Antimicrobial Resistance of Urinary Tract Isolates in Acute Uncomplicated Cystitis Among College-Aged Women: Choosing a First-Line Therapy

OBJECTIVESTo evaluate changes in outpatient fluoroquinolone (FQ) and nitrofurantoin (NFT) use and resistance among E. coli isolates after a change in institutional guidance to use NFT over FQs for acute uncomplicated cystitis.DESIGNRetrospective preintervention–postintervention study.SETTINGUrban, integrated healthcare system.PATIENTSAdult outpatients treated for acute cystitis.METHODSWe compared 2 time periods: January 2003–June 2007 when FQs were recommended as first-line therapy, and July 2007–December 2012, when NFT was recommended. The main outcomes were changes in FQ and NFT use and FQ- and NFT-resistant E. coli by time-series analysis.RESULTSOverall, 5,714 adults treated for acute cystitis and 11,367 outpatient E. coli isolates were included in the analysis. After the change in prescribing guidance, there was an immediate 26% (95% CI, 20%–32%) decrease in FQ use (P<.001), and a nonsignificant 6% (95% CI, −2% to 15%) increase in NFT use (P=.12); these changes were sustained over the postintervention period. Oral cephalosporin use also increased during the postintervention period. There was a significant decrease in FQ-resistant E. coli of −0.4% per quarter (95% CI, −0.6% to −0.1%; P=.004) between the pre- and postintervention periods; however, a change in the trend of NFT-resistant E. coli was not observed.CONCLUSIONSIn an integrated healthcare system, a change in institutional guidance for acute uncomplicated cystitis was associated with a reduction in FQ use, which may have contributed to a stabilization in FQ-resistant E. coli. Increased nitrofurantoin use was not associated with a change in NFT resistance.Infect Control Hosp Epidemiol 2017;38:461–468

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Vaginal Estrogen as First-Line Therapy for Recurrent Urinary Tract Infections in Postmenopausal Women and Risk Factors for Needing Additional Therapy

Female Pelvic Medicine & Reconstructive Surgery ◽

10.1097/spv.0000000000000989 ◽

2021 ◽

Vol 27 (3) ◽

pp. e487-e492

Author(s):

Eric Chang ◽

Laura Kent ◽

Isabel Prieto ◽

Erica Eggers ◽

Jean Paul Tanner ◽

...

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Postmenopausal Women ◽

Urinary Tract Infections ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Vaginal Estrogen ◽

Tract Infections ◽

Additional Therapy

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Efficacy and Tolerability of Bacillus Calmette-Guérin Therapy as the First-Line Therapy for Upper Urinary Tract Carcinoma In Situ

Cancer Investigation ◽

10.1080/07357907.2018.1430815 ◽

2018 ◽

Vol 36 (2) ◽

pp. 152-157 ◽

Cited By ~ 3

Author(s):

Ikko Tomisaki ◽

Tatsuhiko Kubo ◽

Akinori Minato ◽

Naohiro Fujimoto

Keyword(s):

Urinary Tract ◽

Carcinoma In Situ ◽

Upper Urinary Tract ◽

Bacillus Calmette Guerin ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Upper Urinary Tract Carcinoma

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Retrospective 8-Year Study on the Antibiotic Resistance of Uropathogens in Children Hospitalised for Urinary Tract Infection in the Emilia-Romagna Region, Italy

Antibiotics ◽

10.3390/antibiotics10101207 ◽

2021 ◽

Vol 10 (10) ◽

pp. 1207

Author(s):

Susanna Esposito ◽

Giuseppe Maglietta ◽

Margherita Di Costanzo ◽

Martina Ceccoli ◽

Gianluca Vergine ◽

...

Keyword(s):

Urinary Tract Infection ◽

Antibiotic Resistance ◽

Urinary Tract ◽

Tract Infection ◽

Third Generation ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Amoxicillin Clavulanate ◽

Third Generation Cephalosporins

The development and spread of antibiotic resistance is an increasingly important global public health problem, even in paediatric urinary tract infection (UTI). In light of the variability in the data, it is necessary to conduct surveillance studies to determine the prevalence of antibiotic resistance in specific geographical areas to optimize therapeutic management. In this observational, retrospective, multicentre study, the medical records of 1801 paediatric patients who were hospitalised for UTI between January 1st, 2012, and June 30th, 2020, in Emilia-Romagna, Italy, were analysed. Escherichia coli was the most frequently detected pathogen (75.6%), followed by Klebsiella pneumoniae (6.9%) and Pseudomonas aeruginosa (2.5%). Overall, 840 cases (46.7%) were due to antimicrobial-resistant uropathogens: 83 (4.7%) extended spectrum beta-lactamase (ESBL)-producing, 119 (6.7%) multidrug resistant (MDR) and 4 (0.2%) extensively drug resistant (XDR) bacteria. Empirical antibiotic therapy failed in 172 cases (9.6%). Having ESBL or MDR/XDR uropathogens, a history of recurrent UTI, antibiotic therapy in the preceding 30 days, and empirical treatment with amoxicillin or amoxicillin/clavulanate were significantly associated with treatment failure, whereas first-line therapy with third-generation cephalosporins was associated with protection against negative outcomes. In conclusion, the increase in the resistance of uropathogens to commonly used antibiotics requires continuous monitoring, and recommendations for antibiotic choice need updating. In our epidemiological context, amoxicillin/clavulanate no longer seems to be the appropriate first-line therapy for children hospitalised for UTI, whereas third-generation cephalosporins continue to be useful. To further limit the emergence of resistance, every effort to reduce and rationalise antibiotic consumption must be implemented.

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