Written by Clay Smith
Highly resistant extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in the urine are becoming increasingly common in unexpected patients in the ED.
Why does this matter?
We need to be aware of the growing threat of highly resistant bacteria. This can happen in patients we would not suspect, who don’t have traditional risk factors for resistance. ESBL means resistance to ceftriaxone and ceftazidime.
Don’t join the resistance
This was a retrospective study of a single northern California ED. They found 5.9% of urine culture isolates were ESBL. Most, 79%, were E. coli. About half were started on initial antibiotics to which the organism was resistant. Nearly half had no associated risk factors, such as recent hospitalization, age ≥65, indwelling catheter, urologic procedure, functional dependence, or antibiotics in the previous 90 days. There was additional resistance to levofloxacin in 71% and to nitrofurantoin in 23%. ESBL is a growing concern in patients with UTI. Nitrofurantoin is an excellent first choice for most patients with cystitis and will still cover many ESBL strains.
Emergency Department Urinary Tract Infections Caused by Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: Many Patients Have No Identifiable Risk Factor and Discordant Empiric Therapy Is Common. Ann Emerg Med. 2018 Oct;72(4):449-456. doi: 10.1016/j.annemergmed.2018.05.006. Epub 2018 Jul 3.
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