Association between Antidepressant Usage and Multidrug Resistant Urinary Tract Infections

Author(s):
Isaac Sears; Kevin Gibas; Michel Davis; Leonard Mermel; Daithi Heffernan

Background:

Antimicrobial resistance is a growing threat among surgical patients. Urinary Tract Infections (UTIs), one of the most common infectious complications among surgical patients is, often treated empirically, are increasingly resistant to first-line antibiotics. Further, antidepressants have become the third most prescribed drug in the US. Recent studies have demonstrated that antidepressants can induce antibiotic resistance in microbes in vitro. We hypothesize that a significant increase in antibiotic resistance would be observed in patients taking antidepressant medication.

Hypothesis:

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Methods:

This is a retrospective analysis of the Medical Information Mart for Intensive Care version IV (MIMIC-IV) database for patients presenting to the ED with a UTI. A Multi-Drug Resistant Organism (MDRO) was defined as demonstrating resistance to two or more classes of antibiotics. Records were queried for presence of the ten most prescribed antidepressants. Odds ratio computed the association between any antidepressant usage and MDRO. A logistic regression model then assess the association between individual antidepressants and the presence of MDRO.

Results:

Overall, 12,248 patients were identified with a positive urine culture. Of these, 13% had an MDRO and 31% were taking an antidepressant. Compared to patients without MDROs organisms, patients with MDROs were older (72.9+/-16.9 vs 70.5+/-20.7 yrs;p<0.001) and less likely female (61.3% vs 70.5%;p<0.001). Antidepressant usage was markedly higher among patients with an MDRO infection (39% versus 31%; p<0.001). Usage of any antidepressant was significantly associated with MDRO with an unadjusted odds ratio of 1.51 (95% CI=1.35-1.68;p<0.001). Six of the 10 individual antidepressants were associated with significantly increased odds of MDRO on urine cultures: citalopram, duloxetine, fluoxetine, mirtazapine, trazadone, and venlafaxine. The antidepressant most associated with MDR organisms was duloxetine, (OR=1.78; 95%CI=1.38-2.29). The remaining four antidepressants, amitriptyline, bupropion, escitalopram, and sertraline were not associated with significantly increased odds of MDRO.

Conclusions:

A significant association between antidepressant usage and MDRO infections exists. Importantly, given our current findings, providers must be cognizant that current empiric regimes for patients presenting with urinary tract infections in the context of antidepressant usage may not offer appropriate antimicrobial coverage.