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Among patients with urinary tract infections, predictive features of antibiotic resistance in UTI treatment included region, prior nonsusceptibility, and previous UTIs.
Top predictors for nonsusceptibility to commonly prescribed antibiotics in patients with uncomplicated urinary tract infection (UTI) caused by Escherichia coli include several previous UTI episodes and race, according to study findings published in Clinical Infectious Diseases.
The researchers developed predictive models for nonsusceptibility to nitrofurantoin, trimethoprim-sulfamethoxazole, β-lactams, and fluoroquinolones using deidentified electronic health record data for 87,487 patients with E coli-caused uncomplicated UTI.
Predictive Features for Nonsusceptibility
In addition to previous UTIs and race, common predictive features for nonsusceptibility across at least three of the four classes were US Census Bureau region (particularly the South), prior nonsusceptibility to β-lactams, and prior treatment with fluoroquinolones, researchers reported.
“Our identification of race as a predictor of antibiotic nonsusceptibility may be due in part to its strong correlation with factors (eg, socioeconomic indicators) that were not available in the data and are associated with antibiotic nonsusceptibility,” Ryan K. Shields, PharmD, and colleagues wrote.
According to the study’s risk categorization framework, 8.1% of patients had isolates at high risk of nonsusceptibility to nitrofurantoin, 14.4% had isolates at high risk of nonsusceptibility to trimethoprim-sulfamethoxazole, 17.4% had isolates at high risk of nonsusceptibility to β-lactams, and 6.3% had isolates at high risk of nonsusceptibility to fluoroquinolones.
“Across all antibiotic classes, the proportion of patients categorized as having an isolate at high risk of nonsusceptibility was 3- to 12-fold higher among patients with truly nonsusceptible isolates than in patients with truly susceptible isolates,” researchers wrote. “Moreover, the proportion of patients with truly nonsusceptible isolates was 3- to 10-fold higher among patients with isolates categorized as high risk of nonsusceptibility versus those with isolates categorized as low risk of nonsusceptibility.”
The authors noted that the study demonstrates how data-driven strategies can ease challenges in identifying patients at high risk of nonsusceptibility to common antibiotic treatments.
“Findings from our study provide valuable insight on key patient characteristics to consider when assessing risk of antibiotic nonsusceptibility,” they wrote, “thereby advancing the understanding of antibiotic nonsusceptibility in uncomplicated UTI, and potentially informing optimal treatment strategies in this population.”
