Multidrug Resistance of Escherichia coli From Outpatient Uncomplicated Urinary Tract Infections in a Large United States Integrated Healthcare Organization

Jennifer H Ku; Katia J Bruxvoort; S Bianca Salas; Cara D Varley; Joan A Casey; Eva Raphael; Sarah C Robinson; Keeve E Nachman; Bruno J Lewin; Richard Contreras; Rong X Wei; Magdalena E Pomichowski; Harpreet S Takhar; Sara Y Tartof

doi:10.1093/ofid/ofad287

Multidrug Resistance of Escherichia coli From Outpatient Uncomplicated Urinary Tract Infections in a Large United States Integrated Healthcare Organization

Open Forum Infect Dis. 2023 May 23;10(7):ofad287. doi: 10.1093/ofid/ofad287. eCollection 2023 Jul.

Authors

Jennifer H Ku¹, Katia J Bruxvoort^{1

2}, S Bianca Salas¹, Cara D Varley^{3

4}, Joan A Casey^{5

6}, Eva Raphael^{7

8}, Sarah C Robinson⁹, Keeve E Nachman¹⁰, Bruno J Lewin^{1

11}, Richard Contreras¹, Rong X Wei¹, Magdalena E Pomichowski¹, Harpreet S Takhar¹, Sara Y Tartof^{1

11}

Affiliations

¹ Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
² Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
³ Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
⁴ Oregon Health & Science University-Portland State University, School of Public Health, Portland, Oregon, USA.
⁵ Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA.
⁶ Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA.
⁷ Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
⁸ Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA.
⁹ Center for Health Systems Research, Sutter Health, Walnut Creek, California, USA.
¹⁰ Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, Maryland, USA.
¹¹ Kaiser Permanente Southern California and Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.

Abstract

Background: Urinary tract infections (UTIs) cause significant disease and economic burden. Uncomplicated UTIs (uUTIs) occur in otherwise healthy individuals without underlying structural abnormalities, with uropathogenic Escherichia coli (UPEC) accounting for 80% of cases. With recent transitions in healthcare toward virtual visits, data on multidrug resistance (MDR) (resistant to ≥3 antibiotic classes) by care setting are needed to inform empiric treatment decision making.

Methods: We evaluated UPEC resistance over time by care setting (in-person vs virtual), in adults who received outpatient care for uUTI at Kaiser Permanente Southern California between January 2016 and December 2021.

Results: We included 174 185 individuals who had ≥1 UPEC uUTI (233 974 isolates) (92% female, 46% Hispanic, mean age 52 years [standard deviation 20]). Overall, prevalence of UPEC MDR decreased during the study period (13% to 12%) both in virtual and in-person settings (P for trend <.001). Resistance to penicillins overall (29%), coresistance to penicillins and trimethoprim-sulfamethoxazole (TMP-SMX) (12%), and MDR involving the 2 plus ≥1 antibiotic class were common (10%). Resistance to 1, 2, 3, and 4 antibiotic classes was found in 19%, 18%, 8%, and 4% of isolates, respectively; 1% were resistant to ≥5 antibiotic classes, and 50% were resistant to none. Similar resistance patterns were observed over time and by care setting.

Conclusions: We observed a slight decrease in both class-specific antimicrobial resistance and MDR of UPEC overall, most commonly involving penicillins and TMP-SMX. Resistance patterns were consistent over time and similar in both in-person and virtual settings. Virtual healthcare may expand access to UTI care.

Keywords: multidrug antibiotic resistance; urinary tract infection; uropathogenic Escherichia coli.

Abstract

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