Table 2.
Resistance profile of antibiotics and antibiotic combinations in urosepsis, its subgroups (geographical location, sepsis severity) and other HAUTIs (MAGI, cystitis, pyelonephritis)
| Pathogen | Geographical location | Sepsis severitya | Clinical diagnosis | Overall urosepsis | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Europe %(R/total) |
Asia %(R/total) |
Africa %(R/total) |
Americas %(R/total) |
Simple %(R/total) |
Severe and shock %(R/total) |
p c | MAGI %(R/total) |
Cystitis %(R/total) |
Pyelonephritis %(R/total) |
p b | ||
| Amx/BLI | 58 % (100/172) | 70 % (21/30) | 92 % (11/12) | 75 % (3/4) | 60 % (82/136) | 64 % (21/33) | NS | 52 % (65/124) | 46 % (160/345) | 60 % (149/248) | 0.003 | 62 % (135/218) |
| NS | OR 0.5 (CI 0.3–0.8) p = 0.002 | NS | ||||||||||
| TZP | 34 % (47/137) | 40 % (10/25) | 50 % (4/8) | 67 % (2/3) | 37 % (40/109) | 35 % (12/34) | NS | 26 % (26/99) | 33 % (84/258) | 30 % (57/189) | NS | 36 % (63/173) |
| TMP/SMX | 56 % (87/156) | 50 % (15/30) | 86 % (12/14) | 63 % (5/8) | 59 % (84/143) | 61 % (22/36) | NS | 54 % (63/117) | 52 % (182/353) | 53 % (122/232) | NS | 57 % (119/208) |
| CIP | 59 % (106/181) | 61 % (22/36) | 47 % (8/17) | 22 % (2/9) | 53 % (79/148) | 55 % (23/42) | NS | 49 % (76/155) | 47 % (196/420) | 49 % (157/324) | NS | 57 % (138/243) |
| LVX | 59 % (57/97) | 57 % (4/7) | 50 % (6/12) | 67 % (2/3) | 56 % (40/71) | 63 % (12/19) | NS | 42 % (41/98) | 45 % (122/271) | 39 % (76/196) | 0.009 | 58 % (69/119) |
| OR 0.4 (CI 0.2–0.7), p = 0.006 | OR 0.5 (CI 0.3–0.9) p = 0.03 | OR 0.4 (CI 0.2–0.7) p = 0.002 | ||||||||||
| CXM | 57 % (78/137) | 56 % (14/25) | 71 % (10/14) | 67 % (4/6) | 60 % (68/113) | 52 % (14/27) | NS | 48 % (50/104) | 42 % (142/339) | 45 % (109/245) | 0.008 | 58 % (106/182) |
| NS | OR 0.5 (CI 0.3–0.7) p = 0.001 | OR 0.5 (CI 0.3–0.8), p = 0.007 | ||||||||||
| CTX | 52 % (77/147) | 42 % (15/36) | 31 % (5/16) | 56 % (5/9) | 50 % (68/135) | 43 % (13/30) | NS | 36 % (41/115) | 36 % (130/363) | 39 % (110/208) | 0.02 | 49 % (102/208) |
| OR 0.5 (CI 0.3–0.9) p = 0.03 | OR 0.5 (CI = 0.3–0.8), p = 0.003 | OR 0.6 (CI 0.4–0.9) p = 0.01 | ||||||||||
| CAZ | 42 % (52/124) | 71 % (17/24) | 33 % (4/12) | 67 % (2/3) | 49 % (47/96) | 27 % (8/29) | 0.005 | 30 % (31/102) | 35 % (114/326) | 33 % (83/251) | 0.008 | 46 % (75/163) |
| (OR = 4.07,CI 1.45–11.44, p = 0.005) | – | OR 0.4 (CI 0.2–0.8), p = 0.01 | OR 0.5 (CI 0.3–0.8), p = 0.005 | OR 0.4 (CI 0.3–0.7), p = 0.002 | ||||||||
| IPM | 8 % (11/141) | 13 % (4/32) | 0 (0/7) | 0 (0/6) | 8 % (9/110) | 7 % (3/43) | NS | 12 %(14/114) | 7 % (19/289) | 12 % (29/252) | NS | 8 % (15/186) |
| GEN | 36 % (68/187) | 46 % (21/46) | 75 % (12/16) | 44 % (4/9) | 37 % (57/154) | 42 % (23/55) | NS | 42 % (63/150) | 36 % (150/418) | 40 % (130/326) | NS | 40 % (105/258) |
| CAZ + CIP | 38 % (42/111) | 56 % (10/18) | 33 % (4/12) | 67 % (2/3) | 45 % (37/83) | 21 % (5/24) | 0.004 | 25 % (23/93) | 28 % (82/292) | 27 % (61/227) | 0.006 | 40 % (58/144) |
| OR = 5.1 CI 1.5–17.5, p = 0.009) | – | OR 0.4 (CI 0.2–0.8), p = 0.009 | OR 0.4 (CI 0.3–0.7) p = 0.003 | OR 0.4 (CI 0.2–0.7) p = 0.001 | ||||||||
| CAZ + GEN | 30 % (29/97) | 52 % (12/23) | 25 % (3/12) | 67 % (2/3) | 38 % (30/80) | 23 % (5/22) | NS | 24 % (22/90) | 24 % (67/281) | 21 % (46/218) | 0.025 | 34 %(46/135) |
| NS | OR 0.5 CI 03–0.9, p = 0.02 | OR 0.5 CI 0.2–0.7, p = 0.003 | ||||||||||
| CAZ + TMP/SMX | 30 % (22/74) | 50 % (8/16) | 25 % (3/12) | 67 % (2/3) | 41 % (29/71) | 6 % (1/18) | 0.000 | 23 % (16/70) | 25 % (58/232) | 24 % (38/158) | NS | 33 % (35/105) |
| OR 24.9 CI 2.4–255, p = 0.007 | – | |||||||||||
| TZP + CIP | 33 % (36/108) | 32 % (6/19) | 50 % (4/8) | 67 % (2/3) | 36 % (30/83) | 39 % (10/26) | NS | 20 % (17/87) | 27 % (63/231) | 20 % (33/165) | 0.03 | 35 % (48/138) |
| OR 0.4 (CI 0.2–0.9) p = 0.03 | NS | OR 0.5 (CI 0.3–0.9) p = 0.04 | ||||||||||
| TZP + GEN | 20 % (19/93) | 26 % (6/23) | 50 % (4/8) | 67 % (2/3) | 26 % (20/77) | 19 % (5/26) | NS | 13 % (11/84) | 18 % (29/161) | 21 % (49/231) | NS | 24 % (31/127) |
| TZP + TMP/SMX | 20 % (14/69) | 36 % (5/14) | 50 % (4/8) | 67 % (2/3) | 30 % (19/64) | 19 % (3/16) | NS | 16 % (11/69) | 22 % (44/199) | 19 % (24/129) | NS | 26 % (25/94) |
| CIP + GEN | 31 % (41/134) | 44 % (14/32) | 44 % (7/16) | 25 % (2/8) | 31 % (35/114) | 35 % (11/32) | NS | 32 % (39/124) | 32 % (114/358) | 32 % (85/268) | NS | 34 % (64/190) |
| CIP + TMP/SMX | 37 % (37/102) | 42 % (10/24) | 50 % (7/14) | 25 % (2/8) | 40 % (40/99) | 25 % (6/24) | NS | 30 % (28/95) | 33 % (101/302) | 33 % (63/190) | NS | 38 % (56/148) |
Amp/BLI ampicillin or amoxicillin/BLI, TZP piperacillin/tazobactam, CIP ciprofloxacin, LVX levofloxacin, CXM cefuroxime, CTX cefotaxime, CAZ ceftazidime, IPM imipenem, GEN gentamicin, TMP/SMX trimethoprim/sulfamethoxazole
aSeverity of sepsis was included in the logistic regression model analysis that already included geographical region, study year and hospital type. Based on this model resistance rates of CAZ and two of its combinations (CAZ + TMP/SMX and CAZ + CIP) showed a lower resistance rate in simple urosepsis. However, the wide confidence intervals are of notice
bMultiple logistic regression analysis, Likelihood ratio p value