Abstract：
BACKGROUND: Data on antibiotic resistance of uropathogens for UTI recurrences are lacking.
METHODS: In a retrospective cohort of adults at Kaiser Permanente Southern California with culture-confirmed index uncomplicated UTI (uUTI) between 01/2016 and 12/2020, we examined the number and characteristics of subsequent culture-confirmed UTIs through 2021.
RESULTS: We identified 148,994 individuals with a culture-confirmed index uUTI (88% female, 44% Hispanic, mean age 51 years [s.d. 19]), of whom 19% developed a subsequent culture-confirmed UTI after a median 300 days (IQR: 126-627). The proportion of UTI due to E. coli was highest for index uUTI (79%) and decreased to 73% for sixth UTI (UTI 6) (p-for trend <0.001), while the proportion due to Klebsiella spp increased from index UTI (7%) to UTI 6 (11%) (p-for-trend <0.001). Non-susceptibility to ≥1 and ≥3 antibiotic classes was observed in 57% and 13% of index uUTIs, respectively, and was higher for subsequent UTIs (65% and 20%, respectively, for UTI 6). Most commonly observed antibiotic non-susceptibility patterns included penicillins alone (12%), and penicillins, trimethoprim-sulfamethoxazole plus ≥1 additional antibiotic class (9%).
CONCLUSIONS: Antibiotic non-susceptibility is common in UTIs and increases with subsequent UTIs. Continuous monitoring of UTI recurrences and susceptibility patterns are needed to guide treatment decisions.
METHODS: In a retrospective cohort of adults at Kaiser Permanente Southern California with culture-confirmed index uncomplicated UTI (uUTI) between 01/2016 and 12/2020, we examined the number and characteristics of subsequent culture-confirmed UTIs through 2021.
RESULTS: We identified 148,994 individuals with a culture-confirmed index uUTI (88% female, 44% Hispanic, mean age 51 years [s.d. 19]), of whom 19% developed a subsequent culture-confirmed UTI after a median 300 days (IQR: 126-627). The proportion of UTI due to E. coli was highest for index uUTI (79%) and decreased to 73% for sixth UTI (UTI 6) (p-for trend <0.001), while the proportion due to Klebsiella spp increased from index UTI (7%) to UTI 6 (11%) (p-for-trend <0.001). Non-susceptibility to ≥1 and ≥3 antibiotic classes was observed in 57% and 13% of index uUTIs, respectively, and was higher for subsequent UTIs (65% and 20%, respectively, for UTI 6). Most commonly observed antibiotic non-susceptibility patterns included penicillins alone (12%), and penicillins, trimethoprim-sulfamethoxazole plus ≥1 additional antibiotic class (9%).
CONCLUSIONS: Antibiotic non-susceptibility is common in UTIs and increases with subsequent UTIs. Continuous monitoring of UTI recurrences and susceptibility patterns are needed to guide treatment decisions.
摘要：
背景：缺乏关于尿路感染复发的尿路病原体的抗生素耐药性的数据。
方法：在2016年01月至2020年12月12日期间，在南加州KaiserPermanente进行了一项成人回顾性队列研究，研究了随后的文化确认的UTI的数量和特征。
结果：我们确定了148,994名具有文化确认指数uUTI的个体（88％为女性，44%的西班牙裔,平均年龄51岁[s.d.19])，其中19%在中位数300天后发展为随后的培养证实的UTI(IQR:126-627)。由于大肠杆菌引起的UTI的比例对于指数uUTI最高（79％），对于第六个UTI（UTI6）下降到73％（趋势p<0.001），而克雷伯菌属的比例从UTI指数(7%)增加到UTI6指数(11%)(趋势p<0.001)。在57％和13％的指标uUTI中观察到对≥1和≥3种抗生素类别的不敏感性，分别,并且在随后的UTI中更高(65%和20%，分别,对于UTI6）。最常见的抗生素非敏感性模式包括单独的青霉素（12％），还有青霉素,甲氧苄啶-磺胺甲恶唑加≥1个额外的抗生素类（9％）。
结论：抗生素非敏感性在尿路感染中是常见的，并随着随后的尿路感染而增加。需要持续监测UTI复发和易感性模式以指导治疗决策。
方法：在2016年01月至2020年12月12日期间，在南加州KaiserPermanente进行了一项成人回顾性队列研究，研究了随后的文化确认的UTI的数量和特征。
结果：我们确定了148,994名具有文化确认指数uUTI的个体（88％为女性，44%的西班牙裔,平均年龄51岁[s.d.19])，其中19%在中位数300天后发展为随后的培养证实的UTI(IQR:126-627)。由于大肠杆菌引起的UTI的比例对于指数uUTI最高（79％），对于第六个UTI（UTI6）下降到73％（趋势p<0.001），而克雷伯菌属的比例从UTI指数(7%)增加到UTI6指数(11%)(趋势p<0.001)。在57％和13％的指标uUTI中观察到对≥1和≥3种抗生素类别的不敏感性，分别,并且在随后的UTI中更高(65%和20%，分别,对于UTI6）。最常见的抗生素非敏感性模式包括单独的青霉素（12％），还有青霉素,甲氧苄啶-磺胺甲恶唑加≥1个额外的抗生素类（9％）。
结论：抗生素非敏感性在尿路感染中是常见的，并随着随后的尿路感染而增加。需要持续监测UTI复发和易感性模式以指导治疗决策。
