scholarly journals Treatment of urinary tract infections in condition of growing antibiotic resistance: Antimicrobial Stewardship program

2019 ◽  
pp. 62-71
Author(s):  
O.I. Chub ◽  
O.V. Bilchenko ◽  
O.M. Godlevska ◽  
S.V. Teslenko
Keyword(s):  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antimicrobial Stewardship ◽  
Third Generation ◽  
Antimicrobial Stewardship Program ◽  
E Coli ◽  
Stewardship Program ◽  
The Right ◽  
Tract Infections

 Resistance to common groups of antibiotics has been increasing in the treatment of urinary tract infections worldwide. In the United States, CDC has estimated that more thаn 2 million infections and 23,000 deaths are due to antibiotic resistance each year. In Europe, an еstimated 25,000 deaths are attributable to antibiotic-rеsistant infections. By 2050, it is estimated that antibiotic resistance will cause 10 million deaths every year.At the EU/EEA level, more than half (58.2%) of the E. coli isolates reported to EARS-Net for 2017 were resistant to at least one of the antimicrobial groups under regular surveillance, i.e. aminopenicillins, fluoroquinolones, third-generation cephalosporins, aminoglycosides and carbapenems. A majority (87.4%) of the third-generation cephalosporin-resistant E. coli isolates from 2017 were extended-spectrum beta-lactamase (ESBL)-positive. Use of broad-spectrum antimicrobials is a known risk factor for colonization and spread of resistant Enterobacteriaceae, including E. coli. The high levels of ESBLs and increasing resistance to key antimicrobial groups might also lead to an increased consumption of carbapenems, which in turn can increase the selection pressure and facilitated the spread of carbapenem-resistant Enterobacteriaceae. According to annual reports of CDC, WHO, EARS-Net and others,estimate that 30 percent of all antibiotics prescribed in outpatient clinics and 40 percent of all antibiotics prescribed in inpatient clinics were unnecessary. Improving the way we use antibiotics, often referred to as «antibiotic stewardship», is part of the National Action Plan. Appropriate antibiotic use means using the right antibiotic, at theright dose, for the right duration, and at the right time. The article reflects the recommendations of the European Association of Urology 2019 on the management and treatment of urinary tract infections in accordance with the principles of Antimicrobial Stewardship Program.

scholarly journals 1125. In with the Out-patient Antimicrobial Stewardship Initiative: A Collaboration between a Children’s Hospital Antimicrobial Stewardship Program and a Nonaffiliated Pediatric Private Practice

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S400-S400
Author(s):  
Katie Namtu ◽  
David M Berman ◽  
Catherine Hough-Telford
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Prescribing Patterns ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Resistance Patterns ◽  
Outpatient Practice ◽  
Tract Infections

Abstract Background While antibiotic stewardship programs have been well described in the inpatient setting, data on effectiveness and guidance on implementing outpatient stewardship in pediatric patients is scarce. To the best of our knowledge, this is the first study describing the impact that an established inpatient pediatric antimicrobial stewardship program (ASP) has had on antimicrobial prescribing practices in a multi-site (14 locations) nonacademic, nonaffiliated pediatric outpatient practice. This study’s main objective was to compare the prescribing patterns for urinary tract infections (UTIs) at baseline (before education was provided on local uropathogen resistance patterns, implications of broad-spectrum antibiotic usage, national practice guidelines, cost, etc.) and after antimicrobial stewardship education and interventions. Methods Prescribing patterns for UTIs at baseline were reviewed and assessed for appropriateness by the inpatient ASP the summer of 2018. Following this review, education was provided to the outpatient prescribers that included discussion on local uropathogen resistance patterns, UTI guidelines, antimicrobial properties, risk for adverse effects, appropriate antimicrobial selections and dosing for UTIs. After education was provided prescribing patterns from the various sites and prescribers was reviewed on a quarterly basis. Email reminders were also sent out to providers reminding them to use cephalexin as first-line treatment. Unblinded peer comparison was utilized as a behavioral intervention in which all prescribers received reports comparing their antibiotic prescribing rates for UTIs to their peers. Results The rate by which cephalexin was prescribed for UTIs has steadily improved from 4.02% of all prescriptions for UTIs during the reporting period of December 2017 - February 28, 2018 to 67.55% during the reporting period January 1 - March 31, 2019. Conclusion Collaboration between an established inpatient pediatric ASP and a nonaffiliate, multi-site private pediatric outpatient practice resulted in decreased utilization of broad-spectrum antibiotics and optimization of empiric treatment of urinary tract infections based on local resistance patterns. Disclosures All authors: No reported disclosures

Impact of an Antimicrobial Stewardship Care Bundle to Improve the Management of Patients with Suspected or Confirmed Urinary Tract Infection

2016 ◽  
Vol 37 (12) ◽  
pp. 1499-1501 ◽  
Author(s):  
Curtis D. Collins ◽  
Jared J. Kabara ◽  
Sarah M. Michienzi ◽  
Anurag N. Malani
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antimicrobial Stewardship ◽  
Asymptomatic Bacteriuria ◽  
Care Bundle ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Bundle Compliance ◽  
Tract Infections

Implementation of an antimicrobial stewardship program bundle for urinary tract infections among 92 patients led to a higher rate of discontinuation of therapy for asymptomatic bacteriuria (52.4% vs 12.5%; P =.004), more appropriate durations of therapy (88.7% vs 63.6%; P =.001), and significantly higher overall bundle compliance (75% vs 38.2%; P < .001).Infect Control Hosp Epidemiol 2016;1499–1501

scholarly journals Evaluation of Urine Isolated Bacteria and Their Antimicrobial Resistance in Hospitalized Patients in Ahvaz Golestan Hospital in 2019

2021 ◽  
Vol 20 (2) ◽  
pp. 128-139
Author(s):  
Ladan Fatahi ◽  
Mohammad Soleymani Zar ◽  
Keyword(s):  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Relevant Information ◽  
Cross Sectional Study ◽  
Hospitalized Patients ◽  
Urine Samples ◽  
Cross Sectional ◽  
E Coli ◽  
Tract Infections

Background and Objectives: Urinary Tract Infection (UTI) is one of the most common infections in the community and hospitalized patients. The aim of the present study was to investigate bacteria isolated from urinary tract infections and their antibiotic resistance in hospitalized patients. Subjects and Methods In the this descriptive-cross-sectional study, the results of about 5,000 urine samples sent for culture from the hospitalized patients of Golestan Hospital in Ahvaz in 2019 were examined. Relevant information was extracted from patients’ medical records. Results Out of 5000 samples studied (39.7% female and 60.3% male), about 468 samples (9.36%) showed positive urine culture. Of the patients with UTI, 205 patients were women (43.8%). The risk of UTI increased with age. The most common bacteria caused urinary tract infections were E. coli with 51.5%, followed by Klebsiella with 29.3%. It was also observed that bacteria isolated from urine samples of people with UTI had antibiotic resistance, and for each bacteria special groups of antibiotics were more effective. Conclusion The prevalence of UTI in the studied patients was 9.36%. In females and with increasing age, the prevalence of UTI was higher. The most common bacteria that caused UTI were E. coli and then Klebsiella. Due to the fact that the resistance and sensitivity of bacteria to antibiotic used, it is recommended that the most common bacterial agents of UTI must be diagnosed and then the most appropriate antibiotic must be prescribed

Antibiotic resistance in E. coli isolates from patients with urinary tract infections presenting to the emergency department

Infection ◽  
2018 ◽  
Vol 46 (3) ◽  
pp. 325-331 ◽  
Author(s):  
Florian Hitzenbichler ◽  
Michaela Simon ◽  
Thomas Holzmann ◽  
Michael Iberer ◽  
Markus Zimmermann ◽  
...  
Keyword(s):  
Emergency Department ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
E Coli ◽  
Tract Infections

scholarly journals Urine Microbial Landscape in Children with Urinary Tract Infections in Ryazan and Ryazan Region

Doctor Ru ◽  
2021 ◽  
Vol 20 (10) ◽  
pp. 48-53
Author(s):  
N.A. Belykh ◽  
◽  
S.V. Tereschenko ◽  
N.A. Anikeeva ◽  
S.S. Kantutis ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Klebsiella Pneumoniae ◽  
Urinary Tract Infections ◽  
Patient Specific ◽  
E Coli ◽  
Resistance Determinants ◽  
Study Results ◽  
Tract Infections

Study Objective: To study a spectrum of uropathogens and their sensitivity to antimicrobials in urinary tract infections (UTIs) in children in Ryazan and Ryazan Region. Study Design: retrospective study. Materials and Methods. We conducted a retrospective local laboratory monitoring of urinary microflora and analysed its sensitivity to antimicrobials in 111 patients aged 2 months to 17 years old who were undergoing traditional UI therapy in 2020. The study group comprised 75 (67.6%) girls and 36 (32.4%) boys. Pathogen isolation and type identification were performed using urine specimens collected in sterile disposable plastic containers prior to antimicrobial therapy. Material was delivered for analysis within 2 hours from collection. For testing of pathogen sensitivity to antimicrobials, we used the phenotyping diffusion test and an analytical test for carbapenems inactivation. Study Results. Prevailing causative agents of UIs were Escherichia coli (50.4%) and Klebsiella pneumoniae (14.4%). Resistance determinants were found in 9.0% and 2.7% of Е. соli and K. pneumoniae urological strains, respectively. The main mechanism of resistivity was production of wide spectrum plasmid β-lactamases. The highest activity in E. coli was demonstrated by generation III–IV cephalosporins, aminoglycosides, fosfomicin (100%), nitrofurantoin (91.3%), and aminopenicillins (76.1–86.9%). For K. pneumoniae, generation III–IV cephalosporins and aminoglycosides were most potent (100%). All resistant pathogens were sensitive to cefoperazone sulbactam, meropenem, imipenem, aminoglycosides (100%); tigecycline, nitrofurantoin, and fosfomicin were most potent against E. coli. Conclusion. Children with UIs in Ryazan Region had mostly gram-negative bacteria in their urine (85.6%), Enterobacteralеs (81.1%) being a prevailing type. Antimicrobials resistance determinants were quite rare (17.8%) in these urine isolates; all of them were class A ЕSBL producers. These characteristic features of antibiotic resistance of uropathogenic enterobacteria strains allow using β-lactam antibiotics in empiric initial treatment and emphasising the need in patient-specific selection of antimicrobials. Keywords: antibacterial therapy, antibiotic resistance, children, urinary tract infections, Escherichia coli, Klebsiella pneumoniae.

scholarly journals Selection and co-selection of antibiotic resistances among Escherichia coli by antibiotic use in primary care: an ecological analysis

2019 ◽  
Author(s):  
Koen B Pouwels ◽  
Berit Muller-Pebody ◽  
Timo Smieszek ◽  
Susan Hopkins ◽  
Julie V Robotham
Keyword(s):  
Escherichia Coli ◽  
Primary Care ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Respiratory Tract ◽  
Urinary Tract Infections ◽  
Respiratory Tract Infections ◽  
Antibiotic Use ◽  
E Coli ◽  
Tract Infections

AbstractThe majority of studies that link antibiotic usage and resistance focus on simple associations between the resistance against a specific antibiotic and the use of that specific antibiotic. However, the relationship between antibiotic use and resistance is more complex. Here we evaluate which antibiotics, including those mainly prescribed for respiratory tract infections, are associated with increased resistance among Escherichia coli isolated from urinary samples.Monthly primary care prescribing data were obtained from National Health Service (NHS) Digital. Positive E. coli records from urine samples in English primary care (n=888,207) between April 2014 and January 2016 were obtained from the Second Generation Surveillance System. Elastic net regularization was used to evaluate associations between prescribing of different antibiotic groups and resistance against amoxicillin, cephalexin, ciprofloxacin, co-amoxiclav and nitrofurantoin at the clinical commissioning group (CCG) level. England is divided into 209 CCGs, with each NHS practice prolonging to one CCG.Amoxicillin prescribing (measured in DDD/ 1000 inhabitants / day) was positively associated with amoxicillin (RR 1.03, 95% CI 1.01 – 1.04) and ciprofloxacin (RR 1.09, 95% CI 1.04 – 1.17) resistance. In contrast, nitrofurantoin prescribing was associated with lower levels of resistance to amoxicillin (RR 0.92, 95% CI 0.84 – 0.97). CCGs with higher levels of trimethoprim prescribing also had higher levels of ciprofloxacin resistance (RR 1.34, 95% CI 1.10 – 1.59).Amoxicillin, which is mainly (and often unnecessarily) prescribed for respiratory tract infections is associated with increased resistance against various antibiotics among E. coli causing urinary tract infections. Our findings suggest that when predicting the potential impact of interventions on antibiotic resistances it is important to account for use of other antibiotics, including those typically used for other indications.Author summaryAntibiotic resistance is increasingly recognised as a threat to modern healthcare. Effective antibiotics are crucial for treatment of serious bacterial infections and are necessary to avoid that complicated surgical procedures and chemotherapy becoming life-threatening. Antibiotic use is one of the main drivers of antibiotic resistance. The majority of antibiotic prescriptions are prescribed in primary care, however, a large proportion of these antibiotic prescriptions are unnecessary. Understanding which antibiotics are causing antibiotic resistance to what extent is needed to prevent under- or over-investment in interventions lowering use of specific antibiotics, such as rapid diagnostic tests for respiratory tract infection.We have statistically evaluated which antibiotics are associated with higher and lower levels of antibiotic resistance against common antibiotics among Escherichia coli bacteria sampled from the urinary tract by comparing antibiotic prescribing and resistance in different geographical areas in England. Our model shows that amoxicillin, the most commonly used antibiotic in England and mainly used for respiratory tract infections, is associated with increased resistance against several other antibiotics among bacteria causing urinary tract infections. The methods used in this study, that overcome several of the limitations of previous studies, can be used to explore the complex relationships between antibiotic use and antibiotic resistance in other settings.

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