Prediction of Sulfamethoxazole/Trimethoprim Resistance in Community-Onset Urinary Tract Infections
Abstract
OBJECTIVE
The study aims to predict resistance to sulfamethoxazole/trimethoprim (SXT) in patients with community-onset urinary tract infections (UTIs) due to Enterobacteriaceae based on patient-specific risk factors.
DESIGN
Retrospective case-control study.
SETTING
Prisma Health facilities in central South Carolina, USA, including three community hospitals, affiliated emergency departments, and ambulatory clinics.
PATIENTS
Adult patients with community-onset UTIs due to Enterobacteriaceae from April 1, 2015 to February 29, 2016.
METHODS
Multivariate logistic regression was used to examine risk factors for SXT resistance.
RESULTS
Among 351 unique patients with community-onset UTIs, 71 (20%) had Enterobacteriaceae urinary isolates that were SXT-resistant (SXT-R). Overall, median age was 64 years and 252 (72%) were women. Multivariate model identified prior urinary infections or colonization with SXT-R Enterobacteriaceae (odds ratio [OR] 8.58, 95% confidence intervals [CI] 3.92-18.81, p < 0.001) and SXT use within past 12 months (OR 2.58, 95% CI 1.13-5.89, p = 0.02) as predictors of SXT resistance among urinary isolates. Most patients with UTIs (285; 81%) had no risk factors for SXT resistance. SXT resistance rates increased from 13% in the absence of risk factors to 31% in patients with prior SXT use, 66% in those with prior urinary infections or colonization with SXT-R Enterobacteriaceae, and 73% in the presence of both risk factors.
CONCLUSIONS
SXT resistance in…
How strong is the evidence?
Evidence Hub reads this as a case-control, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 351 participants or records.
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