Up to 50% of complicated urinary tract infections diagnosed in patients admitted to the emergency department were resistant to at least one antibiotic, according to a new national study. The findings underscore the need for new oral antibiotic options, the researchers contend.

The risk of getting a UTI increases with age, and the infections can be deadly in frail elders. UTIs are one of the most common infections found in nursing homes. Complicated UTIs are infections associated with patient risk factors that raise the dangers of poor health outcomes and the chances of failing antibiotic therapy. 

Investigators analyzed national Premier Healthcare Database records from 2013 through 2018. The multicenter study focused on patients who had cUTIs caused by the Enterobacterales bacteria. 

The data showed high rates of resistance to commonly used oral antibiotics, including  fluoroquinolones, trimethoprim-sulfamethoxazole (TMP-SMX), nitrofurantoin and third-generation cephalosporins. 

Among patients admitted to the emergency department, 40% to 50% of the cUTIs in each U.S. census region were resistant to at least one antibiotic, and 10% to 18% were resistant to two or more, according to the Center for Infectious Disease Research and Policy at the University of Minnesota.

Resistance was even greater for those who went on to be admitted to the hospital, the news outlet reported. Fully 55% to 65% of these patients’ cUTIs were resistant to at least one drug, and 25% to 35% resistant to two or more. Resistance to nitrofurantoin and fluoroquinolones topped 15%, and resistance to TMP-SMX exceeded 25%.

The findings should serve as an alert to clinicians, according to the researchers. Such patients are at an elevated risk for receiving an inappropriate drug when prescribed a fluoroquinolone, TMP-SMX, nitrofurantoin or an oral third generation cephalosporin, they wrote.

“New oral cUTI options are needed to address the growing challenge of antibiotic resistance,” the authors concluded.

The study was published in Open Forum Infectious Diseases.

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