A Prediction Tool for the Presence of Ceftriaxone-Resistant Uropathogens upon Hospital Admission.
Nancy Yanzhe LiGang Quan PohGladys Chung Wei TengHui Hiong ChenDouglas Su Gin ChanSiew-Pang ChanPaul Anantharajah TambyahNatasha BagdasarianJia En WuPublished in: Antibiotics (Basel, Switzerland) (2020)
Antimicrobial resistance among uropathogens is a particularly pressing problem in the Asia-Pacific region. The objectives of this study were to determine the incidence and susceptibility of uropathogens upon hospital admission and to develop a risk-scoring model to predict the presence of ceftriaxone-resistance uropathogens (CrP). This was a retrospective observational cohort study of patients with a positive urine culture within 48 h of presentation at National University Hospital, Singapore between June 2015 and August 2015. Escherichia coli was the most common uropathogen isolated (51.7%), followed by Klebsiella pneumonia (15.1%) and Pseudomonas aeruginosa (8.2%). Overall, 372 out of 869 isolates (42.8%) were resistant to ceftriaxone. Hospitalization for ≥2 days within past 30 days, antibiotic use within the past 3 months and male gender were associated with the presence of CrP. A risk score based on these parameters successfully predicted CrP with an area under the curve of 0.68. The risk score will help clinicians to accurately predict antibiotic resistance at the individual patient level and allow physicians to safely prescribe empiric ceftriaxone in patients at low risk of CrP, thus reducing the antibiotic selection pressure that is driving carbapenem resistance in hospitals throughout Asia.
Keyphrases
- urinary tract infection
- antimicrobial resistance
- pseudomonas aeruginosa
- escherichia coli
- healthcare
- end stage renal disease
- emergency department
- primary care
- acinetobacter baumannii
- ejection fraction
- newly diagnosed
- chronic kidney disease
- klebsiella pneumoniae
- case report
- risk factors
- prognostic factors
- cystic fibrosis
- acute care
- palliative care
- drug resistant
- gram negative
- staphylococcus aureus
- patient reported outcomes
- multidrug resistant
- drug induced