Mohammed Alshehri, Ibrahim Tawhari, Mona M Alshahrani, Ali M Somily, Khalifa Binkhamis, Ghassan S Alaskar, Esmahan Tahtouh, Nawar Said Tayfour, Ayman Nasr Tawifik Khalil, Yahya Shabi
The findings suggest that both individual sociodemographic characteristics as well as interpersonal and structural healthcare-related characteristics play a significant role in shaping PrEP use among transgender women of color taking GAHT. This highlights the need for multilevel interventions that address structural and interpersonal determinants of health access to promote equity in HIV prevention.
INTRODUCTION: Prior urine-culture results can guide empiric antimicrobial therapy, but their value depends on whether the same organism recurs and the prior phenotype remains informative. We estimated the duration of same-species antimicrobial non-susceptibility persistence among urinary gram-negative bacilli in a tertiary-care cohort.
METHODS: We conducted a retrospective longitudinal cohort study of urine cultures from patients aged ≥12 years at Aseer Central Hospital, Saudi Arabia, from 2013 to 2024. Consecutive within-patient, same-species isolate pairs were formed for gram-negative bacilli. Among pairs in which the prior isolate was non-susceptible and the next same-species isolate was class-evaluable, persistence was defined as non-susceptibility of the next isolate to the same drug class. Estimates were stratified by organism, drug class, and time since the prior isolate; uncertainty was addressed using patient-clustered bootstrap or Wilson intervals, and temporal decay used modified Poisson regression.
RESULTS: The source cohort included 14,587 eligible urinary gram-negative bacilli cultures from 8,045 patients. The trajectory cohort included 2,401 patients with ≥2 eligible cultures, yielding 4,332 consecutive same-species pairs from 1,745 patients; 3,380 pairs from 1,368 patients entered class-evaluable persistence analyses. Escherichia coli and Klebsiella pneumoniae met support thresholds for organism-specific inference. Fluoroquinolone non-susceptibility persistence declined from 96.8% within 30 days to 79.9% after 365 days in E. coli and from 93.2% to 77.1% in K. pneumoniae. Extended-spectrum cephalosporin non-susceptibility declined from 90.0% to 48.2% in E. coli and from 94.9% to 63.6% in K. pneumoniae. Carbapenem non-susceptibility persistence in K. pneumoniae declined from 86.8% to 41.9%. All supported organism-class decay models had risk ratios below 1.0 per doubling of time.
DISCUSSION: Prior same-species urinary gram-negative bacilli non-susceptibility carried substantial empiric memory, especially for fluoroquinolones, but persistence declined with time and differed by organism and drug class. Prior results should be interpreted as time-dependent, species- and class-specific evidence, not as an indefinite resistance flag.