{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T18:25:28Z","timestamp":1788805528548,"version":"build-2803163510"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2023,5,23]],"date-time":"2023-05-23T00:00:00Z","timestamp":1684800000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institute of Health","doi-asserted-by":"publisher","award":["5R01AI130066-05"],"award-info":[{"award-number":["5R01AI130066-05"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Urinary tract infections (UTIs) cause significant disease and economic burden. Uncomplicated UTIs (uUTIs) occur in otherwise healthy individuals without underlying structural abnormalities, with uropathogenic Escherichia coli (UPEC) accounting for 80% of cases. With recent transitions in healthcare toward virtual visits, data on multidrug resistance (MDR) (resistant to \u22653 antibiotic classes) by care setting are needed to inform empiric treatment decision making.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We evaluated UPEC resistance over time by care setting (in-person vs virtual), in adults who received outpatient care for uUTI at Kaiser Permanente Southern California between January 2016 and December 2021.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We included 174 185 individuals who had \u22651 UPEC uUTI (233 974 isolates) (92% female, 46% Hispanic, mean age 52 years [standard deviation 20]). Overall, prevalence of UPEC MDR decreased during the study period (13% to 12%) both in virtual and in-person settings (P for trend &amp;lt;.001). Resistance to penicillins overall (29%), coresistance to penicillins and trimethoprim-sulfamethoxazole (TMP-SMX) (12%), and MDR involving the 2 plus \u22651 antibiotic class were common (10%). Resistance to 1, 2, 3, and 4 antibiotic classes was found in 19%, 18%, 8%, and 4% of isolates, respectively; 1% were resistant to \u22655 antibiotic classes, and 50% were resistant to none. Similar resistance patterns were observed over time and by care setting.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We observed a slight decrease in both class-specific antimicrobial resistance and MDR of UPEC overall, most commonly involving penicillins and TMP-SMX. Resistance patterns were consistent over time and similar in both in-person and virtual settings. Virtual healthcare may expand access to UTI care.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofad287","type":"journal-article","created":{"date-parts":[[2023,5,23]],"date-time":"2023-05-23T22:40:12Z","timestamp":1684881612000},"source":"Crossref","is-referenced-by-count":33,"title":["Multidrug Resistance of <i>Escherichia coli<\/i> From Outpatient Uncomplicated Urinary Tract Infections in a Large United States Integrated Healthcare Organization"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9469-5875","authenticated-orcid":false,"given":"Jennifer H","family":"Ku","sequence":"first","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California , Pasadena, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katia J","family":"Bruxvoort","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California , Pasadena, California , USA"},{"name":"Department of Epidemiology, University of Alabama at Birmingham , Birmingham, Alabama , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S Bianca","family":"Salas","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California , Pasadena, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cara D","family":"Varley","sequence":"additional","affiliation":[{"name":"Department of Medicine, Oregon Health & Science University , Portland, Oregon , USA"},{"name":"Oregon Health & Science University-Portland State University, School of Public Health , Portland, Oregon , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9809-4695","authenticated-orcid":false,"given":"Joan A","family":"Casey","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Sciences, Columbia University Mailman School of Public Health , New York, New York , USA"},{"name":"Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Raphael","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of California, San Francisco , San Francisco, California , USA"},{"name":"Department of Family and Community Medicine, University of California, San Francisco , San Francisco, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2336-8476","authenticated-orcid":false,"given":"Sarah C","family":"Robinson","sequence":"additional","affiliation":[{"name":"Center for Health Systems Research, Sutter Health , Walnut Creek, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keeve E","family":"Nachman","sequence":"additional","affiliation":[{"name":"Department of Environmental Health and Engineering, Johns Hopkins University , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno J","family":"Lewin","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California , Pasadena, California , USA"},{"name":"Kaiser Permanente Southern California and Kaiser Permanente Bernard J. Tyson School of Medicine , Pasadena, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Contreras","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California , Pasadena, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong X","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California , Pasadena, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena E","family":"Pomichowski","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California , Pasadena, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harpreet S","family":"Takhar","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California , Pasadena, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara Y","family":"Tartof","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California , Pasadena, California , USA"},{"name":"Kaiser Permanente Southern California and Kaiser Permanente Bernard J. 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