Epidemiological and microbiological characteristics of uncomplicated urinary infections
DOI:
https://doi.org/10.31053/1853.0605.v77.n3.27610Keywords:
urinary tract infections, cystitis, pyelonephritis, anti-infective agentsAbstract
Introduction: Uncomplicated urinary tract infections(UC-UTI) represent a frequent reason for consultation. Most cases are empirically treated, but the antimicrobial susceptibility of the causative microorganisms has changed over the past years. The objectives of this study where to determine UC-UTI causative microorganism and their antimicrobial susceptibility profiles in adult women.
Methods: A prospective analytic study was conducted in two hospital in Córdoba, Argentina, between November/2016 and October/2017. From the identification of positive urine cultures, urinary tract infections (UTI) in women ≥18 years without risk factors for complicated UTIs were included, excluding asymptomatic bacteriurias.
Results: A total of 610 UC-UTI were identified and 62.6% of them in patients younger than 50 years; 73.3% of cases were cystitis, being more frequent in older women. Escherichia coli was isolated in 89.2% of UTI and negative coagulase Staphylococcus in 4.2%. As regards Escherichia coli, its resistance against ciprofloxacin was 18.8%; 4.4% against ceftriaxone and 1.8% against nitrofurantoin. There was an elevated resistance against ampicillin, trimethoprim–sulfamethoxazole and ampicillin–sulbactam.
Main conclusion: The most frequent isolated microorganism was Escherichia coli, consistent with global epidemiology. This microorganism showed less than 20% total resistance against ciprofloxacin, ceftriaxone and nitrofurantoin.
Downloads
References
Pigrau C. Infecciones del tracto urinario nosocomiales [Nocosomial urinary tract infections]. Enferm Infecc Microbiol Clin. 2013 Nov;31(9):614-24. Spanish. doi: 10.1016/j.eimc.2012.11.015.
Orrego-Marin CP, Henao-Mejia CP, Cardona-Arias JA. Prevalencia de infección urinaria, uropatógenos y perfil de susceptibilidad antimicrobiana. Acta Med Colomb. 2014 Oct;39(4):352-358.
Hooton TM. Clinical practice. Uncomplicated urinary tract infection. N Engl J Med. 2012 Mar 15;366(11):1028-37. doi: 10.1056/NEJMcp1104429.
Detweiler K, Mayers D, Fletcher SG. Bacteruria and Urinary Tract Infections in the Elderly. Urol Clin North Am. 2015 Nov;42(4):561-8. doi: 10.1016/j.ucl.2015.07.002.
Gharbi M, Drysdale JH, Lishman H, Goudie R, Molokhia M, Johnson AP, Holmes AH, Aylin P. Antibiotic management of urinary tract infection in elderly patients in primary care and its association with bloodstream infections and all cause mortality: population based cohort study. BMJ. 2019 Feb 27;364:l525. doi: 10.1136/bmj.l525.
Kamenski G, Wagner G, Zehetmayer S, Fink W, Spiegel W, Hoffmann K. Antibacterial resistances in uncomplicated urinary tract infections in women: ECO·SENS II data from primary health care in Austria. BMC Infect Dis. 2012 Sep 18;12:222. doi: 10.1186/1471-2334-12-222.
Palou J, Pigrau C, Molina I, Ledesma JM, Angulo J; Grupo Colaborador Español del Estudio ARESC. Etiología y sensibilidad de los uropatógenos identificados en infecciones urinarias bajas no complicadas de la mujer (Estudio ARESC): implicaciones en la terapia empírica [Etiology and sensitivity of uropathogens identified in uncomplicated lower urinary tract infections in women (ARESC Study): implications on empiric therapy]. Med Clin (Barc). 2011 Jan 15;136(1):1-7. Spanish. doi: 10.1016/j.medcli.2010.02.042.
Khawcharoenporn T, Vasoo S, Singh K. Urinary Tract Infections due to Multidrug-Resistant Enterobacteriaceae: Prevalence and Risk Factors in a Chicago Emergency Department. Emerg Med Int. 2013;2013:258517. doi: 10.1155/2013/258517.
Walker E, Lyman A, Gupta K, Mahoney MV, Snyder GM, Hirsch EB. Clinical Management of an Increasing Threat: Outpatient Urinary Tract Infections Due to Multidrug-Resistant Uropathogens. Clin Infect Dis. 2016 Oct 1;63(7):960-5. doi: 10.1093/cid/ciw396.
Seija V, Frantchez V, Ventura V, Pintos M, González M. Factores asociados al desarrollo de infección urinaria de origen comunitario causada por Escherichia coli resistente a fluoroquinolonas. Rev. chil. infectol. 2014 Ago;31(4): 400-405.
Bertoni G, Pessacq P, Guerrini MG, Calmaggi A, Barberis F, Jorge L, Bonvehi P, Temporiti E, Herrera F, Obed M, Alcorta B, Farías J, Mykietiuk A. Etiología y resistencia a antimicrobianos de la infección no complicada del tracto urinario [Etiology and antimicrobial resistance of uncomplicated urinary tract infections]. Medicina (B Aires). 2017;77(4):304-308.
Lopardo G, Fridman D, Gonzalez Arzac M, Calmaggi A, Smayevsky J, Podesta O, Clara L. Uropathogen resistance: are laboratory-generated data reliable enough? J Chemother. 2007 Feb;19(1):33-7. doi: 10.1179/joc.2007.19.1.33.
Baenas DF, Palmieri HJ, Alomar JM, Álvarez Garzón JH, Berenguer L, Vilaró M, Albertini RA. Infección urinaria no complicada en mujeres: etiología y resistencia a antimicrobianos [Uncomplicated urinary tract infection in women: etiology and antimicrobial resistance]. Rev Fac Cien Med Univ Nac Cordoba. 2017 Sep 10;74(3):180-185. Spanish. doi: 10.31053/1853.0605.v74.n3.10208.
Control CfD, Prevention. Urinary tract infection (catheter-associated urinary tract infection [CAUTI] and non-catheter-associated urinary tract infection [UTI]) and other urinary system infection [USI]) events. Centers for Disease Control and Prevention, Atlanta, GA. En: http://www.cdc gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent pdf 2015. Consultado Julio 2019.
Hooton TM, Stamm WE. Diagnosis and treatment of uncomplicated urinary tract infection. Infect Dis Clin North Am. 1997 Sep;11(3):551-81. doi: 10.1016/s0891-5520(05)70373-1.
Scott RD II. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Division of Healthcare Quality Promotion National Center for Preparedness, Detection, and Control of Infectious Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention. 2009. En: http://www.cdc.gov/hai/ pdfs/hai/scott_costpaper.pdf. Consultado el 2 de Julio 2019.
Mody L, Juthani-Mehta M. Urinary tract infections in older women: a clinical review. JAMA. 2014 Feb 26;311(8):844-54. doi: 10.1001/jama.2014.303.
Beveridge LA, Davey PG, Phillips G, McMurdo ME. Optimal management of urinary tract infections in older people. Clin Interv Aging. 2011;6:173-80. doi: 10.2147/CIA.S13423.
Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE; Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011 Mar 1;52(5):e103-20. doi: 10.1093/cid/ciq257.
Tal S, Guller V, Levi S, Bardenstein R, Berger D, Gurevich I, Gurevich A. Profile and prognosis of febrile elderly patients with bacteremic urinary tract infection. J Infect. 2005 May;50(4):296-305. doi: 10.1016/j.jinf.2004.04.004.
Czaja CA, Scholes D, Hooton TM, Stamm WE. Population-based epidemiologic analysis of acute pyelonephritis. Clin Infect Dis. 2007 Aug 1;45(3):273-80. doi: 10.1086/519268.
Zhanel GG, Hisanaga TL, Laing NM, DeCorby MR, Nichol KA, Palatnik LP, Johnson J, Noreddin A, Harding GK, Nicolle LE, Hoban DJ; NAUTICA Group. Antibiotic resistance in outpatient urinary isolates: final results from the North American Urinary Tract Infection Collaborative Alliance (NAUTICA). Int J Antimicrob Agents. 2005 Nov;26(5):380-8. doi: 10.1016/j.ijantimicag.2005.08.003.
Andreu A, Alós JI, Gobernado M, Marco F, de la Rosa M, García-Rodríguez JA; Grupo Cooperativo Español para el Estudio de la Sensibilidad Antimicrobiana de los Patógenos Urinarios. Etiología y sensibilidad a los antimicrobianos de los uropatógenos causantes de la infección urinaria baja adquirida en la comunidad. Estudio nacional multicéntrico [Etiology and antimicrobial susceptibility among uropathogens causing community-acquired lower urinary tract infections: a nationwide surveillance study]. Enferm Infecc Microbiol Clin. 2005 Jan;23(1):4-9. Spanish. doi: 10.1157/13070401.
Kahlmeter G. Prevalence and antimicrobial susceptibility of pathogens in uncomplicated cystitis in Europe. The ECO.SENS study. Int J Antimicrob Agents. 2003 Oct;22 Suppl 2:49-52. doi: 10.1016/s0924-8579(03)00229-2.
Naber KG, Schito G, Botto H, Palou J, Mazzei T. Surveillance study in Europe and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): implications for empiric therapy. Eur Urol. 2008 Nov;54(5):1164-75. doi: 10.1016/j.eururo.2008.05.010.
Sanchez GV, Master RN, Karlowsky JA, Bordon JM. In vitro antimicrobial resistance of urinary Escherichia coli isolates among U.S. outpatients from 2000 to 2010. Antimicrob Agents Chemother. 2012 Apr;56(4):2181-3. doi: 10.1128/AAC.06060-11.
Swami SK, Liesinger JT, Shah N, Baddour LM, Banerjee R. Incidence of antibiotic-resistant Escherichia coli bacteriuria according to age and location of onset: a population-based study from Olmsted County, Minnesota. Mayo Clin Proc. 2012 Aug;87(8):753-9. doi: 10.1016/j.mayocp.2012.02.025.
World Health Organization. e selection and use of essential medicines: report of the WHO Expert Committee, 2017 (including the 20th WHO Model List of Essential Medicines and the 6th Model List of Essential Medicines for Children). World Health Organization; 2017. Disponible en: https://www.who.int/medicines/publications/essentialmedicines/en/. Consultado el Consultado el 2 de Julio 2019.
Talan DA, Krishnadasan A, Abrahamian FM, Stamm WE, Moran GJ; EMERGEncy ID NET Study Group. Prevalence and risk factor analysis of trimethoprim-sulfamethoxazole- and fluoroquinolone-resistant Escherichia coli infection among emergency department patients with pyelonephritis. Clin Infect Dis. 2008 Nov 1;47(9):1150-8. doi: 10.1086/592250.
Hooton TM, Besser R, Foxman B, Fritsche TR, Nicolle LE. Acute uncomplicated cystitis in an era of increasing antibiotic resistance: a proposed approach to empirical therapy. Clin Infect Dis. 2004 Jul 1;39(1):75-80. doi: 10.1086/422145.
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 Universidad Nacional de Córdoba
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The Faculty of Medical Sciences Journal (RFCM) subscribes to the Open Access policy and does not charge authors fees for publishing, nor does it charge readers fees for accessing published articles (APC).
