Antimicrobial Susceptibility Trends Observed in Urinary Pathogens Obtained From New York State

Abstract International guidelines recommend using local susceptibility data to direct empiric therapy for acute uncomplicated cystitis. We evaluated outpatient urinary isolate susceptibility trends in New York State. Nitrofurantoin had the lowest resistance prevalence whereas trimethoprim-sulfamethoxazole and fluoroquinolones had higher prevalences. This study highlights the need for local outpatient antimicrobial stewardship programs.

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1237. New York State Outpatient Regional Antibiogram for Urinary Pathogens: Have We Reached a Post Antibiotic Era for the Treatment of UTIs?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1070 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S376-S376

Author(s):

Elliot Rank ◽

Thomas P Lodise ◽

Lisa Avery ◽

Eve Bankert ◽

Erica Dobson ◽

...

Keyword(s):

New York ◽

New York State ◽

Empiric Therapy ◽

Outpatient Setting ◽

York State ◽

E Coli ◽

Enterococcus Spp ◽

Acute Uncomplicated Cystitis ◽

Uncomplicated Cystitis ◽

Outpatient Settings

Abstract Background Outpatient prescribing for acute uncomplicated cystitis is a significant driver of antimicrobial use. Empiric therapy should be based on local susceptibility data. However, there is limited guidance on regional susceptibility trends in outpatient settings. This study describes the epidemiology and prevalence of antimicrobial resistance in uropathogens in New York State outpatient settings to help inform empiric treatment decisions. Methods Retrospective analysis of positive urine cultures sent to Quest Diagnostics in 2016 from outpatient settings. Cultures that grew ≥105 CFU/mL were included from 17 NYS counties. Bacterial identification and antimicrobial sensitivities were determined on the Vitek-2 using CLSI M-100 S-25 breakpoints. Data were summarized as proportions and stratified by age (<17, 18–64, ≥65) and sex. Results Over 78,000 isolates were included (Table 1). The most prevalent isolates were Escherichia coli (65.2%), Enterococcus spp. (11.9%), and Klebsiella pneumoniae (9.9%). E. coli was highly susceptible to nitrofurantoin (NTF, 97.2%) and cefazolin (CFZ, 89.9%) and less susceptible to trimethoprim–sulfamethoxazole (TMP-SMX, 72.9%) and ciprofloxacin (CIP, 78.0%). Enterococcus spp. was highly susceptible to NTF (99.0%) and ampicillin (99.8%). K. pneumoniae was highly susceptible to TMP-SMX (90.0%) and CIP (95.2%) and markedly less susceptible to NTF (42.0%). E. coli was more prevalent in females (69.7% vs. 39.6%, P < 0.001). Enterococcus was more prevalent in males (39.6% vs. 10.1%, P < 0.001). The prevalence of K. pneumoniae was similar in men and women (9.6% vs. 10.1%, P = 0.08). Resistance was more prevalent in males (NTF: 6.3% vs. 4.2%; TMP-SMX: 26.3% vs. 22.7%; CIP: 35% vs. 17.3%) and for adults ≥65 (NTF: 6.2% vs. 3.6%; TMP-SMX: 25.1% vs. 22.1%; CIP: 30.0% vs. 14.0%) P < 0.001 for all comparisons. Conclusion NTF appears to be the best empiric choice for outpatient treatment of acute uncomplicated cystitis in New York State. TMP-SMX and ciprofloxacin should be avoided empirically. These data also highlight the necessity to obtain uropathogen sensitivity data to confirm empiric therapy or make appropriate adjustments in the outpatient setting. Table 1. Summary of Antimicrobial Susceptibilities Disclosures T. P. Lodise Jr., Motif BioSciences: Board Member, Consulting fee.

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Antibiotic Prescribing in New York State Medicare Part B Beneficiaries Diagnosed With Cystitis Between 2016 and 2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz544 ◽

2020 ◽

Vol 7 (1) ◽

Cited By ~ 1

Author(s):

Joyce Y Yu ◽

Valerie A McKenna ◽

Ghinwa K Dumyati ◽

Teresa J Lubowski ◽

Joseph J Carreno

Keyword(s):

New York ◽

Antimicrobial Stewardship ◽

New York State ◽

Outpatient Setting ◽

Medicare Part ◽

Antibiotic Prescribing ◽

Oral Antibiotic ◽

First Line ◽

York State ◽

Medicare Part B

Abstract Background Statewide tracking and reporting is an outpatient antimicrobial stewardship tool that may be useful for many stakeholders. However, to date, these evaluations have been limited. This study aimed to track and report outpatient antibiotic prescribing in Medicare Part B enrollees diagnosed with cystitis in the outpatient setting. Methods This was a retrospective, cohort study of Medicare Part B enrollees in New York State. Inclusion criteria include outpatient visit in 2016 or 2017, cystitis diagnosis code, and oral antibiotic prescription ≤3 days after diagnosis of cystitis. Antibiotics were categorized as first-line, oral β-lactams, fluoroquinolones, or other per Infectious Diseases Society of America acute uncomplicated cystitis guidelines. Data were stratified by sex. Annual prescriptions proportions were compared using χ 2 test or Fisher’s exact test as appropriate. Results A total of 50 658 prescriptions were included. For females’ prescriptions, first line increased (41.5% vs 43.8%, P < .0001), oral β-lactams increased (17.8% vs 20.5%, P < .0001), fluoroquinolones decreased (34.1% vs 29.1%, P < .0001), and other increased (6.5% vs 6.6%, P = .76) in 2017. For males’ prescriptions, first line increased (25.2% vs 26.7%, P = .11), oral β-lactams increased (23.1% vs 26.2%, P = .0003), fluoroquinolones decreased (44.0% vs 39.3%, P < .0001), and other remained unchanged (7.8% vs 7.8%, P = .92) in 2017. Conclusions Guideline concordant therapy prescribing for cystitis increased among Medicare Part B beneficiaries in New York State between 2016 and 2017. However, there was still a high prevalence of fluoroquinolone prescribing. These data highlight the need for additional outpatient antimicrobial stewardship efforts in New York State.

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