Drug-resistant UTIs need longer follow-up

Patients with resistant Enterobacteriaceae seven times more likely to require a second antibiotic

Patients with a UTI caused by antibiotic-resistant bacteria need longer follow-up, say US researchers after their study found they are at much higher risk of treatment failure.

urine test

The research shows that those in the community with a UTI caused by extended spectrum cephalosporin-resistant Enterobacteriaceae (ESC-R EB) are seven times more likely than those with a UTI caused by the non-resistant version of the bacteria to:

  • Have ongoing symptoms
  • Continued bacteria in their urine 
  • Require a second antibiotic

They are also four times more likely to receive an inappropriate initial antibiotic, which may have contributed to treatment failure, but didn’t fully explain the association with worse clinical outcomes, the University of Pennsylvania researchers report in Infection Control & Hospital Epidemiology.

Other explanations include:

  • Increased virulence of the resistant organisms, resulting in more severe infections
  • Unmeasured host factors that predispose the patients to worse clinical outcomes
  • More severe baseline infection not captured by pyelonephritis and bloodstream infections

The findings highlight the need to closely monitor patients with ESC-R EB for longer, even in the absence of bacteraemia, pyelonephritis or hospital admission, they say.

"UTIs are one of the most common bacterial infections we see in the outpatient setting, which makes the increasing prevalence of antibiotic resistance a significant problem," says lead author and clinical epidemiologist Dr Judith Anesi.

The study compared clinical outcomes for 151 patients with ESC-R EB with the same number of patients with a UTI caused by the non-resistant form of the bacteria.

Among all 302 patients, 86 experienced treatment failure and 158 failed to receive an appropriate antibiotic within 48 hours of urine culture.

But even when patients were prescribed the correct antibiotic from the start, patients with ESC-R EB continued to have symptoms or had to be treated again for the same infection within a week.

“Further studies are needed to determine which patients in the community are at high risk for drug-resistant infection to help inform prompt diagnosis and appropriate antibiotic prescribing for ESC-R EB,” the researchers concluded.


More information: Infection Control & Hospital Epidemiology 2018

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