scholarly journals Antimicrobial resistance in patients with urinary tract infections and the impact on empiric therapy in Serbia

2016 ◽  
Vol 10 (10) ◽  
pp. 1065-1072
Author(s):  
Simon Zec ◽  
Aleksa Despotovic ◽  
Aleksandra Spurnic-Radovanovic ◽  
Ivana Milosevic ◽  
Milica Jovanovic ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Resistance ◽  
Urinary Tract Infections ◽  
Large Scale ◽  
Empiric Therapy ◽  
Age And Gender ◽  
And Gender ◽  
Tract Infections ◽  
Resistance Rates ◽  
The Impact

Introduction: Surveillance of antimicrobial resistance is essential in establishing treatment guidelines for urinary tract infections. The aim of this pilot study was to analyse resistance rates of pathogens, across different demographics and determine whether adjustments in empiric therapy should be considered for different age and gender groups. Methodology: A 5-year retrospective study included 256 patients hospitalised, under the initial diagnosis of Fever of Unknown Origin who were then subsequently diagnosed with a urinary tract infection at the Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia. Patients were evaluated using demographic, clinical, and antimicrobial resistance data with appropriate statistical analysis including ANOVA significance testing, univariate, and multivariate analysis. Results: Resistance rates were above the threshold of 20% for the majority of the antimicrobials tested, the only exception being carbapenems. Amikacin, cefepime, and norfloxacin were agents that could be effectively used as empiric therapy in younger adults with resistance rates of 4.2, 8.0, and 10.0%, respectively. Moderate resistance rates of 17.4% for amikacin and 19.1% for cefepime were observed in the age group 35-64 years. High resistance rates were observed for all antimicrobials among patients 65 years and over. Among male patients, resistance rates to most antimicrobials were high. In female patients, amikacin and cefepime had resistance rates less than 20%. Younger age presented as a negative risk factor for infection by a multi-drug resistant pathogen. Conclusion: Age and gender demonstrated to be significant factors for determining proper empiric therapy; large-scale studies from Serbia are needed to solidify these findings.

scholarly journals Gender and Age-Dependent Etiology of Community-Acquired Urinary Tract Infections

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Enrico Magliano ◽  
Vittorio Grazioli ◽  
Loredana Deflorio ◽  
Antonia Isabella Leuci ◽  
Roberto Mattina ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antimicrobial Agents ◽  
Age And Gender ◽  
E Coli ◽  
Gender And Age ◽  
Amoxicillin Clavulanate ◽  
And Gender ◽  
Tract Infections

Urinary tract infections (UTIs) are among the most frequent community-acquired infections worldwide.Escherichia coliis the most common UTI pathogen although underlying host factors such as patients’ age and gender may influence prevalence of causative agents. In this study, 61 273 consecutive urine samples received over a 22-month period from outpatients clinics of an urban area of north Italy underwent microbiological culture with subsequent bacterial identification and antimicrobial susceptibility testing of positive samples. A total of 13 820 uropathogens were isolated and their prevalence analyzed according to patient’s gender and age group. OverallEscherichia coliaccounted for 67.6% of all isolates, followed byKlebsiella pneumoniae(8.8%),Enterococcus faecalis(6.3%),Proteus mirabilis(5.2%), andPseudomonas aeruginosa(2.5%). Data stratification according to both age and gender showedE. coliisolation rates to be lower in both males aged ≥60 years (52.2%),E. faecalisandP. aeruginosabeing more prevalent in this group (11.6% and 7.8%, resp.), as well as in those aged ≤14 years (51.3%) in whomP. mirabilisprevalence was found to be as high as 21.2%.Streptococcus agalactiaeoverall prevalence was found to be 2.3% although it was shown to occur most frequently in women aged between 15 and 59 years (4.1%). Susceptibility ofE. colito oral antimicrobial agents was demonstrated to be as follows: fosfomycin (72.9%), trimethoprim/sulfamethoxazole (72.9%), ciprofloxacin (76.8%), ampicillin (48.0%), and amoxicillin/clavulanate (77.5%). In conclusion, both patients’ age and gender are significant factors in determining UTIs etiology; they can increase accuracy in defining the causative uropathogen as well as providing useful guidance to empiric treatment.

scholarly journals Value of an Aggregate Index in Describing The Impact of Trends in Antimicrobial Resistance forEscherichia coli

2015 ◽  
Vol 26 (1) ◽  
pp. 33-38 ◽  
Author(s):  
David M Patrick ◽  
Catharine Chambers ◽  
Dale Purych ◽  
Mei Chong ◽  
Diana George ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Resistance ◽  
Urinary Tract Infections ◽  
Age Group ◽  
Cumulative Impact ◽  
Adaptive Use ◽  
Aggregate Index ◽  
Tract Infections ◽  
The Impact ◽  
Over Time

BACKGROUND: Drug resistance indexes (DRIs) quantify the cumulative impact of antimicrobial resistance on the likelihood that a given pathogen will be susceptible to antimicrobial therapy.OBJECTIVE: To derive a DRI for community urinary tract infections caused byEscherichia coliin British Columbia for the years 2007 to 2010, and to examine trends over time and across patient characteristics.METHODS: Indication-specific utilization data were obtained from BC PharmaNet for outpatient antimicrobial prescriptions linked to diagnostic information from physician payment files. Resistance data forE coliurinary isolates were obtained from BC Biomedical Laboratories (now part of LifeLabs Medical Laboratory Services). DRIs were derived by multiplying the rate of resistance to a specific antimicrobial by the proportional rate of utilization for that drug class and aggregating across drug classes. Higher index values indicate more resistance.RESULTS: Adaptive-use DRIs remained stable over time at approximately 18% (95% CI 17% to 18%) among adults ≥15 years of age and approximately 28% (95% CI 26% to 31%) among children <15 years of age. Similar results were observed when proportional drug use was restricted to the baseline year (ie, a static-use model). Trends according to age group suggest a U-shaped distribution, with the highest DRIs occurring among children <10 years of age and adults ≥65 years of age. Males had consistently higher DRIs than females for all age groups.CONCLUSIONS: The stable trend in adaptive-use DRIs over time suggests that clinicians are adapting their prescribing practices for urinary tract infections to local resistance patterns. Results according to age group reveal a higher probability of resistance to initial therapy among young children and elderly individuals.

scholarly journals 2094. Acceptability of Antibiotic Substitutions for Fluoroquinolones and Third and Fourth-generation Cephalosporins: A Report from the VA-CDC Practice-Based Research Network (PBRN)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S708-S708
Author(s):  
Matthew B Goetz ◽  
Stacey Hockett Sherlock ◽  
Cassie Goedken ◽  
Erin C Balkenende ◽  
Charlesnika T Evans ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antimicrobial Stewardship ◽  
Empiric Therapy ◽  
Research Network ◽  
Fourth Generation ◽  
Structured Interviews ◽  
Practice Based Research ◽  
Tract Infections ◽  
The Impact

Abstract Background Studies suggest fluoroquinolones (FQ), and third (3C) and fourth (4C) generation cephalosporins, agents often used for empiric therapy, place patients at higher risk for C. difficile infection. Substituting alternative antibiotics for empiric therapy might reduce risk. We surveyed inpatient physician (MD) and pharmacist (PharmD) antimicrobial stewardship champions to evaluate their preferred FQ, 3C and 4C substitutions for empiric therapy. Methods Semi-structured interviews were conducted with the antimicrobial stewardship MD and the PharmD champion from each of the 15 VA-CDC Practice Based Research Network (PBRN) sites. Interviewees were asked what empiric antibiotics for pneumonia and urinary tract infections would be recommended in local guidelines if all 3C, 4C and FQ were restricted. Respondents could list multiple antibiotics. Templated data collection and analysis were used to assist in rapid analysis of interviews. Results Narrow β-lactams were identified as appropriate options for CAP by 8 MD and 9 PharmD (table). Piperacillin/tazobactam was the preferred choice by MDs and PharmDs for HCAP (7 and 12, respectively) and HAP (10 and 12, respectively). For community-onset urinary tract infections (cUTI), numerous alternatives to FQ, 3C and 4C were identified. For hospital-onset (hUTI), piperacillin/tazobactam was most frequently mentioned by MD and PharmDs (7 and 9, respectively). 4 of 5 MDs and 5 of 7 PharmDs who chose 3C for CAP indicated that 3C were preferred over all other choices for CAP, few stewards indicated that 3C were the sole preferred agents for other conditions. Conclusion Antimicrobial stewardship MD and PharmD champions were readily able to find FQ substitutions for all indications; 3C and 4C substitutions were found for all indications with a notable exception of treatment of CAP. These results suggest considerable opportunity to reduce use of these antibiotic classes. Future studies should examine the appropriateness and acceptability of the substitutions identified by stewardship champions to providers and the impact of restriction of FQ, 3C and 4C on clinical outcomes. Disclosures All authors: No reported disclosures.

scholarly journals MICROBIOLOGICAL ANALYSIS OF URINARY TRACT INFECTIONS IN NORTH WEST ENGLAND AND THE IMPACT OF FLUID INTAKE ON THE INCIDENCE OF URINARY TRACT INFECTION

2018 ◽  
Author(s):  
Morkos Iskander
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract ◽  
Confidence Interval ◽  
Urinary Tract Infections ◽  
Fluid Intake ◽  
Microbiological Analysis ◽  
North West ◽  
Tract Infections ◽  
Resistance Rates ◽  
The Impact

BACKGROUNDManagement of urinary tract infections (UTIs) is compounded by the rising rates of resistance to antimicrobials. Public Health England highlighted areas of the North West of England as having suboptimal practices in the treatment of UTIs. This project aims to evaluate the resistance in Merseyside compared to the national rates, examine resistance in urological patients, review the rates of extended spectrum β-lactamase producing (ESBL) Escherichia coli over time, as well as consider increased fluid intake in the management of UTIs.METHODSUropathogen resistance rates in Merseyside from December 2012 to February 2013 were compared to those nationally reported, with sub analysis of resistance rates in urological patients. The rate of ESBL Escherichia coli in Cheshire was reviewed.MEDLINE, EMBASE, and unpublished literature using OpenGrey and OpenDOAR, were searched since inception to February 2015. Five studies recruiting 2182 patients were included in the analyses. Statistical analysis was performed using SPSS 22 and MedCalc 15.4.RESULTSResistance rates in Merseyside were not found to be higher than the national rates. Urological patients exhibited a statistically significant higher resistance (p&lt;0.0001). The relative risk of ESBL UTI in 2013 compared to 2005 was 8.18, 95% confidence interval (4.86 - 13.74). A preventative effect of increased fluid intake on the incidence of UTIs was found, odds ratio of UTI with increased fluid 0.27, 95% confidence interval (0.21 - 0.33).DISCUSSIONThe equivocal resistance rates in Merseyside and nationally suggests that modification of local practice is indicated. The higher resistance rate in urological patients highlights the need for separate empirical treatment.Increased fluid intake is appealing, due to the low cost and morbidity. Increase fluid intake has been demonstrated to be an effective method of reducing the rate of UTIs.

scholarly journals Impact of restriction of over-the-counter sales of antimicrobials on antimicrobial resistance in Escherichia coli from community-onset urinary tract infections in inner São Paulo State, Brazil

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259632
Author(s):  
Fernanda Saad Rodrigues ◽  
Helena Ribeiro Aiello Amat ◽  
Carlos Magno Castelo Branco Fortaleza
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract ◽  
Antimicrobial Resistance ◽  
Urinary Tract Infections ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Over The Counter ◽  
Tract Infections ◽  
The Impact ◽  
Community Onset

Background Antimicrobial resistance in community-associated infections is an increasing worldwide concern. In low-to-middle income countries, over-the-counter (OTC) sales of antimicrobials without medical prescription have been blamed for increasing consumption and resistance. We studied the impact of restriction of OTC sales of antimicrobials in Brazil (instituted in October 2010) on resistance trends of Escherichia coli from community-onset urinary tract infections. Methods We analyzed monthly resistance trend of Escherichia coli from community-onset urinary tract infections from 2005 through 2018. The data were submitted to interrupted time series analysis in both linear and Poisson regression models. Results We found impact on cefazolin (p<0.001) and amikacin (p<0.001) resistance as immediate impact of the intervention, and no beneficial impact on resistance to ciprofloxacin, ceftriaxone or sulfamethoxazole-trimethoprim. Conclusion At the present study, we found that OTC sales restriction did not generally impact on antimicrobial resistance.

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