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Rise of Extended Spectrum β-Lactamase UTI in Emergency Patients

December 17, 2020

Written by Clay Smith

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The prevalence of extended-spectrum β-lactamases (ESBL) among patients admitted from the ED with UTI caused by Enterobacteriaceae was 17.2%.

Why does this matter?
Enterobacteriaceae are bacteria that commonly cause UTI and other infections. These are familiar and include: Citrobacter spp, Enterobacter spp, E. coli, Klebsiella spp, Proteus spp, Salmonella enterica, Serratia marcescens, Shigella spp, Yersinia spp. Ceftriaxone is often used to empirically treat patients with UTI. But is the old standby still effective?

Bacterial thugs
This was a multicenter prospective study with 11 EDs participating in 2018 and 2019. Among 527 patients admitted from the ED with UTI, 444 (84%) grew Enterobacteriaceae. Of the 435 with confirmatory testing, the prevalence of ESBL was 17.2% (89/435). Prevalence of resistance to other common antibiotics was: “fluoroquinolone 32.3%, gentamicin 13.7%, amikacin 1.3%, and meropenem 0.3%.” Time to treatment with an effective drug was, as expected, longer in the ESBL group. Patients who had received antibiotics in the previous 90 days, those in long term care facilities, those with recent hospitalization, and those with prior antibiotic resistance were at greater risk for having ESBL strains. This is concerning. Work with your local ID team on how to handle ESBL at your facility.

Emergence of Extended-Spectrum β-Lactamase Urinary Tract Infections Among Hospitalized Emergency Department Patients in the United States. Ann Emerg Med. 2020 Oct 31;S0196-0644(20)30686-7. doi: 10.1016/j.annemergmed.2020.08.022. Online ahead of print.

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