Regional Differences in Antibiotic-resistant Enterobacterales Urine Isolates in the United States: 2018-2020

Antimicrobial resistance (AMR) can complicate effective management of urinary tract infections. We con-ducted a retrospective study of AMR in Enterobacterales urine isolates from ambulatory and hospital-ized adult patients from 2018-2020 (BD Insights Research Database) to evaluate regional differences in isolates with an extended-spectrum beta-lactamase-producing phenotype and those not susceptible to beta-lactams, fluoroquinolone (FQ), nitrofurantoin (NFT), trimethoprim/sulfamethoxazole (TMP/SMX), or multiple antibiotic classes ( > 2 or > 3). Our analyses included 349,741 Enterobacterales urine isolates from 321 inpatient facilities and 980,354 isolates from 338 ambulatory care facilities. In multivariable analyses, the highest rate of resistance was to beta-lactams (60.8% and 55.8% for inpatient and ambula-tory settings, respectively), followed by FQ (27.5%), NFT (27.0%), and TMP/SMX (25.4%) for inpatients and by TMP/SMX (22.4%), FQ (21.6%), and NFT (21.6%) for ambulatory patients. Isolates with an extended-spectrum beta-lactamase-producing phenotype (13.2% and 8.6% for inpatient and ambulatory settings, respectively) and multidrug resistance (inpatient and ambulatory rates of 23.4% and 17.7% for > 2 drugs; 9.9% and 6.4% for > 3 drugs) were also prevalent. Statistically significant differences by geographic re-gion (P < 0.005) were observed for AMR classes in both inpatient and ambulatory settings, but the rates remained above the thresholds recommended for empiric urinary tract infection therapy across most regions. (c) 2022 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.