXT use, 66% in those with prior urinary infections or colonization with SXT-R Enterobacteriaceae, and 73% in the presence of both risk factors.
CONCLUSIONS: SXT resistance in Enterobacteriaceae urinary isolates may be predicted based on prior urine culture results and SXT use within the previous year. Utilization of patient-specific antibiogram may allow empirical SXT use in patients with community-onset UTIs in the absence of risk factors for resistance.
PMID: 31683038 [PubMed - as supplied by publisher]