%0 Journal Article
%T Urinary Tract Infections due to Multidrug-Resistant Enterobacteriaceae: Prevalence and Risk Factors in a Chicago Emergency Department
%A Thana Khawcharoenporn
%A Shawn Vasoo
%A Kamaljit Singh
%J Emergency Medicine International
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/258517
%X Background. Selection of empiric antibiotics for urinary tract infections (UTIs) has become more challenging because of the increasing rates of multidrug-resistant Enterobacteriaceae (MDRE) infections. Methods. This retrospective study was conducted to determine antibiotic resistance patterns, risk factors, and appropriate empiric antibiotic selection for MDRE UTIs. Adult patients seen in the Emergency Department (ED) with Enterobacteriaceae UTIs during 2008-2009 were identified from review of microbiology records. MDRE were defined as organisms resistant to at least 3 categories of antibiotics. Results. There were 431 eligible patients; 83 (19%) had MDRE UTIs. Resistance rates for individual antibiotics among MDRE UTIs were significantly greater than non-MDRE UTIs: levofloxacin, 72% versus 14%; TMP-SMX, 77% versus 12%; amoxicillin-clavulanate, 35% versus 4%; nitrofurantoin, 21% versus 12%, and ceftriaxone, 20% versus 0%. All Enterobacteriaceae isolates were susceptible to ertapenem (MIC ¡Ü 2£¿mg/L). Independent risk factors for MDRE UTI were prior fluoroquinolone use within 3 months (adjusted odds ratio (aOR) 3.64; ), healthcare-associated risks (aOR 2.32; ), and obstructive uropathy (aOR 2.22; ). Conclusion. Our study suggests that once-daily intravenous or intramuscular ertapenem may be appropriate for outpatient treatment of ED patients with MDRE UTI. 1. Introduction Enterobacteriaceae are the most common cause of urinary tract infections (UTIs) in both community and healthcare settings. Selection of empiric antibiotic therapy for UTIs is therefore often based on the institutional susceptibility profiles of the Enterobacteriaceae [1]. Recent guidelines from the Infectious Diseases Society of America recommended that empiric antibiotic therapy for UTIs should be based on local resistance data, drug availability, and antibiotic intolerance/allergy history of treated patients [1, 2]. For uncomplicated cystitis, nitrofurantoin or trimethoprim-sulfamethoxazole (TMP-SMX, if local resistance ¡Ü 20%) can be used empirically, while fluoroquinolones, ceftriaxone, aminoglycosides, and carbapenems are appropriate for pyelonephritis and complicated UTIs. The increase in rates of antibiotic resistance among Enterobacteriaceae has posed challenges in choosing empiric regimens, especially when infections due to multidrug-resistant Enterobacteriaceae (MDRE) are suspected or endemic [3]. In the past decade, emerging resistance among the Enterobacteriaceae due to extended-spectrum beta-lactamases (ESBL) has been reported worldwide, including in Chicago [4]. In addition,
%U http://www.hindawi.com/journals/emi/2013/258517/