Risk factors for multidrug-resistant gram-negative urinary tract infections

Suspect multidrug-resistant gram-negative urinary tract infection in patients with a history of any of the following in the prior three months:

A multidrug-resistant gram-negative urinary isolate or a fluoroquinolone-resistant Pseudomonas aeruginosa isolate

Inpatient stay at a health care facility (eg, hospital, nursing home, long-term acute care facility)

Use of a fluoroquinolone, trimethoprim-sulfamethoxazole, or broad-spectrum beta-lactam (eg, third or later generation cephalosporin)*

Travel to parts of the world with high rates of multidrug-resistant organisms^¶

NOTE: The predictive value of these risk factors for multidrug-resistant gram-negative urinary tract infections has not been systematically evaluated. In particular, the time interval since these exposures is not well validated. The threshold for empirically covering a multidrug-resistant infection varies with the severity of infection, with a lower threshold warranted for more severe disease.

Multidrug resistance refers to nonsusceptibility to at least one agent in three or more antibiotic classes. This includes isolates that produce an extended-spectrum beta-lactamase (ESBL).

* This includes a single antibiotic dose given for prophylaxis prior to prostate procedures.

¶ The prevalence of multidrug resistance is not well documented in all parts of the world. Some countries where the prevalence is particularly high include India, Israel, Spain, and Mexico.

Graphic 114310 Version 4.0

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Risk factors for multidrug-resistant gram-negative urinary tract infections