Antimicrobial susceptibility trends for urinary isolates in the veteran population

Guidance on empiric treatment for urinary tract infections (UTIs) is lacking for the male population which comprises much of the Veteran population in the United States. This study evaluated susceptibility trends in antimicrobials used for treatment of UTIs in the inpatient and outpatient Veteran population nationwide.

Urine culture data was retrospectively obtained from Corporate Data Warehouse. All urine cultures from Veteran Health Administration patients 18 years of age or older who were treated at any VA health care center in the years 2009 and 2018 were eligible. Antibiograms were constructed for bacterial isolate susceptibility.

In 2009 and 2018 isolates from 54,788 and 58,983 Veterans were analyzed, respectively. Escherichia coli was the most common bacteria isolated. For ceftriaxone, E coli susceptibilities were relatively high but trended downward from 2009 to 2018. Common urinary pathogen susceptibilities remained low for fluoroquinolones and trimethoprim-sulfamethoxazole.

Empiric therapy for Veterans with UTIs should be based on local susceptibility patterns as previously recommended first-line agents have fallen out of favor due to increasing resistance rates.

Both inpatient and outpatient stewardship is needed to ensure appropriate treatment, as viable treatment options for UTIs are becoming increasingly limited.