Highlights

We evaluated 1,330,095 Enterobacterales urine isolates from US facilities (2018-20)
Isolates had high rates of resistance to drugs used for urinary tract infections
Geographic variations in antibiotic resistance were observed
The East South Central region had the highest rates of antibiotic resistance
In most regions, drug resistance levels exceeded thresholds for empiric therapy

Abstract

Antimicrobial resistance (AMR) can complicate effective management of urinary tract infections (UTIs). We conducted a retrospective study of AMR in Enterobacterales urine isolates from ambulatory and hospitalized adult patients from 2018-2020 (BD Insights Research Database) to evaluate regional differences in isolates with an extended-spectrum beta-lactamase (ESBL)-producing phenotype or not susceptible to beta-lactams, fluoroquinolones (FQ), nitrofurantoin (NFT), trimethoprim/sulfamethoxazole (TMP/SMX), or multiple antibiotic classes (2+ or 3+). Our analyses included 349,741 Enterobacterales urine isolates from 321 inpatient facilities and 980,354 isolates from 338 ambulatory care facilities. In multivariable analyses, the highest rate of resistance was to beta-lactams (60.8% and 55.8% for inpatient and ambulatory settings, respectively), followed by FQ (27.5%), NFT (27.0%), and TMP/SMX (25.4%) for inpatients and by TMP/SMX (22.4%), FQ (21.6%), and NFT (21.6%) for ambulatory patients. Isolates with an ESBL-producing phenotype (13.2% and 8.6% for inpatient and ambulatory settings, respectively) and multidrug resistance (inpatient and ambulatory rates of 23.4% and 17.7% for ≥2 drugs; 9.9% and 6.4% for ≥3 drugs) were also prevalent. Statistically significant differences by geographic region (P ≤ 0.005) were observed for AMR classes in both inpatient and ambulatory settings, but rates remained above thresholds recommended for empiric UTI therapy across most regions.

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