ArticleInfectious diseases and therapy2026
Complicated Urinary Tract Infections Caused by Fluoroquinolone-Non-Susceptible/Trimethoprim-Sulfamethoxazole-Resistant Extended-Spectrum β-Lactamase-Producing Enterobacterales: Patient Characteristics, Resistance Phenotypes, Treatment Patterns, and Clinical Outcomes.
Article in Infectious diseases and therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionPatients with complicated urinary tract infections (cUTIs) caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-E) not susceptible (NS) to fluoroquinolones (FQ-NS) or resistant (R) to trimethoprim-sulfamethoxazole (TMP/SMX-R) have few effective oral treatment options.
methodsData from the Optum de-identified Electronic Health Record data set (Optum EHR) (January 2018-September 2023) were used. The primary objective was to describe cumulative incidence of treatment failure (TF) by care setting (hospital versus non-hospital) within 30 days of the initiation of the latest intravenous antibiotic treatment prescribed ± 7 days from the microbiology results (index).
resultsAmong 7388 eligible patients, mean (standard deviation) age was 65.6 (17.7) years, and 66.3% were female. Most patients (5211, 70.5%) had a cUTI with a complicating factor; 3415 (46.2%) were diagnosed in hospital. Among the 7902 ESBL-E isolates from eligible patients with cUTIs, Escherichia coli was the predominant pathogen (75.1%), followed by Klebsiella pneumoniae (13.4%). Overall, 6384 (81.7%) isolates were FQ-NS, 5323 (68.0%) TMP/SMX-R, and 170 (2.2%) carbapenem-NS. Kaplan-Meier estimates revealed that the cumulative incidence of TF by day 30 post-index was 27.5% among hospitalized patients and 25.2% among non-hospitalized, with variation by resistance profile, driven primarily by receipt of another antibiotic (both settings). Most patients (5013, 67.9%) were prescribed an intravenous antibiotic at index, often carbapenems (2157, 43.0%), but treatment sequences were heterogeneous. Recurrence occurred in 2116 patients (28.6%), hospitalization (among those not hospitalized at index) in 975 (24.5%), and readmission in 663 (19.4%).
conclusionsThese data indicate a substantial burden of cUTIs caused by ESBL-E that were FQ-NS or TMP/SMX-R, characterized by high rates of treatment failures and hospitalization for IV antibiotic treatment.
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