{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:14:12Z","timestamp":1785428052879,"version":"3.56.0"},"reference-count":36,"publisher":"American Society for Microbiology","issue":"6","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2026,6,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Urinary tract infections (UTIs) are one of the most common infections. Management of UTIs often involves empiric antibiotics, which can contribute to antibiotic overuse. We aimed to investigate the causative organisms, prevalence of antimicrobial resistance, and empiric prescribing practices to improve antibiotic use for UTIs. We conducted a retrospective audit of UTIs in premenopausal nonpregnant persons with a vagina aged 18\u201351 years attending the Melbourne Sexual Health Centre from 2 January 2018 to 24 January 2023. We calculated the proportion of culture samples with pathogen(s) isolated, and their antimicrobial resistance profiles with 95% confidence intervals (CIs). We assessed adherence to first-line Australian Therapeutic guideline recommendations for acute uncomplicated lower UTIs (trimethoprim, nitrofurantoin, and cefalexin) during our study period. We included 1,680 acute UTI episodes (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1,569 patients). Midstream urine culture was performed in 1,503 episodes, with 911 (60.6%, 95% CI: 58.1\u201363.1) classified as laboratory-defined UTIs. The most common isolate was\n                      <jats:italic toggle=\"yes\">Escherichia coli<\/jats:italic>\n                      (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 615\/948; 64.9%, 95% CI: 61.7\u201367.9). Of the first-line Australian Therapeutic Guideline recommended antibiotics,\n                      <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                      isolates were most commonly resistant to trimethoprim (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 195\/612; 31.9%, 95% CI: 28.2\u201335.7). Empiric antibiotics were prescribed for 1,533 (91.3%, 95% CI: 89.8\u201392.6) episodes. Most prescriptions (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1,465\/1,533; 95.6%, 95% CI: 94.4\u201396.5) adhered to first-line recommendations, and trimethoprim accounted for 842 (54.9%, 95% CI: 52.4\u201357.4) prescriptions. At Australia\u2019s largest sexual health service,\n                      <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                      caused two-thirds of UTIs, with one-third of\n                      <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                      isolates demonstrating trimethoprim resistance. Empiric antibiotics were commonly prescribed and compliant with national recommendations; trimethoprim accounted for &gt;50% of empiric prescriptions. Trimethoprim resistance indicates changes to empiric recommendations could be needed.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        <jats:italic toggle=\"yes\">Escherichia coli<\/jats:italic>\n                        was the most common uropathogen isolated in women with uncomplicated urinary tract infection (UTI) over the past 5 years. One-third of these infections were resistant to trimethoprim, an antibiotic recommended as first-line presumptive therapy for UTIs in Australia and prescribed in over 50% of these\n                        <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                        urinary tract infections. These data demonstrate higher than previously reported levels of trimethoprim resistance in community-acquired\n                        <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                        UTIs in Australia, and the need for changes to empiric antimicrobial recommendations.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.02674-25","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T04:06:11Z","timestamp":1777953971000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Urinary tract infections at an Australian sexual health service: bacterial etiologies, antibiotic susceptibilities, and antimicrobial prescribing patterns"],"prefix":"10.1128","volume":"14","author":[{"given":"S. E.","family":"Carter","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02bfwt286","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Translational Medicine, Monash University","place":["Melbourne, Australia"]},{"id":[{"id":"https:\/\/ror.org\/013fdz725","id-type":"ROR","asserted-by":"publisher"}],"name":"Melbourne Sexual Health Centre, Alfred Health","place":["Carlton, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5710-2671","authenticated-orcid":false,"given":"E. L.","family":"Plummer","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02bfwt286","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Translational Medicine, Monash University","place":["Melbourne, Australia"]},{"id":[{"id":"https:\/\/ror.org\/013fdz725","id-type":"ROR","asserted-by":"publisher"}],"name":"Melbourne Sexual Health Centre, Alfred Health","place":["Carlton, Australia"]},{"id":[{"id":"https:\/\/ror.org\/01ej9dk98","id-type":"ROR","asserted-by":"publisher"}],"name":"Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne","place":["Melbourne, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. A.","family":"Vodstrcil","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02bfwt286","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Translational Medicine, Monash University","place":["Melbourne, Australia"]},{"id":[{"id":"https:\/\/ror.org\/013fdz725","id-type":"ROR","asserted-by":"publisher"}],"name":"Melbourne Sexual Health Centre, Alfred Health","place":["Carlton, Australia"]},{"id":[{"id":"https:\/\/ror.org\/01ej9dk98","id-type":"ROR","asserted-by":"publisher"}],"name":"Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne","place":["Melbourne, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"De Petra","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/016899r71","id-type":"ROR","asserted-by":"publisher"}],"name":"Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity","place":["Melbourne, Victoria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Abbott","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02bfwt286","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Infectious Diseases and Microbiology Unit, Alfred Hospital and School of Translational Medicine, Monash University","place":["Melbourne, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Sherry","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/016899r71","id-type":"ROR","asserted-by":"publisher"}],"name":"Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity","place":["Melbourne, Victoria"]},{"id":[{"id":"https:\/\/ror.org\/05dbj6g52","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Infectious Diseases & Immunology, Austin Health","place":["Heidelberg, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. K.","family":"Fairley","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02bfwt286","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Translational Medicine, Monash University","place":["Melbourne, Australia"]},{"id":[{"id":"https:\/\/ror.org\/013fdz725","id-type":"ROR","asserted-by":"publisher"}],"name":"Melbourne Sexual Health Centre, Alfred Health","place":["Carlton, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6643-5678","authenticated-orcid":false,"given":"C. S.","family":"Bradshaw","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02bfwt286","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Translational Medicine, Monash University","place":["Melbourne, Australia"]},{"id":[{"id":"https:\/\/ror.org\/013fdz725","id-type":"ROR","asserted-by":"publisher"}],"name":"Melbourne Sexual Health Centre, Alfred Health","place":["Carlton, Australia"]},{"id":[{"id":"https:\/\/ror.org\/01ej9dk98","id-type":"ROR","asserted-by":"publisher"}],"name":"Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne","place":["Melbourne, Australia"]},{"id":[{"id":"https:\/\/ror.org\/016899r71","id-type":"ROR","asserted-by":"publisher"}],"name":"Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity","place":["Melbourne, Victoria"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1086\/318850"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/1756287219832172"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-021-03913-0"},{"key":"e_1_3_5_5_2","volume-title":"General practice activity in Australia 2015\u201316","author":"Britt H","year":"2016","unstructured":"Britt H, Miller GC, Henderson J, et al.. 2016. General practice activity in Australia 2015\u201316. Sydney University Press, Sydney."},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrmicro3432"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0000000000000228"},{"key":"e_1_3_5_8_2","first-page":"451","article-title":"Diagnosis and management of uncomplicated urinary tract infections","volume":"72","author":"Mehnert-Kay SA","year":"2005","unstructured":"Mehnert-Kay SA. 2005. Diagnosis and management of uncomplicated urinary tract infections. Am Fam Physician 72:451\u2013456.","journal-title":"Am Fam Physician"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007182.pub2"},{"key":"e_1_3_5_10_2","unstructured":"Australian Therapeutic Guidelines. 2025. Acute cystitis in adults. Therapeutic Guidelines Limited (Australia). Available from: https:\/\/www.tg.org.au"},{"key":"e_1_3_5_11_2","unstructured":"The Australian Commission on Safety and Quality in Health Care. 2023. AURA 2023: Fifth Australian report on antimicrobial use and resistance in human health. Sydney: The Australian Commission on Safety and Quality in Health Care. Available from: https:\/\/www.safetyandquality.gov.au\/sites\/default\/files\/2023-11\/aura_2023_fifth_australian_report_on_antimicrobial_use_and_resistance_in_human_health.pdf"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1086\/344656"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2022.05.016"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0164306"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.18773\/austprescr.2019.002"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines11112937"},{"key":"e_1_3_5_17_2","unstructured":"World Health Organization. 2017. Prioritization of pathogens to guide discovery research and development of new antibiotics for drug-resistant bacterial infections including tuberculosis. Geneva: World Health Organization. Available from: https:\/\/www.who.int\/publications\/i\/item\/WHO-EMP-IAU-2017.12"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2296-11-78"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12171"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.12.231"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofad332"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciq257"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.coph.2011.06.011"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2018.10.026"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/jacamr\/dlad145"},{"key":"e_1_3_5_26_2","unstructured":"Australian Commission on Safety and Quality in Health Care. 2022. Australian passive antimicrobial resistance surveillance \u2013 third-generation cephalosporin resistance in Escherichia coli and Klebsiella pneumoniae: prevalence of extended-spectrum \u03b2-lactamase (ESBL) phenotype. Sydney: ACSQHC. Available from: https:\/\/www.safetyandquality.gov.au\/sites\/default\/files\/2022-08\/apas_report_2022_-_resistance_to_third-generation_cephalosporins_-_esbls_in_e._coli_and_k._pneumoniae.pdf"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00670-15"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2013.12.18989"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/09564624211030040"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1111\/jep.13340"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.idh.2020.01.001"},{"key":"e_1_3_5_32_2","unstructured":"European Association of Urology. 2024. EAU guidelines on urological infections. Arnhem: EAU Guidelines Office. Available from: https:\/\/uroweb.org\/guidelines\/urological-infections"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2020.106121"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1302186"},{"key":"e_1_3_5_35_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00044-16"},{"key":"e_1_3_5_36_2","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.00652-20"},{"key":"e_1_3_5_37_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyu094"}],"container-title":["Microbiology Spectrum"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.02674-25","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.02674-25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T13:11:47Z","timestamp":1781701907000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/spectrum.02674-25"}},"subtitle":[],"editor":[{"given":"Reema","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,2]]},"references-count":36,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6,2]]}},"alternative-id":["10.1128\/spectrum.02674-25"],"URL":"https:\/\/doi.org\/10.1128\/spectrum.02674-25","relation":{},"ISSN":["2165-0497"],"issn-type":[{"value":"2165-0497","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,2]]},"assertion":[{"value":"2025-08-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e02674-25"}}