In vitro susceptibility testing to antimicrobial agents of urinary tract infection bacteria in women: a 5-year retrospective study
Abstract
Introduction: The growing resistance rates of urinary pathogens represent a serious problem. The aim of this study was to analyze the etiology of community-acquired urinary tract infections, their first-line antimicrobial resistance and the presence of extended-spectrum beta-lactamases (ESBL) in gram negative bacilli. Methods: The study was conducted between January 2011 and December 2015 using data from the Microbiology Laboratory at the teaching hospital Hospital de Clínicas, which belongs to the National University of Asunción. Results: A total of 1957 urinary pathogens were found in women. Escherichia coli was the most commonly isolated bacterium (57%), followed by Klebsiella pneumoniae (11%) and Streptococcus agalactiae (2%), Staphylococcus saprophyticus (2%) and Proteus mirabilis (2%). The resistance rates of Escherichia coli were the following: to trimetoprim-sulfametoxazol, 43%; to ciprofloxacin, 32%; to ampicilin/sulbactam, 32%; to cefotaxime, 13 %; to piperacillin/tazobactam, 8%; nitrofurantoin, 2%, whereas it did not show resistance to meropenem during this period. Extended-spectrum beta-lactamases were produced by 11% of the E. coli isolates and 30% of the Klebsiella pneumoniae isolates. Conclusions: The resistance and cross-resistance rates found in this study pose a serious problem which compels the continuous assessment of the empirical therapy for urinary tract infections at this hospital.
References
Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369(9):840-51.
Foxman B, Barlow R, D’Arcy H, Gillespie B, Sobel JD. Urinary tract infection: self-reported incidence and associated costs. Ann Epidemiol. 2000;10(8):509-15.
Griebling TL. Urologic diseases in America project: trends in resource use for urinary tract infections in women. J Urol. 2005;173(4):1281-7.
Gupta K, Sahm DF, Mayfield D, Stamm WE. Antimicrobial resistance among uropathogens that cause community-acquired urinary tract infections in women: a nationwide analysis. Clin Infect Dis. 2001;33(1):89-94.
Gniadkowski M. Evolution and epidemiology of extended-spectrum beta-lactamases (ESBLs) and ESBL-producing microorganisms. Clin Microbiol Infect. 2001;7(11):597-608.
García-Hernández AM, García-Vázquez E, Hernández-Torres A, Ruiz J, Yagüe G, Herrero JA, et al. Bacteraemia due to Escherichia coli producing extended-spectrum beta-lactamases (ESBL): clinical relevance and today’s insights. Rev Esp Quimioter. 2011;24(2):57-66.
Procedimientos en microbiología clínica. Recomendaciones de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Emilia Cercenado y Rafael Cantón eds. SEIMC; 2003. [27 p.]
KASS EH. Bacteriuria and the diagnosis of infections of the urinary tract; with observations on the use of methionine as a urinary antiseptic.
JAMA Arch Intern Med. 1957;100(5):709-14.
Patel BA, Cockerill FR, Bradford PA, Eliopoulos GM, Hindler JA, Jenkins SG, et al. Methods for Dilution Antimicrobial Susceptibility Tests for
Bacteria that Grow Aerobically MO7-A10. 10th ed. Wayne, PA: Clinical and Laboratory Standards Institute; 2015. 87 p.
Schappert SM, Rechtsteiner EA. Ambulatory medical care utilization estimates for 2007. Vital Health Stat 13. 2011;(169):1-38.
Hooton TM. Clinical practice. Uncomplicated urinary tract infection. N Engl J Med. 2012;366(11):1028-37.
Foxman B, Brown P. Epidemiology of urinary tract infections: transmission and risk factors, incidence, and costs. Infect Dis Clin North Am. 2003;17(2):227-41.
Marston HD, Dixon DM, Knisely JM, Palmore TN, Fauci AS. Antimicrobial Resistance. JAMA. 2016;316(11):1193-204.
Castro-Orozco R, Barreto-Maya AC, Guzmán Álvarez H, Ortega-Quiroz, RJ, Benítez-Peña L. Patrones de resistencia antimicrobiana en uropatógenos gramnegativos aislados de pacientes ambulatorios y hospitalizados Cartagena, 2005-2008. Rev Salud Pública. 2010;12(6):1010-9.
Andreua A, Planells I. Etiología de la infección urinaria baja adquirida en la comunidad y resistencia de Escherichia coli a los antimicrobianos de primera línea. Estudio nacional multicéntrico. Med Clin. 2008;130(13):481-6.
Alósa JI. Epidemiología y etiología de la infección urinaria comunitaria. Sensibilidad antimicrobiana de los principales patógenos y significado clínico de la resistencia. Enferm Infecc Microbiol Clin. 2005;23(Supl 4):3-8.
Guevara PA, Machado BS, Manrique TE. Infecciones urinarias adquiridas en la comunidad: epidemiología, resistencia a los antimicrobianos y opciones terapéuticas. Kasmera 2011;39(2):87-97.
Rodríguez-Baño J, Navarro MD. Impacto de las BLEE en los tratamientos empíricos y las políticas antibióticas. Enferm Infecc Microbiol Clin. 2007;25(Supl. 2):54-9.
Díaz MA, Hernández JR, Martínez-Martínez L, Rodríguez-Baño J, Pacual A. Escherichia coli y Klebsiella pneumoniae productoras de betalactamasas de espectro extendido en hospitales españoles: segundo estudio multicéntrico (proyecto GEIH-BLEE 2006). Enferm Infecc Microbiol Clin. 2009;27(9):503-10.
Kuo KC, Shen YH, Hwang KP. Clinical implications and risk factors of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae infection in children: a case-control retrospective study in a medical center in southern Taiwan. J Microbiol Immunol Infect. 2007;40(3):248-54.
Cantón R, Oliver A, Coque TM, Varela Mdel C, Pérez-Díaz JC, Baquero F. Epidemiology of extended-spectrum beta-lactamase-producing Enterobacter isolates in a Spanish hospital during a 12-year period. J Clin Microbiol. 2002;40(4):1237-43.
Etienne M, Lefebvre E, Frebourg N, Hamel H, Pestel-Caron M, Caron F. Antibiotic treatment of acute uncomplicated cystitis based on rapid urine test and local epidemiology: lessons from a primary care series. BMC Infect Dis. 2014;14:137.
Sabuncu E, David J, Bernède-Bauduin C, Pépin S, Leroy M, Boëlle PY, et al. Significant reduction of antibiotic use in the community after a nationwide campaign in France, 2002-2007. PLoS Med. 2009;6(6):e1000084.
Kahlmeter G; ECO.SENS. An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project. J Antimicrob Chemother. 2003;51(1):69-76.
