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September 13, 2022

Novel Weighted-Incidence Syndromic Combination Antibiogram (WISCA) Resistance (WISCA-R) Profiling of Oral Agents Commonly Used in the Treatment of Community Urinary Tract Infections, and Comparison to Previous WISCA-R Findings

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Background: The recently described weighted-incidence syndromic combination antibiogram (WISCA) displays antimicrobial susceptibilities per drug for a given syndrome, rather than per organism as in traditional antibiograms. We sought to (1) construct a WISCA resistance (R) profile (WISCA-R) per oral agent among drugs commonly used in the treatment of community urinary tract infections (UTIs), to identify oral agents with low R, and (2) compare our 2018 vs 2019 WISCA-R profiles. 

Methods: Isolates were identified by conventional methods from urine cultures over a 2-year period ending in December 2019, and were tested by disk diffusion or Vitek2 (bioMérieux), according to CLSI guidelines, against amoxicillin-clavulanate (AMC), ampicillin (AM), cefazolin (KZ), ciprofloxacin (CIP), fosfomycin (FOS), nitrofurantoin (FM), and trimethoprim/sulfamethoxazole (SXT). For FOS, CLSI Escherichia coli and Enterococcus faecalis breakpoints were applied to Gram-negative and -positive organisms, respectively, similar to recently published investigations. WISCA-R was constructed by multiplying the probability of weighted incidence per organism by the corresponding probability of R to the studied drug, including intrinsic R and known/imputed susceptibility per organism/drug combination, followed by the sum of obtained probabilities, to arrive at the WISCA-R rate for that drug. WISCA-R rates for 2018 vs 2019 were compared for each drug.

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