ArticleFrontiers in cellular and infection microbiology2026
Class-matched antibiotic dispensing and susceptibility transitions in recurrent urinary gram-negative bacilli.
Article in Frontiers in cellular and infection microbiology, 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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12 authors.
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Abstract
Objectives: Antimicrobial resistance (AMR) among urinary Gram-negative bacilli (GNB) is rising in Saudi Arabia, but how interim antibiotic exposure relates to within-patient changes in susceptibility is not well characterized. We evaluated the association between class-matched antibiotic exposure occurring between consecutive cultures and susceptible (S)-to-non-susceptible (NS) and non-susceptible-to-susceptible transitions. Methods: In a single-center, retrospective, culture-based, pharmacy-linked paired-culture cohort at a 500-bed tertiary hospital in southern Saudi Arabia (Aseer Central Hospital [ACH]), consecutive same-patient, same-species urinary GNB cultures 14-365 days apart formed pairs, and interim exposure was defined as ACH-recorded antibiotic dispensing. For each of the seven feasible phenotypes, adjusted transition models estimated S→NS odds and separate direct models estimated NS→S odds, with supporting analyses using inverse probability weighting, cross-class models, E-values, penalized-likelihood sensitivity analyses, and exploratory pragmatic null-covariable diagnostics. Results: The primary cohort comprised 1,274 pairs from 1,078 patients, of whom 807 (74.9%) had at least one interim ACH-recorded systemic antibiotic dispensing. Class-matched dispensing was associated with higher adjusted odds of an S→NS transition for extended-spectrum cephalosporins (OR, 3.83), difficult-to-treat resistance (OR, 2.91), piperacillin-tazobactam (OR, 2.46), and fluoroquinolones (OR, 2.29), but not carbapenems (OR, 0.93). In direct models, matched dispensing was associated with lower odds of an NS→S transition, reaching significance only for piperacillin-tazobactam (OR, 0.39). Conclusions: In recurrent urinary GNB, interim class-matched hospital-recorded antibiotic dispensing was associated with within-patient S→NS transitions for several clinically important phenotypes. These observational associations do not establish treatment effects; they identify patterns for confirmation in prospective studies and may inform surveillance and stewardship evaluation.
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