New research has revealed a strain of multidrug-resistant (MDR) bacteria spreading in older women with urinary tract infections (UTIs) across the United States, researchers reported yesterday in Nature Communications.

Using whole-genome sequencing, a team led by researchers with the Center for Discovery and Innovation examined 2,006 unique ceftriaxone-nonsusceptible K pneumoniae isolates collected from July 2023 to July 2024 from 10 Quest Diagnostic laboratories that primarily serve community outpatients. K pneumoniae is a leading cause of UTIs, and research has shown a steady increase in MDR strains in US hospitals in recent decades, particularly those carrying extended-spectrum beta-lactamase (ESBL) genes. The researchers were hoping to get a better understanding of how these strains are spreading in the community.

“Unlike most surveillance studies, which focus on hospital infections, our study design emphasized outpatients in the community, a potential reservoir that has not been systematically sampled,” the study authors wrote.

Nearly 70% of the K pneumoniae isolates, which were primarily from women over age 60 with UTIs treated in outpatient settings, were nonsusceptible to the oral antibiotics routinely used to treat UTIs (levofloxacin, ciprofloxacin, trimethoprim/sulfamethoxazole, and nitrofurantoin), and more than 20% were resistant to all tested antibiotics except carbapenems and amikacin. All were classified as MDR.

“These resistance profiles, together with high community prevalence, sharply limit empiric outpatient options for suspected Gram-negative infections,” the authors wrote.

Sequencing revealed that the spread of these MDR K pneumoniae strains has been driven by the ESBL gene bla_CTX-M-15, which is carried on mobile pieces of DNA called plasmids that can be shared among bacteria. The plasmids also harbored other genes the researchers believe make them capable of adapting to environmental pressures.

Strains could be targets for vaccine development

The authors say that clinicians may have to look beyond commonly used antibiotics for treating these MDR K pneumoniae strains. But they also identified a subset of serotypes they say could be targets for vaccine development.

“A protective or therapeutic vaccine, irrespective of antibiotic resistance, could address a critical unmet need, particularly for older women with drug-resistant UTIs,” they wrote.

Remotely monitoring patients after sepsis or an infection failed to reduce hospital readmissions, according to a study published yesterday in JAMA Network Open. The randomized clinical trial looked at traditional hospital follow-up compared to four remote interventions to determine if patients benefitted. 

“Health systems, insurers, and policy makers all want to reduce hospital readmissions, and most patients prefer to recover safely at home,” Sachin Yende, MD, lead author and professor of critical care medicine at the University of Pittsburgh School of Medicine, said in a university press release. “Remote monitoring … use has grown. But, aside from a few conditions, there’s a dearth of high-quality data to show it reduces readmissions.” 

None of the interventions reduced readmissions

Sepsis occurs when the body overreacts to an infection, and it can cause organ damage and death. More than 1.7 million adults develop sepsis annually and at least 350,000 die from it, says the Centers for Disease Control and Prevention (CDC).

The researchers randomly assigned 1,286 adult participants convalescing at home after sepsis or a lower respiratory tract infection to what they called usual care or one of four types of remote monitoring. Usual care includes a phone call from the hospital and oversight from the patient’s primary care physician. 

Health systems, insurers, and policy makers all want to reduce hospital readmissions, and most patients prefer to recover safely at home.

In the remote-monitoring groups, people received short or long questionnaires on their smartphones paired with either a standard response or an enhanced response. For the standard-response group, nurses noted worrisome answers and worked with the patient’s doctors on treatment. For the enhanced-response group, registered nurse practitioners experienced in palliative care oversaw much of patients’ care. 

Those who received usual care experienced a 37.8% hospital readmission rate. People who received the long questionnaire with the enhanced response had a 36.3% readmission rate. Participants who received the long questionnaire with a standard response experienced a 44.2% readmission rate. 

“Among trial patients discharged after hospitalizations for serious infections, remote monitoring did not increase time spent alive at home but reduced it in those 65 and older,” the authors wrote.

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