A specific antibiogram is necessary for the empiric antibiotic treatment of community-acquired urinary tract infections (UTI) because of the global spread of antimicrobial resistance. This study aimed to develop an antibiogram specific for community-acquired UTI and assess the risk factors associated with community-acquired UTI caused by antimicrobial-resistant organisms. This cross-sectional observational retrospective study included patients with community-acquired UTI caused by Gram-negative rods (GNR) who were admitted to the emergency department at a tertiary care hospital in Ibaraki, Japan, in 2017–2018. A total of 172 patients were enrolled (including 38 nursing home residents). Of the 181 GNR strains considered as causative agents, 135 (75%) were Escherichia coli, and 40 (22%) exhibited third-generation cephalosporin resistance. Extended-spectrum β-lactamase (ESBL)-producing E. coli accounted for 25/40 (63%) of resistant GNR. Overall susceptibility rate of Enterobacterales was 92%, 81%, 100%, 75%, and 89% for cefmetazole, ceftriaxone, meropenem, levofloxacin, and trimethoprim–sulfamethoxazole, respectively. Residence in a nursing home (odds ratio (OR), 2.83; 95% confidence interval (CI), 1.18–6.79) and recent antibiotic use (OR, 4.52; 95% CI, 1.02–19.97) were independent risk factors for UTI with resistant GNR. ESBL-producing E. coli was revealed to have a strong impact on antimicrobial resistance pattern. Therefore, an antibiotic strategy based on a disease-specific antibiogram is required.

中文翻译：

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来自社区获得性尿路感染患者的革兰氏阴性生物及相关的耐药性危险因素：在日本的单中心回顾性观察研究。

由于抗菌素耐药性在全球范围内的传播，对于社区获得性尿路感染（UTI）的经验性抗生素治疗，必须使用特定的抗菌素。这项研究旨在开发一种针对社区获得性UTI的抗菌素，并评估由耐药菌引起的与社区获得性UTI相关的危险因素。这项横断面观察性回顾性研究纳入了2017-2018年在日本茨城县三级医院急诊科就诊的由革兰氏阴性杆菌（GNR）引起的社区获得性UTI患者。总共招募了172名患者（包括38名疗养院居民）。在181种被认为是病原体的GNR菌株中，有135种（75％）是大肠杆菌，其中40例（22％）表现出第三代头孢菌素耐药性。产生超广谱β-内酰胺酶（ESBL）的大肠杆菌占耐药GNR的25/40（63％）。头孢美唑，头孢曲松，美罗培南，左氧氟沙星和甲氧苄啶-磺胺甲基异恶唑的肠杆菌总敏感性分别为92％，81％，100％，75％和89％。居住在疗养院（几率（OR），2.83； 95％置信区间（CI），1.18–6.79）和最近使用抗生素（OR，4.52； 95％CI，1.02-19.97）是发生UTI的独立危险因素抗性GNR。产ESBL的大肠杆菌对抗菌素耐药性模式有很大影响。因此，需要基于疾病特异性抗菌素的抗生素策略。