2226. Analysis of Co-Resistance Among Klebsiella pneumoniae Urine Isolates From Female Outpatients in the United States. (15th December 2022)

• Record Type: Journal Article
• Authors: Kaye, Keith S; Gupta, Vikas; Mulgirigama, Aruni; Joshi, Ashish V; Scangarella-Oman, Nicole E; Yu, Kalvin; Watts, Janet; Mitrani-Gold, Fanny S
• Is Part Of: Open forum infectious diseases. Volume 9:(2022)Supplement 2
• Publication Date: 2022-12-15
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofac492.1845
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Over the past decade, extended spectrum β-lactamase producing Enterobacterales (ESBL) and multidrug resistance has risen among community-acquired uncomplicated urinary tract infections (uUTIs). This study was conducted to determine co-resistance among Klebsiella pneumoniae ( K. pneumoniae ) isolates in urine from female outpatients in the United States (US). Methods: This was a retrospective, cross-sectional study of 30-day non-duplicate K. pneumoniae urine isolates from female outpatients (≥ 12 years of age) at 304 US facilities, with ≥ 3 months of data from 2011–2019 (Becton, Dickinson and Company [BD] Insights Research Database). K. pneumoniae isolates were defined as those that were ESBL-positive (ESBL+) (by commercial panel or not susceptible [NS] to ceftriaxone, cefotaxime, ceftazidime or cefepime), or NS if intermediate/resistant to any of the following: fluoroquinolones (FQs), trimethoprim/sulfamethoxazole (SXT), nitrofurantoin (NFT). Co-resistance phenotypes were characterized in isolates NS to ≥ 2 of the 4 resistance phenotypes assessed. Results: Among 250, 719 non-duplicate K. pneumoniae isolates evaluated, 11, 065 were ESBL+ (Table). Co-resistance among ESBL+ isolates was observed as follows: 54.9% to FQ; 65.7% to SXT; 75.5% to NFT; and 38.2% to all 4 resistance phenotypes. Of 10, 962 isolates NS to FQ, co-resistance was observed as follows: 55.4% were ESBL+; 65.7% to SXT; 79.6% to NFT; and 38.6% to all 4 resistance phenotypes. Of 141, 545 isolates NS to NFT, co-resistance was observed as follows: 5.9% were ESBL+; 6.2% to FQ; 11.8% to SXT; and 3.0% to all 4 resistance phenotypes. Among 23, 887 isolates NS to SXT, co-resistance was observed as follows: 30.4% were ESBL+; 30.1% to FQ; 69.7% to NFT; and 17.7.% to all 4 resistance phenotypes. Table. Co-resistance phenotype combinations observed among Klebsiella pneumoniae isolates in urine from 2011–2019 In total, 250, 719 non-duplicate (30-day) Klebsiella pneumoniae isolates were evaluated. Note: Some isolates had overlapping susceptibilities/antimicrobial resistance types, hence individual phenotype totals do not reflect total number of isolates evaluated. Abbreviations: ESBL+, extended spectrum β-lactamase-producing or not susceptible to ceftriaxone, cefotaxime, ceftazidime or cefepime; FQ, fluoroquinolone; NFT, nitrofurantoin; NS, not susceptible; SXT, trimethoprim/sulfamethoxazole. Conclusion: The high prevalence of co-resistance in 30-day non-duplicate outpatient K. pneumoniae urinary isolates, particularly towards NFT (70–80% of isolates), limits the effective oral treatment options for uUTI. These analyses may help inform and optimize appropriate empiric treatment of female outpatients with uUTI in the US. Disclosures: Keith S. Kaye, MD, MPH, Allecra: Advisor/Consultant|GlaxoSmithKline plc.: Receiving symposia honoraria|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study 212502|Merck: Advisor/Consultant|qpex: Advisor/Consultant|Shionogi: Grant/Research Support|Spero: Advisor/Consultant Vikas Gupta, PharmD, Becton, Dickinson and Company: Employee of, and shareholder in, Becton, Dickinson and Company, and the company received funding from GlaxoSmithKline plc. to conduct this study|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study 212502 Aruni Mulgirigama, MBBS, GlaxoSmithKline plc.: Employee and shareholder|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study 212502 Ashish V. Joshi, PhD, GlaxoSmithKline plc.: Employee and shareholder|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study Nicole E. Scangarella-Oman, MS, GlaxoSmithKline plc.: Employee and shareholder Kalvin Yu, MD, FIDSA, Becton, Dickinson and Company: Employee of, and shareholder in, Becton, Dickinson and Company, and the company received funding from GlaxoSmithKline plc. to conduct this study|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study 212502 Janet Watts, PhD, Becton, Dickinson and Company: Employee of Becton, Dickinson and Company, and the company received funding from GlaxoSmithKline plc. to conduct this study|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study 212502 Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc.: Employee and shareholder|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study 212502.