To identify factors linked to nonsusceptibility, further analysis was done between individuals with susceptible vs. nonsusceptible cUTIs.
A recent study in Open Forum Infectious Diseases suggests that clinical risk scores could be instrumental in guiding empiric antibiotic treatment for adult outpatients diagnosed with complicated urinary tract infections (cUTIs).
- The study was a retrospective cohort analysis of adult Kaiser Permanente Southern California members from December 2017 to December 2020.
- 26,326 patients were included, representing 30,450 unique cUTI episodes.
- 37.4% of identified uropathogens were nonsusceptible to TMP-SMX, with 20%, 27%, and 24% being non-susceptible to fluoroquinolones, nitrofurantoin, and 3-GC respectively.
- Multidrug resistance was observed in 60.7% of cUTI episodes.
- Patients with nonsusceptible infections were typically older men with more comorbidities, prior antibiotics, cUTI recurrences, and prior hospital and ED admissions.
- Prior receipt of an antibiotic was the most significant predictor of nonsusceptibility for all four antibiotics studied.
- For TMP-SMX, the risk for nonsusceptibility exceeded 20% even without significant risk factors, suggesting its empiric use may be questionable.
- Limitations of the study include potential missed predictors of nonsusceptibility and lack of data on prior colonization, resistant infections, urinalysis results, and physical examination findings.
- Clinical risk scoring systems can potentially assist clinicians in making informed antibiotic selection decisions, aiming to reduce treatment delays and adverse outcomes in cUTI adult outpatients.