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Clinical predictors of ceftriaxone resistance in microorganisms causing febrile urinary tract infections in men

Ramos Lázaro J, Smithson A, Jovè Vidal N, Batida Vila MT

Servicio Medicina Interna, Fundació Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain.

Background and objectives. Because of high rates of resistance to fluoroquinolones, ceftriaxone has become one of the main options for treating febrile urinary tract infection (FUTI). This study aimed to identify predictors of ceftriaxone resistance in community-acquired FUTIs in men.
Methods. Cross-sectional ambispective study enrolling men with FUTIs treated in the emergency department of a local area hospital in Spain.
Results. A total of 552 FUTI episodes were studied; 103 (18.6%) were caused by a ceftriaxone-resistant microorganism. Variables associated with a ceftriaxone-resistant FUTI were older age, health care-associated FUTI, dementia, diabetes mellitus, neoplasms, a history of UTIs, urologic disease, and complicated FUTI. Patients with ceftriaxone-resistant FUTIs also had higher rates of recent antibiotic treatment. Independent variables associated with FUTI due to a ceftriaxoneresistant microorganism were cirrhosis of the liver (odds ratio [OR], 6,00 95% CI, 1.25–28; P = .025), health careassociated FUTI (OR, 2.3 95% CI, 1.23–4.27; P = .009), and prior treatment with antibiotics (OR, 2.15; 95% CI,
1.23–3.76 P = .007). Components of health care-associated FUTI were a history of admission to a long-term residence (OR, 2.90 95% CI, 1.21–7.16; P = .017) and use of penicillins with or without beta-lactamase inhibitors (OR, 2.16; 95% CI, 1.05–4.42; P = .035).
Conclusion. Cirrhosis of the liver; history of health care-associated FUTI, especially in patients residing in a long-term care facility; and recent use of antibiotics, mainly penicillins with or without beta-lactamase inhibitors, are risk factors for ceftriaxone-resistant FUTI in men.

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