New research suggests that antibiotic-resistant infections remain a challenging problem, leaving frontline providers with few options when tried-and-true medicines fail to knock out invading bacteria.1

Investigators from Highland Hospital in Oakland, CA, found that nearly 6% of urinary tract infections (UTI) diagnosed in the ED over the course of one year were caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, making the infections resistant to commonly used antibiotics.

The authors reported that 62 out of 1,045 patients with UTIs were infected with the drug-resistant bacteria. Nearly half of these infections were acquired in the community rather than in a healthcare setting. In the past, most drug-resistant bacteria have been acquired in hospital settings. However, researchers noted that in recent years, drug-resistant bacteria have been affecting more people in the community, especially in the case of UTIs. In this study, more than two out of every five infections analyzed were contracted in the community. Investigators noted that is the highest proportion reported thus far in the United States.

Of particular concern to investigators was the fact that in most of these cases, there was no way to determine which patients were at risk. They reported that eight patients were women younger than 50 years of age with no comorbidities and no more than one UTI in the previous year. Twelve tested samples contained Escherichia coli, and genotyping revealed them to exhibit genes for ESBL, making the bugs resistant to most cephalosporins as well as fluoroquinolones. However, the infections were susceptible to fosfomycin.

The researchers noted that nearly half the patients with drug-resistant infections were initially prescribed antibiotics that are not effective for ESBL-producing infections. Consequently, investigators noted that if ESBL-producing Enterobacteriaceae become more prevalent, then cephalosporins may no longer be recommended for treatment of UTIs. They also advised changes to clinical practice in the ED, including the more widespread use of urine culture tests and the development of a reliable follow-up system for patients who test positive for drug-resistant infections.

In addition, investigators urged providers to increase their awareness of their own hospital’s antibiogram, which shows which antibiotics work against specific bacteria. The authors also advised adherence to treatment guidelines and awareness of which antibiotics should be avoided in certain circumstances.

Bradley Frazee, MD, the lead author of the study and an attending physician at Highland Hospital, noted that while more work remains to address the causes of antibiotic resistance, the development of new drugs also is critical.


  1. Frazee BW, Trivedi T, Montgomery M, et al. Emergency department urinary tract infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae: Many patients have no identifiable risk factor and discordant empiric therapy is common. Ann Emerg Med 2018 Jul 3. pii: S0196-0644(18)30415-3. doi: 10.1016/j.annemergmed.2018.05.006. [Epub ahead of print].