de25db46f8158fa148a357bddeeeed46 pmc_34069184.pdf 7526030949004f935bf27c659fdb1e4ffd25b567 pmc_34069184.pdf 96447257772bad14df3d0d1aec956a71a380ece2c04c98531f3a69fa1eec71f6 pmc_34069184.pdf Title: Risk Factors for Amoxicillin-Clavulanate Resistance in Community-Onset Urinary Tract Infections Caused by Escherichia coli or Klebsiella pneumoniae: The Role of Prior Exposure to Fluoroquinolones Subject: Background: High rates of amoxicillin-clavulanate (AMC) resistance among Enterobacterales isolated from urinary tract infections (UTIs) were observed in our area. The aim of this study was to identify risk factors associated with AMC resistance in patients with community-onset UTI in emergency departments (EDs). Methods: A retrospective study was performed of all ED patients with positive urine cultures for Escherichia coli or Klebsiella pneumoniae in a Spanish tertiary-care hospital. Results: 330 urine cultures in all were included: 261 (79.1%) for E. coli and 69 (20.90%) for K. pneumonia. Rates of AMC resistance were 14.94% and 34.78%, respectively. UTI was clinically confirmed in 212 (64.24%) cases. Previous antimicrobial exposure was independently associated with AMC resistance development in E. coli and K. pneumoniae urinary isolates (OR = 2.94, 95% CI = 1.55–5.58). Analyses of infected patients revealed that previous exposure to fluoroquinolones (OR = 3.33, 95% CI = 1.10–10.12, p = 0.034) and to AMC (OR = 5.68, 95% CI = 1.97–16.44, p = 0.001) was significantly associated with isolation of AMC-resistant strains. Conclusions: Prior antibiotic exposure, particularly to AMC or fluoroquinolones, was the only independent risk factor associated with development of AMC resistance in E. coli and K. pneumoniae urinary isolates from patients attending the ED. Keywords: amoxicillin/clavulanate; urinary tract infection (UTI); Enterobacterales; antimicrobial resistance; fluoroquinolones; emergency department Author: Javier Martínez-Casanova, Silvia Gómez-Zorrilla, Nuria Prim, Agustina Dal Molin, Daniel Echeverría-Esnal, María Pilar Gracia-Arnillas, Elena Sendra, Robert Güerri-Fernández, Xavier Durán-Jordà, Eduardo Padilla, Juan Pablo Horcajada, Santiago Grau and on behalf of the PROA-PSMAR Group Creator: LaTeX with hyperref package Producer: pdfTeX-1.40.18 CreationDate: Fri May 14 13:29:03 2021 CEST ModDate: Fri May 14 13:29:03 2021 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 11 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 270955 bytes Optimized: no PDF version: 1.5 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- RGZCJT+URWPalladioL-Ital Type 1 Custom yes yes no 147 0 DNGULW+URWPalladioL-Bold Type 1 Custom yes yes no 148 0 BCSEXG+URWPalladioL-BoldItal Type 1 Custom yes yes no 149 0 HSNKGA+VnURWPalladioL-Bold Type 1 Custom yes yes no 150 0 VFXRIE+URWPalladioL-Roma Type 1 Custom yes yes no 151 0 ARIQJE+VnURWPalladioL Type 1 Custom yes yes no 154 0 YYFPCJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 160 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 177 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 178 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 179 0 LWLIVD+EURM10 Type 1 Builtin yes yes no 198 0 IKKWKP+CMSY10 Type 1 Builtin yes yes no 213 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-10-21 02:37:52 CEST RepresentationInformation: pmc_34069184.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-03-31 12:14:02 CEST Size: 270955 Format: PDF Version: 1.5 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 0 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: 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きどっひはぢどはぬはでどっちぬぜ〴ぜ〰いちぴちぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㌩‾㸊⡜㌷㙜㌷㝜〰げどびにぜ〴ぜ〰うちっぴはひびぜ〴ぜ〰てはひぜ〴ぜ〰ぁきぃぜ〴ぜ〰げづびどびぴちのっづぜ〴ぜ〰どのぜ〴ぜ〰ぁぬぬぜ〴ぜ〰ぐちぴどづのぴびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㐩‾㸊⡜㌷㙜㌷㝜〰げどびにぜ〴ぜ〰うちっぴはひびぜ〴ぜ〰てはひぜ〴ぜ〰ぁきぃぜ〴ぜ〰げづびどびぴちのっづぜ〴ぜ〰どのぜ〴ぜ〰ぉのてづっぴづつぜ〴ぜ〰ぐちぴどづのぴびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: げどびにぜ〴ぜ〰うちっぴはひびぜ〴ぜ〰てはひぜ〴ぜ〰ぁきぃぜ〴ぜ〰げづびどびぴちのっづぜ〴ぜ〰どのぜ〴ぜ〰ぁぬぬぜ〴ぜ〰ぐちぴどづのぴびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㐩‾㸊⡜㌷㙜㌷㝜〰げどびにぜ〴ぜ〰うちっぴはひびぜ〴ぜ〰てはひぜ〴ぜ〰ぁきぃぜ〴ぜ〰げづびどびぴちのっづぜ〴ぜ〰どのぜ〴ぜ〰ぉのてづっぴづつぜ〴ぜ〰ぐちぴどづのぴびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: げどびにぜ〴ぜ〰うちっぴはひびぜ〴ぜ〰てはひぜ〴ぜ〰ぁきぃぜ〴ぜ〰げづびどびぴちのっづぜ〴ぜ〰どのぜ〴ぜ〰ぉのてづっぴづつぜ〴ぜ〰ぐちぴどづのぴびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: いどびっふびびどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸴ Item: Title: きちぴづひどちぬびぜ〴ぜ〰ちのつぜ〴ぜ〰きづぴとはつびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㐮ㄩ‾㸊⡜㌷㙜㌷㝜〰こぴふつべぜ〴ぜ〰いづびどでのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㐮㈩‾㸊⡜㌷㙜㌷㝜〰いちぴちぜ〴ぜ〰ぃはぬぬづっぴどはのぜ〴ぜ〰ちのつぜ〴ぜ〰いづてどのどぴどはのびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㐮㌩‾㸊⡜㌷㙜㌷㝜〰きどっひはぢどはぬはでどっちぬぜ〴ぜ〰いちぴちぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㐮㐩‾㸊⡜㌷㙜㌷㝜〰こぴちぴどびぴどっちぬぜ〴ぜ〰ぁのちぬべびどびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸵ Children: Item: Title: こぴふつべぜ〴ぜ〰いづびどでのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㐮㈩‾㸊⡜㌷㙜㌷㝜〰いちぴちぜ〴ぜ〰ぃはぬぬづっぴどはのぜ〴ぜ〰ちのつぜ〴ぜ〰いづてどのどぴどはのびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㐮㌩‾㸊⡜㌷㙜㌷㝜〰きどっひはぢどはぬはでどっちぬぜ〴ぜ〰いちぴちぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㐮㐩‾㸊⡜㌷㙜㌷㝜〰こぴちぴどびぴどっちぬぜ〴ぜ〰ぁのちぬべびどびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸵ Item: Title: いちぴちぜ〴ぜ〰ぃはぬぬづっぴどはのぜ〴ぜ〰ちのつぜ〴ぜ〰いづてどのどぴどはのびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㐮㌩‾㸊⡜㌷㙜㌷㝜〰きどっひはぢどはぬはでどっちぬぜ〴ぜ〰いちぴちぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㐮㐩‾㸊⡜㌷㙜㌷㝜〰こぴちぴどびぴどっちぬぜ〴ぜ〰ぁのちぬべびどびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸵ Item: Title: きどっひはぢどはぬはでどっちぬぜ〴ぜ〰いちぴちぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㐮㐩‾㸊⡜㌷㙜㌷㝜〰こぴちぴどびぴどっちぬぜ〴ぜ〰ぁのちぬべびどびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸵ Item: Title: こぴちぴどびぴどっちぬぜ〴ぜ〰ぁのちぬべびどびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸵ Item: Title: ぃはのっぬふびどはのびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸵ Item: Title: げづてづひづのっづび Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: RGZCJT+URWPalladioL-Ital FontSubset: true FirstChar: 2 LastChar: 121 FontDescriptor: FontName: RGZCJT+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: DNGULW+URWPalladioL-Bold FontSubset: true FirstChar: 3 LastChar: 252 FontDescriptor: FontName: 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