{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:37:17Z","timestamp":1791387437077,"version":"4.3.3"},"reference-count":28,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T00:00:00Z","timestamp":1659657600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Uropathogen resistance, fluoroquinolone\u2010resistance (FQR), and extended spectrum beta\u2010lactamase (ESBL), has been observed to be emerging worldwide with prevalences above recommended thresholds for routine empirical treatment. The primary aim of our study was to determine the prevalence of FQR from a geographically diverse sample of United States emergency departments (EDs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a multi\u2010center, observational cohort study using a network of 15 geographically diverse US EDs. All patients \u226518\u2009years of age with the primary or secondary diagnosis of urinary tract infection (UTI) in the ED identified using International Classification of Diseases (ICD\u201010) diagnosis code of cystitis, pyelonephritis, or UTI from 2018 to 2020 were included. We calculated descriptive statistics for uropathogens and susceptibilities. Logistic regression analysis was used to identify antimicrobial resistance risk factors associated with FQR <jats:italic>Escherichia coli<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 3779 patients who met inclusion criteria, median age was 62.9\u2009years (interquartile range [IQR]: 41\u201377.6) and 76.3% were female. The most common diagnoses were complicated (41.2%) and uncomplicated cystitis (40.3%). <jats:italic>E. coli<\/jats:italic> was the most common pathogen (63.2%), followed by <jats:italic>Klebsiella pneumoniae<\/jats:italic> (13.2%) and <jats:italic>Enterococcus<\/jats:italic> species (5.8%). Across all sites, overall <jats:italic>E. coli<\/jats:italic> FQ\u2010resistance prevalence was 22.1%, ranging from 10.5 to 29.7% by site. The prevalence of ESBL\u2010producing uropathogen was 7.4%, ranging from 3.6% to 11.6% by site. Previous IV or oral antimicrobial use in the past 90\u2010days and history of a multi\u2010drug resistant pathogen were associated with FQ\u2010resistant <jats:italic>E. coli<\/jats:italic> (odds ratio [OR] 2.68, 95% confidence interval [CI]: 2.04\u20133.51, and OR 6.93, 95% CI: 4.95\u20139.70, respectively). Of the patients who had FQ\u2010resistant <jats:italic>E. coli<\/jats:italic> or an ESBL\u2010producing uropathogen isolated, 116 (37.1%) and 61 (36.7%) did not have any documented risk factors for resistance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>FQ\u2010resistant <jats:italic>E. coli<\/jats:italic> is widely prevalent across US sites highlighting the need for ongoing monitoring of antimicrobial resistance and, at some locations, modification of empirical treatments.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14545","type":"journal-article","created":{"date-parts":[[2022,6,2]],"date-time":"2022-06-02T11:42:54Z","timestamp":1654170174000},"page":"1096-1105","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["High prevalence of fluoroquinolone\u2010resistant <scp>UTI<\/scp> among <scp>US<\/scp> emergency department patients diagnosed with urinary tract infection, 2018\u20132020"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5759-9857","authenticated-orcid":false,"given":"Brett A.","family":"Faine","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine and Pharmacy University of Iowa Hospitals and Clinics  Hawkins Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan A.","family":"Rech","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Loyola University Medical Center  Maywood Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Vakkalanka","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Iowa  Coralville Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9352-8389","authenticated-orcid":false,"given":"Alan","family":"Gross","sequence":"additional","affiliation":[{"name":"University of Illinois at Chicago College of Pharmacy  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin","family":"Brown","sequence":"additional","affiliation":[{"name":"Assistant Professor of Pharmacy and Emergency Medicine Mayo Clinic School of Medicine and Science  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie J.","family":"Harding","sequence":"additional","affiliation":[{"name":"Infectious Diseases Clinical Pharmacy Specialist Wesley Medical Center  Wichita Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giles","family":"Slocum","sequence":"additional","affiliation":[{"name":"Emergency Medicine Clinical Pharmacy Specialist, Assistant Professor, Department of Pharmacy Emergency Medicine Rush University Medical Center  Chicago Illinois 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T.","family":"Howington","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Science University of Kentucky College of Pharmacy Emergency Medicine Clinical Pharmacy Specialist  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7698-477X","authenticated-orcid":false,"given":"Matt","family":"Campbell","sequence":"additional","affiliation":[{"name":"Emergency Medicine Clinical Coordinator, Department of Pharmacy Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Dawson","sequence":"additional","affiliation":[{"name":"Emergency Medicine and Critical Care Denver Health Medical Center  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9558-5499","authenticated-orcid":false,"given":"Cierra N.","family":"Treu","sequence":"additional","affiliation":[{"name":"New York\u2010Presbyterian Brooklyn Methodist Hospital  Brooklyn New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Nelson","sequence":"additional","affiliation":[{"name":"Emergency Center Pharmacist Lead Park Nicollet, Methodist Hospital  Saint Louis Park Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandy","family":"Jones","sequence":"additional","affiliation":[{"name":"Emergency Medicine Clinical Pharmacy Specialist UK HealthCare, Fellow, Center for Interprofessional Healthcare Education, University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"Flack","sequence":"additional","affiliation":[{"name":"Emergency Medicine Clinical Pharmacist Indiana University Health Methodist Hospital  Indianapolis Indiana 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