Antimicrobial-resistant UTI hero image

Discover key challenges in UTI management

Consider the characteristics that can put your patients at risk of failing their initial treatment. Several risk factors can impact the success of urinary tract infection (UTI) management, including recurrence,
age >50 years, recent antibiotic use,
and more.1-4 Another challenge
is the
emergence of antimicrobial-resistant
pathogens in the
community setting.5,6

Antimicrobial-resistant UTI hero image

Discover key challenges in UTI management

Consider the characteristics that can put your patients at risk of failing their initial treatment. Several risk factors can impact the success of urinary tract infection (UTI) management, including recurrence,
age >50 years, recent antibiotic use,
and more.1-4 Another challenge
is the
emergence of antimicrobial-resistant
pathogens in the
community setting.5,6

Antimicrobial-resistant UTI hero image
Resistance in UTI
Risk Factors & Challenges
Antimicrobial Resistance

Challenges in successful UTI management

  • Show video transcript

    00:00:00 - 00:03:55

    ONSCREEN TEXT:

    ANTIMICROBIAL-RESISTANT UTI
    UTI=urinary tract infection

    ONSCREEN TEXT:

    History of recurrent UTI
    Age >50 years
    Recent antibiotic use
    Antimicrobial-resistant pathogens

    NARRATOR:

    When managing UTIs, there are several key risk factors that can put patients at risk of failing their initial treatment, including a history of recurrent UTIs, age over 50, and recent antibiotic use. Another challenge is the emergence of antimicrobial-resistant pathogens in the community setting.

    Let’s dive deeper.

    ONSCREEN TEXT:

    E. coli is the most frequent cause of uUTI

    uUTI=uncomplicated urinary tract infection

    NARRATOR:

    Antimicrobial resistance among Escherichia coli, or E.coli, the most frequent cause of uncomplicated UTI, is a growing concern in the US.

    ONSCREEN TEXT:

    Antimicrobial resistance (AMR) in E. coli is an emerging concern in outpatients

    NARRATOR:

    Because uncomplicated UTIs are generally treated empirically without benefit of culture and susceptibility testing, antimicrobial resistance increases the likelihood that initial antibiotic therapy may be ineffective.

    ONSCREEN TEXT:

    Overall prevalence of non-susceptibility among ≥1.5 million E. coli urine isolates collected from US female outpatients (2011-2019)*†:

    [Bar chart showing proportion of E. coli isolates for Drug-resistance phenotypes of FQ, TMP-SMX, NFT, ≥2
    NS, ≥3NS, and ESBL+.]

    The prevalence of non-susceptible phenotypes varied across geographic regions, and, in some cases, it varied considerably.

    *Distribution of facilities in the database was similar to that of the US as a whole, suggesting appropriate demographic coverage.

    †A retrospective, multicenter, cohort study investigated the prevalence of non-susceptibility among E. coli urine isolates from female outpatients ≥12 years in the US between 2011-2019. AMR among non-duplicate E. coli isolates was defined as non-susceptible (resistant or intermediate susceptibility results) to FQ, NFT, or TMP-SMX and ESBL+.

    ESBL+=extended spectrum β-lactamase producing; FQ=fluoroquinolone; NFT=nitrofurantoin; NS=non-susceptible (resistant or intermediate susceptibility results); TMP-SMX=trimethoprim-sulfamethoxazole.

    NARRATOR:

    A study that looked at the overall prevalence of non-susceptibility among at least 1.5 million E. coli urine isolates, collected from US female outpatients…

    ONSCREEN TEXT:

    Overall rates of FQ and TMP-SMX and non-susceptible E. coli were >20%*

    *Distribution of facilities in the database was similar to that of the US as a whole, suggesting appropriate demographic coverage.

    †A retrospective, multicenter, cohort study investigated the prevalence of non-susceptibility among E. coli urine isolates from female outpatients ≥12 years in the US between 2011-2019. AMR among non-duplicate E. coli isolates was defined as non-susceptible (resistant or intermediate susceptibility results) to FQ, NFT, or TMP-SMX and ESBL+.

    ESBL+=extended spectrum β-lactamase producing; FQ=fluoroquinolone; NFT=nitrofurantoin; NS=non-susceptible (resistant or intermediate susceptibility results); TMP-SMX=trimethoprim-sulfamethoxazole.

    NARRATOR:

    …showed that overall rates of trimethoprim-sulfamethoxazole (TMP-SMX) and fluoroquinolone (FQ) non-susceptible E. coli were greater than 20%. However, the prevalence of non-susceptible phenotypes varied across geographic regions, and, in some cases, it varied considerably.

    ONSCREEN TEXT:

    Data from ≥1.5 million urine E. coli isolates collected from US female outpatients*†:

    [Line graph showing trends in AMR among E. coli isolates (2011-2019) for TMP-SMX NS, FQ NS, ≥2 NS Phenotypes. EXBL+, >3 NS Phenotypes, and NFT NS.]
    The prevalence of non-susceptible phenotypes varied across geographic regions.

    ESBL+ E. coli isolates increased an average of 7.7% annually, rising from 4.1% - 7.3%.‡

    *Distribution of facilities in the database was similar to that of the US as a whole, suggesting appropriate demographic coverage.

    †A retrospective, multicenter, cohort study investigated the prevalence of non-susceptibility among E. coli urine isolates from female outpatients ≥12 years in the US between 2011-2019. AMR among non-duplicate E. coli isolates was defined as non-susceptible (resistant or intermediate susceptibility results) to FQ, NFT, or TMP-SMX and ESBL+.

    ‡2011-2019, except 2018.

    ESBL+=extended spectrum β-lactamase producing; FQ=fluoroquinolone; NFT=nitrofurantoin; NS=non-susceptible (resistant or intermediate susceptibility results); TMP-SMX=trimethoprim-sulfamethoxazole.

    NARRATOR:

    In addition, data from the same study showed that ESBL+, or extended-spectrum beta-lactamase producing E. coli isolates increased an average of 7.7% annually, rising from 4.1 to 7.3%.

    ONSCREEN TEXT:

    ESBL+ E.coli
    Can be co-resistant to TMP-SMX and FQs
    Can transfer resistance to other strains

    FQ= fluoroquinolone
    TMP-SMX= trimethoprim-sulfamethoxazole

    NARRATOR:

    Importantly, ESBL+ E. coli can also be co-resistant to trimethoprim-sulfamethoxazole and fluoroquinolones.

     

    This is a concern because ESBL-producing E. coli can transfer their resistance genes for multiple antibiotics to antibiotic-susceptible organisms.

    ONSCREEN TEXT:

    Are your patients with UTI at risk for antibiotic resistance?
    Risk factors for an antibiotic-resistant UTI

    NARRATOR:

    Some patients may have an increased risk for antibiotic-resistant infections that puts them at risk of treatment failure.

    With E. coli resistance becoming a problem in some community settings, it is increasingly important to review a patient's potential risk factors.

    ONSCREEN TEXT:

    Risk factors for an antibiotic-resistant UTI
    History of recurrent UTI
    Previous urine culture showing antibiotic resistance
    Recent antibiotic exposure (within the past 12 months)
    Chronic medical conditions
    Hospitalization within the last 6 months
    Age >50 years old

    NARRATOR:

    When treating UTI, be sure to consider if your patient has any of the following:

    • A history of recurrent UTI
    • A previous urine culture showing antibiotic resistance
    • Recent antibiotic exposure within the past 12 months
    • Chronic medical conditions
    • Prior hospitalization within the last 6 months, or
    • If they are over 50 years old.

    ONSCREEN TEXT:

    Recurrent infections are a concern for the successful management of UTI
    30%-44% of women who have a uUTI will have a recurrence

    NARRATOR:

    Recurrent infections are also a concern for the successful management of UTI.

    Recurrent UTIs are often associated with resistant pathogens. This could be a challenge for your patients, as 30% to 44% of women who have an uncomplicated UTI will have a recurrence.

    ONSCREEN TEXT:

    Other Challenges

    Antibiotic intolerance
    Renal function
    Antibiotic allergy

    NARRATOR:

    Managing a UTI can be further hindered in patients based on antibiotic intolerance, renal function, and any antibiotic allergies the patient may have.

    ONSCREEN TEXT:

    ANTIMICROBIAL-RESISTANT UTI

    NARRATOR:

    As you can see, keeping in mind antimicrobial resistance and factors that increase the risk of resistant infections is important when treating uncomplicated UTI.

    ONSCREEN TEXT:

    More To UTI

    NARRATOR:

    There may be more to UTI than you think.

    ONSCREEN TEXT:

    References:

    1. Wesolek JL, Wu JY, Smalley CM, Wang L, Campbell MJ. Risk factors for trimethoprim and sulfamethoxazole-resistant Escherichia coli in ED patients with urinary tract infections. Am J Emerg Med. 2022;56:178-182. 2. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-e120. 3. Kaye KS, Gupta V, Mulgirigama A, et al. Antimicrobial resistance trends in urine Escherichia coli isolates from adult and adolescent females in the United States from 2011 to 2019: rising ESBL strains and impact on patient management. Clin Infect Dis. 2021;73(11):1992-1999. 4. Reygaert WC. An overview of the antimicrobial resistance mechanisms of bacteria. AIMS Microbiol. 2018;4(3):482-501. 5. Trautner BW, Kaye KS, Gupta V, et al. Risk factors associated with antimicrobial resistance and adverse short-term health outcomes among adult and adolescent female outpatients with uncomplicated urinary tract infection. Open Forum Infect Dis. 2022;9(12):ofac623. 6. DeMarsh M, Bookstaver PB, Gordon C, et al. Prediction of trimethoprim/sulfamethoxazole resistance in community-onset urinary tract infections. J Glob Antimicrob Resist. 2020;21:218-222. 7. Wagenlehner F, Nicolle L, Bartoletti R, et al. A global perspective on improving patient care in uncomplicated urinary tract infection: expert consensus and practical guidance. J Glob Antimicrob Resist. 2022;28:18-29. 8. Kaye KS, Gupta V, Mulgirigama A, et al. Abstract 1699. Variation of antimicrobial resistance by age groups for outpatient UTI isolates in US females: a multicenter evaluation from 2011 to 2019. Open Forum Infectious Diseases. 2020;7(1):S832. 9. Foxman B. Recurring urinary tract infection: incidence and risk factors. Am J Public Health. 1990;80(3):331-333. 10. Gupta K, Trautner BW. Diagnosis and management of recurrent urinary tract infections in non-pregnant women. BMJ. 2013;346:f3140. 11. Critchley IA, Cotroneo N, Pucci MJ, Mendes R. The burden of antimicrobial resistance among urinary tract isolates of Escherichia coli in the United States in 2017. PLoS One. 2019;14(12):e0220265. 12. Brubaker L, Carberry C, Nardos R, Carter-Brooks C, Lowder JL. American Urogynecologic Society best-practice statement: Recurrent urinary tract infection in adult women. Female Pelvic Med Reconstr Surg. 2018;24(5):321-335.

    For US healthcare professionals.
    Trademarks are owned by or licensed to the GSK group of companies.
    [GSK brandmark Logo]
    ©2023 GSK or licensor.
    IDUVID230003 September 2023
    Produced in USA.

Understand how resistance can occur in UTI

Escherichia coli (E.coli) is the most frequent cause of uncomplicated UTI (uUTI).5 E. coli can develop antimicrobial resistance, which can contribute to unsuccessful management of UTI.
Learn more.

  • Show video transcript

    00:00:00 - 00:03:57

    Voiceover Transcript:

    Urinary tract infections (UTIs) are some of the most common types of bacterial infections, with around 50 percent of women in the US experiencing at least 1 UTI by age 32.

    Uncomplicated UTIs typically begin with uropathogens originating from the gut. While they can occasionally be caused by other bacterial species, Escherichia coli, or E. coli, causes around 75-95 percent of uncomplicated UTIs. Uncomplicated UTIs are thought to start with contamination of the periurethral area by a uropathogen that subsequently colonizes the urethra.

    These uropathogenic E. coli have flagella and pili that facilitate their migration up the urethra, towards the bladder, where host inflammatory responses, including neutrophil infilitration begin to clear extracellular bacteria. Some organisms successfully propagate and form a biofilm on the epithelium.Virulence factors, known as adhesins, recognize receptors on the bladder epithelium. Attachment to these receptors promotes the internalization of uropathogenic E. coli, allowing these organisms to evade the host’s innate immune response and antibiotic treatment. These bacteria proliferate, forming intracellular bacterial communities (IBCs). Some bacteria are expelled from the IBCs via exocytosis, allowing E.coli to infect surrounding epithelial tissue. When overwhelmed with bacteria, bladder epithelial cells can initiate pathways that lead to their exfoliation and eventual clearance from the urinary tract. Exfoliation leaves the underlying layers of the bladder epithelium exposed and more susceptible to infection. Some intracellular reservoirs of E.coli can become established in the transitional cells and remain dormant for months, putting the patient at risk of repeat infection.

    E. coli survive the harsh bladder environment by secreting proteases and toxins which, along with infiltrating neutrophils, promote host epithelial cell damage, cellular exfoliation, and the characteristic symptoms of uncomplicated UTIs.

    Antibiotic treatment is typically empirical for uncomplicated UTIs, based on antimicrobial and patient factors. Using an antibiotic to which the pathogen is resistant can lead to delayed symptom resolution and additional healthcare utilization. Antimicrobial resistance is a growing concern in the US and varies by region. Risk factors for uncomplicated UTIs caused by antibiotic resistant bacteria include: history of recurrent uncomplicated UTIs, being over 50 years of age, previous antibiotic resistance, recent antibiotic exposure, chronic medical conditions, and hospitalization within the last 6 months

    In a retrospective study in female outpatients aged 12 years and over, 1 in 5 E. coli urine isolates were found to be nonsusceptible to fluoroquinolones or trimethoprim-sulfamethoxazole. Antibioticresistant infections can increase the likelihood of needing additional antibiotic therapy, which can increase the risk of resistance. This makes choosing an effective empiric antibiotic more challenging and emphasizes the importance for healthcare providers to be aware of regional resistance rates that can limit their effectiveness.

    Onscreen text Transcript:

    Title:

    Onscreen text: “uUTIs and Antimicrobial Resistance”

    Scene 1 Frame 1:

    Infographic: “50% of women in the US have had at least 1 UTI by age 32”

    Scene 2 Frame 1:

    Labels: “Intestines” “Bladder” “Urethra” “E. coli"

    Scene 2 Frame 2:

    Labels: “Gut”

    Scene 2 Frame 3:

    Labels: “Gut” “E. coli”

    Scene 2 Frame 4:

    Labels: “Urethra opening” “E. coli”

    Scene 3 Frame 1:

    Label: “Urethra”

    Scene 3 Frame 2:

    Labels: “Bladder epithelium” “Inflammatory Cytokine” “Neutrophil”

    Scene 3 Frame 3:

    Labels: “Uroplakin receptor” “Bladder epithelial cell surface” 

    Scene 3 Frame 4:

    Labels: “Nucleus”, “Intracellular Bacterial Communities (IBCs)” 

    Scene 3 Frame 5-6:

    Label: “Toxins” “Inflammatory Cytokine”, “IBC”

    Scene 4 Frame 1-2:

    Label: “Toxins” “Bladder Epithelium”

    Scene 5 Frame 1-2:

    Labels: “Antibiotics” “Toxins”

    Scene 5 Frame 3:

    Label: “Antibiotics” “Toxins” “Resistant E. coli”

    Scene 5 Frame 4:

    Onscreen text: “Risk Factors for AMR in uUTIs” “History of recurrent uUTIs” “50 years+” “Previous urine culture showing antibiotic resistance” “Recent antibiotic exposure” “Chronic medical conditions” “Hospitalization within last 6 months”

    Scene 5 Frame 5:

    Labels: “Antibiotics”

    Infographic: “12+” “1 in 5”

    Onscreen text: “US Retrospective study details (2011-2019)” “*A retrospective study conducted between 2011 to 2019, in which more than 1.5 million E. coli isolates collected from US female outpatients aged 12 years and older. Nonsusceptibility prevalence varied across geographic regions.”

    Scene 6 Frame 1

    Onscreen text: “GSK” “Trademarks are owned by or licensed to the GSK group of companies.” “©2023 GSK or licensor.” “IDUVID230001 September 2023” “Produced in USA.’

Are your patients with UTI at risk for antibiotic resistance?

Some patients may have an increased risk
for antibiotic-resistant infections that puts them at risk of treatment failure.1-4
With E. coli resistance growing in community settings,6 it is increasingly important to review a patient's potential risk factors. When treating UTI, be sure
to consider if your patient has any of
the following:

Recurrent UTI icon
A history of recurrent UTI1
Urine culture icon
Previous urine culture showing antibiotic resistance2,3
Antibiotic icon
Recent antibiotic exposure (within the past 12 months)1-3
Chronic medical conditions icon
Chronic medical conditions4
Recent hospitalization icon
Prior hospitalization within the past 6 months2
50 years plus icon
Age >50 years old2

Managing UTI can be further hindered in patients based on:

Medical history icon
Antibiotic intolerance5
Renal function icon
Renal function7
Antibiotic allergies icon
Antibiotic allergy5
Resistant pathogen icon

Recurrent infections are a concern for the successful management of UTI

Recurrent UTIs are often associated with resistant pathogens. This could be a challenge for your patients as 30-44% of women who have a uUTI will have a recurrence.8,9

Antimicrobial resistance (AMR) in E. coli is an emerging concern in outpatients

Overall prevalence of non-susceptibility among ≥1.5 million E. coli urine isolates collected from adolescent and adult female outpatients in the US
(2011-2019)*,†,6:
Overall prevalence of non-susceptibility among E. coli urine isolates
Overall prevalence of non-susceptibility among E. coli urine isolates

The prevalence of non-susceptible phenotypes varied across geographic regions. See below for regional resistance rates.
ESBL+=extended spectrum β-lactamase producing; FQ=fluoroquinolone; NFT=nitrofurantoin; NS=non-susceptible (resistant or intermediate susceptibility results); TMP-SMX=trimethoprim-sulfamethoxazole.

Overall rates of FQ and TMP-SMX non-susceptible E. coli were >20%*,6

Distribution of facilities in the database was similar to that of the US as a whole, suggesting appropriate demographic coverage. The prevalence of
non-susceptible phenotypes varied across geographic regions.6

ESBL + E. coli urine isolates are growing

Data from ≥1.5 million urine E. coli isolates collected from US female outpatients*,†,6:

Trends in AMR Among E. coli Isolates (2011-2019)

Trends in AMR E.coli urine isolates
Trends in AMR E.coli urine isolates

The prevalence of non-susceptible phenotypes varied across geographic regions.

ESBL+ E. coli isolates increased an average of 7.7% (95% CI, 7.2% to 8.2%; P<0.0001) annually, rising from 4.1% to 7.3%.‡,6

‡2011-2019, except 2018.

ESBL+ E. coli can be co-resistant to TMP-SMX and FQs.10

Multidrug resistant ESBL+ E. coli can transfer their resistance genes to antibiotic-susceptible bacteria resulting in the spread of resistance to multiple antibiotic classes.11

Distribution of facilities in the database was similar to that of the US as a whole, suggesting appropriate demographic coverage. The prevalence of
non-susceptible phenotypes varied across
geographic regions.6

Data collected from a retrospective, multicenter, cohort study investigated the non-susceptibility among E. coli urine isolates collected from adolescent and adult female outpatients in the US between 2011 and 2019. Primary analysis was the prevalence and distribution of AMR. Overall, 1,513,882 non-duplicate urine E. coli isolates were included in the primary analyses. AMR among
non-duplicate E. coli was defined as non-susceptible (resistant or intermediate susceptibility results) to FQ, NFT, or TMP-SMX and also included isolates that were ESBL+. ≥2 and ≥3 non-susceptible phenotype categories defined as isolates with 2 or more and 3 or more drug-resistance phenotypes (non-susceptible to FQ, NFT, TMP-SMX, or ESBL+, respectively).6

AMR is a growing concern icon

With outpatient AMR rates rising, local patterns may be higher than you think6

Across treatments and drug classes6

US census regions saw highly contrasting estimated non-susceptible rates
(2011-2019):

  New
England*		 East South
Central
States†
TMP-SMX 17.1% 29.4%
FQ 10.6% 22.8%
≥2 drug
classes		 7.0% 16.7%

FQ=fluoroquinolone; non-susceptible=resistant or intermediate susceptibility results; TMP-SMX=trimethoprim-sulfamethoxazole.

CT, MA, ME, NH, RI, VT.

AL, KY, MS, TN.

Discover more about patient impact

  1. Wesolek JL, Wu JY, Smalley CM, Wang L, Campbell MJ. Risk factors for trimethoprim and sulfamethoxazole-resistant Escherichia coli in ED patients with urinary tract infections. Am J Emerg Med. 2022;56:178-182.
  2. Trautner BW, Kaye KS, Gupta V, et al. Risk factors associated with antimicrobial resistance and adverse short-term health outcomes among adult and adolescent female outpatients with uncomplicated urinary tract infection. Open Forum Infect Dis. 2022;9(12):ofac623.
  3. DeMarsh M, Bookstaver PB, Gordon C, et al; for the Prisma Health Antimicrobial Stewardship Support Team (PHASST). Prediction of trimethoprim/
    sulfamethoxazole resistance in community-onset urinary tract infections. J Glob Antimicrob Resist. 2020;21:218-222.
  4. Wagenlehner F, Nicolle L, Bartoletti R, et al. A global perspective on improving patient care in uncomplicated urinary tract infection: expert consensus and practical guidance. J Glob Antimicrob Resist. 2022;28:18-29.
  5. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-e120.
  6. Kaye KS, Gupta V, Mulgirigama A, et al. Antimicrobial resistance trends in urine Escherichia coli isolates from adult and adolescent females in the United States from 2011 to 2019: rising ESBL strains and impact on patient management. Clin Infect Dis. 2021;73(11):1992-1999.
  7. Macrobid [prescribing information]. Almatica Pharma LLC; 2020.
  8. Gupta K, Trautner BW. Diagnosis and management of recurrent urinary tract infections in non-pregnant women. BMJ. 2013;346:f3140.
  9. Foxman B. Recurring urinary tract infection: incidence and risk factors. Am J Public Health. 1990;80(3):331-333.
  10. Critchley IA, Cotroneo N, Pucci MJ, Mendes R. The burden of antimicrobial resistance among urinary tract isolates of Escherichia coli in the United States in 2017. PLoS One. 2019;14(12):e0220265.
  11. Reygaert WC. An overview of the antimicrobial resistance mechanisms of bacteria. AIMS Microbiol. 2018;4(3):482-501.