2226. Analysis of Co-Resistance Among Klebsiella pneumoniae Urine Isolates From Female Outpatients in the United States
Authors: Kaye Keith S , Gupta Vikas , Mulgirigama Aruni , Joshi Ashish V , Scangarella-Oman Nicole E , Yu Kalvin , Watts Janet , Mitrani-Gold Fanny S 
Published: December 2022

Abstract

Background
Over the past decade, extended spectrum β-lactamase producing Enterobacterales (ESBL) and multidrug resistance has risen among community-acquired uncomplicated urinary tract infections (uUTIs). This study was conducted to determine co-resistance among Klebsiella pneumoniae (K. pneumoniae) isolates in urine from female outpatients in the United States (US).

Methods
This was a retrospective, cross-sectional study of 30-day non-duplicate K. pneumoniae urine isolates from female outpatients (≥ 12 years of age) at 304 US facilities, with ≥ 3 months of data from 2011–2019 (Becton, Dickinson and Company [BD] Insights Research Database). K. pneumoniae isolates were defined as those that were ESBL-positive (ESBL+) (by commercial panel or not susceptible [NS] to ceftriaxone, cefotaxime, ceftazidime or cefepime), or NS if intermediate/resistant to any of the following: fluoroquinolones (FQs), trimethoprim/sulfamethoxazole (SXT), nitrofurantoin (NFT). Co-resistance phenotypes were characterized in isolates NS to ≥ 2 of the 4 resistance phenotypes assessed.

Results
Among 250,719 non-duplicate K. pneumoniae isolates evaluated, 11,065 were ESBL+ (Table). Co-resistance among ESBL+ isolates was observed as follows: 54.9% to FQ; 65.7% to SXT; 75.5% to NFT; and 38.2% to all 4 resistance phenotypes. Of 10,962 isolates NS to FQ, co-resistance was observed as follows: 55.4% were ESBL+; 65.7% to SXT; 79.6% to NFT; and 38.6% to all 4 resistance phenotypes. Of 141,545 isolates NS to NFT, co-resistance was observed as follows: 5.9% were ESBL+; 6.2% to FQ; 11.8% to SXT; and 3.0% to all 4 resistance phenotypes. Among 23,887 isolates NS to SXT, co-resistance was observed as follows: 30.4% were ESBL+; 30.1% to FQ; 69.7% to NFT; and 17.7.% to all 4 resistance phenotypes. Table.Co-resistance phenotype combinations observed among Klebsiella pneumoniae isolates in urine from 2011–2019In total, 250,719 non-duplicate (30-day) Klebsiella pneumoniae isolates were evaluated.Note: Some isolates had overlapping susceptibilities/antimicrobial resistance types, hence individual phenotype totals do not reflect total number of isolates evaluated.Abbreviations: ESBL+, extended spectrum β-lactamase-producing or not susceptible to ceftriaxone, cefotaxime, ceftazidime or cefepime; FQ, fluoroquinolone; NFT, nitrofurantoin; NS, not susceptible; SXT, trimethoprim/sulfamethoxazole.

Conclusion
The high prevalence of co-resistance in 30-day non-duplicate outpatient K. pneumoniae urinary isolates, particularly towards NFT (70–80% of isolates), limits the effective oral treatment options for uUTI. These analyses may help inform and optimize appropriate empiric treatment of female outpatients with uUTI in the US.

Disclosures
Keith S. Kaye, MD, MPH, Allecra: Advisor/Consultant|GlaxoSmithKline plc.: Receiving symposia honoraria|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study 212502|Merck: Advisor/Consultant|qpex: Advisor/Consultant|Shionogi: Grant/Research Support|Spero: Advisor/Consultant Vikas Gupta, PharmD, Becton, Dickinson and Company: Employee of, and shareholder in, Becton, Dickinson and Company, and the company received funding from GlaxoSmithKline plc. to conduct this study|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study 212502 Aruni Mulgirigama, MBBS, GlaxoSmithKline plc.: Employee and shareholder|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study 212502 Ashish V. Joshi, PhD, GlaxoSmithKline plc.: Employee and shareholder|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study Nicole E. Scangarella-Oman, MS, GlaxoSmithKline plc.: Employee and shareholder Kalvin Yu, MD, FIDSA, Becton, Dickinson and Company: Employee of, and shareholder in, Becton, Dickinson and Company, and the company received funding from GlaxoSmithKline plc. to conduct this study|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study 212502 Janet Watts, PhD, Becton, Dickinson and Company: Employee of Becton, Dickinson and Company, and the company received funding from GlaxoSmithKline plc. to conduct this study|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study 212502 Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc.: Employee and shareholder|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study 212502.