Inappropriate Empiric Antibiotic Therapy and Resistance Patterns in Uncomplicated Urinary Tract Infections: A Retrospective Analysis of the AMR-UTI PhysioNet Dataset
Abstract
Background: Antimicrobial resistance in urinary tract infections (UTIs) undermines the efficacy of empirical therapy;
however, the extent of inappropriate empirical prescribing in uncomplicated UTIs is not fully delineated. This study
measured the prevalence of resistance and the rates of inappropriate empiric therapy for commonly prescribed antibiotics,
and examined the association between prior antibiotic use and treatment failure.
Methods: A retrospective cross-sectional analysis was conducted using the AMR-UTI PhysioNet dataset. Uncomplicated
UTI episodes (n=15,806) with complete susceptibility and prescription data were included. Resistance prevalence was
calculated for nitrofurantoin, trimethoprim-sulfamethoxazole, ciprofloxacin, and levofloxacin. Inappropriate empiric
therapy was defined as the prescription of an antibiotic to which the cultured organism demonstrated resistance. Temporal
trends and the effect of prior antibiotic exposure (within 90 days) were assessed using chi-square tests and odds ratios with
95% confidence intervals.
Results: Overall resistance prevalence was 11.1% for nitrofurantoin (95% CI: 10.6-11.6%), 19.6% for trimethoprimsulfamethoxazole (95% CI: 19.0-20.2%), 5.6% for ciprofloxacin (95% CI: 5.3-6.0%), and 5.5% for levofloxacin (95% CI:
5.1-5.8%). Inappropriate empiric therapy occurred in 27.7% of episodes, with the highest rate observed for trimethoprimsulfamethoxazole (17.9%, 95% CI: 17.0-18.9%). Resistance to ciprofloxacin (OR=1.22, 95% CI:…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 15,806 participants or records.
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