Antimicrobial resistance research in uncomplicated urinary tract infection typically focuses on the main causative pathogen, Escherichia coli; however, little is known about the antimicrobial resistance burden of Klebsiella species, which can also cause uncomplicated urinary tract infections. This retrospective cohort study assessed the prevalence and geographic distribution of antimicrobial resistance among Klebsiella species and antimicrobial resistance trends for K. pneumoniae in the United States (2011–2019). K. pneumoniae and K. oxytoca urine isolates (30-day, non-duplicate) among female outpatients (aged ≥ 12 years) with presumed uUTI at 304 centers in the United States were classified by resistance phenotype(s): not susceptible to nitrofurantoin, trimethoprim/sulfamethoxazole, or fluoroquinolone, extended-spectrum β-lactamase-positive/not susceptible; and multidrug-resistant based on ≥ 2 and ≥ 3 resistance phenotypes. Antimicrobial resistance prevalence by census division and age, as well as antimicrobial resistance trends over time for Klebsiella species, were assessed using generalized estimating equations. 270,552 Klebsiella species isolates were evaluated (250,719 K. pneumoniae; 19,833 K. oxytoca). The most frequent resistance phenotypes in 2019 were nitrofurantoin not susceptible (Klebsiella species: 54.0%; K. pneumoniae: 57.3%; K. oxytoca: 15.1%) and trimethoprim/sulfamethoxazole not susceptible (Klebsiella species: 10.4%; K. pneumoniae: 10.6%; K. oxytoca: 8.6%). Extended-spectrum β-lactamase-positive/not susceptible prevalence was 5.4%, 5.3%, and 6.8%, respectively. K. pneumoniae resistance phenotype prevalence varied (p < 0.0001) geographically and by age, and increased over time (except for the nitrofurantoin not susceptible phenotype, which was stable and > 50% throughout). There is a high antimicrobial resistance prevalence and increasing antimicrobial resistance trends among K. pneumoniae isolates from female outpatients in the United States with presumed uncomplicated urinary tract infection. Awareness of K. pneumoniae antimicrobial resistance helps to optimize empiric uncomplicated urinary tract infection treatment.

中文翻译：

---

女性门诊尿克雷伯菌耐药率、区域分布及趋势。分离株：2011 年至 2019 年在美国进行的多中心评估

单纯性尿路感染的抗菌药物耐药性研究通常集中于主要致病菌大肠杆菌；然而，人们对克雷伯菌属的抗菌药物耐药性负担知之甚少，这种细菌也可能导致简单的尿路感染。这项回顾性队列研究评估了美国克雷伯菌属细菌耐药性的流行率和地理分布以及肺炎克雷伯菌耐药性趋势（2011-2019）。美国 304 个中心疑似 uUTI 的女性门诊患者（年龄≥12 岁）的肺炎克雷伯菌和产酸克雷伯菌尿液分离株（30 天，非重复）按耐药表型分类：对呋喃妥因不敏感、甲氧苄啶/磺胺甲恶唑或氟喹诺酮类药物，超广谱 β-内酰胺酶阳性/不敏感；基于 ≥ 2 和 ≥ 3 种耐药表型的多重耐药。使用广义估计方程评估了按普查分区和年龄划分的抗菌药物耐药性流行率，以及克雷伯菌属物种随时间推移的抗菌药物耐药性趋势。对 270,552 种克雷伯氏菌分离株进行了评估（250,719 种肺炎克雷伯菌；19,833 种克雷伯氏菌）。 2019年最常见的耐药表型是呋喃妥因不敏感（克雷伯菌属：54.0%；肺炎克雷伯菌：57.3%；产酸克雷伯菌：15.1%）和甲氧苄啶/磺胺甲恶唑不敏感（克雷伯菌属：10.4%；肺炎克雷伯菌：10.6） %；产酸克雷伯氏菌：8.6%）。超广谱 β-内酰胺酶阳性/不敏感患病率分别为 5.4%、5.3% 和 6.8%。肺炎克雷伯菌耐药表型患病率因地域和年龄而异（p < 0.0001），并随着时间的推移而增加（呋喃妥因不敏感表型除外，该表型始终稳定且> 50%）。在美国疑似无并发症尿路感染的女性门诊患者中分离出的肺炎克雷伯菌中，抗菌药物耐药率很高，而且抗菌药物耐药性呈上升趋势。对肺炎克雷伯菌抗菌素耐药性的认识有助于优化经验性单纯性尿路感染治疗。