Antibacterial resistances in uncomplicated urinary tract infections in women: ECO·SENS II data from primary health care in Austria

Abstract

BackgroundUncomplicated urinary tract infections (UTI) are a frequent reason for consultation of women in primary health care. To avoid therapy failure and development of resistances, the choice of an antibiotic should be based on the knowledge of recent local resistance data but these data are scarce for the Austrian primary health care sector. Within the context of the ECO·SENS II study it was the aim to obtain appropriate and relevant local resistance data and describe the changes in the resistance pattern in comparison to the ECO·SENS study.Methods23 GPs from different parts of Austria participated in the study between July 2007 and November 2008. According to the defined inclusion- and exclusion criteria female patients with symptoms of an uncomplicated UTI were included and a midstream urine sample was collected. In case of significant bacteriuria susceptibility testing of E. coli against 14 antibiotics was performed. Descriptive statistical methods were used.ResultsIn 313 patients included in the study, a total of 147 E. coli isolates (47%) were detected and tested. The resistance rates were in %: Mecillinam (0.0), nitrofurantoin (0.7), fosfomycin trometamol (0.7), gentamycin (1.4), cefotaxime (2.7), ceftazidime (2.7), Cephadroxil (4.1) and ciprofloxacin (4.1). Higher resistance rates were found in amoxicillin/clavulanic acid (8.9), nalidixic acid (9.6), trimethoprim/sulphamethoxazole (14.4), trimethoprim (15.8), sulphamethoxazole (21.2) and ampicillin (28.8). Additionally, the comparison of these results with the results of the ECO·SENS study demonstrated an increase in resistance rates of ampicillin, amoxicillin/clavulanic acid, nalidixic acid and ciprofloxacin.ConclusionsThe resistance data for E. coli in uncomplicated UTIs in women gained by this study are the most recent data for this disease in Austria at the moment. The increased resistance rates of amoxicillin/clavulanic acid, ciprofloxacin and nalidixic acid should be respected when choosing an appropriate antibiotic for uncomplicated UTIs. The use of ampicillin, sulphamethoxazole, trimethoprim and trimethoprim/sulphametoxazole in uncomplicated UTIs in women should be questioned at all. The findings of this study should result in a regular surveillance system of resistances emerging in the ambulatory sector designed after the model of the EARS-Net.

Antimicrobial susceptibilities of Escherichia coli isolates as agents of community-acquired urinary tract infection (2008-2014)

“…In European countries similar rates have been reported. [13] Şenol et al [19] compared fosfomycin, and carbapenem in the treatment of complicated lower UTIs caused by E. coli, and despite comparable clinical, and microbiological success rates, the authors reported favourable cost-effectiveness with fosfomycin treatment. Fosfomycin appears to be an effective alternative in the current treatment of community-acquired urinary system infections thanks to ease of single dose applications, better patient compliance, lower complication rates, and its safe use in children, and pregnants.…”

“…4 percent. [13] In a study performed by Kashef et al [6] in Iran resistance rate to TMP-SXT was detected as 61.8 percent. In our country, resistance rates of E. coli strains isolated from the patients with community-acquired urinary system infection to quinolones varied between 17, and 45 percent.…”

“…In recent years increase in the ESBL content of E. coli which is a microbial agent of communityacquired urinary system infections, and transport of qnr genes on these plasmids might be the reasons for increased quinolone resistance. [13] Besides, in our country nonprescription widespread use of ciprofloxacin which has an increased bioavailability, higher urinary concentration, and broader antibacterial spectrum is another reason for increased resistance. In conclusion, rapidly increasing numbers of quinolone-resistant E. coli isolates suggest that quinolones are not an appropriate choice in the empirical treatment of UTI which obviates the need to use quinolones before antibiotic susceptibility test results are obtained.…”

“…Resistance rates to amikacin were detected as 0.7, and 9.5% in studies conducted by Doğru et al [3] , and Yılmaz et al [10] , respectively. In some studies performed abroad resistance rates to gentamycin ranged between 1.3% (ECO.SENS [13] ) and 63.4% (Gupta et al [5] India). Huang et al [23] could not detect antimicrobial resistance against amikacin, contrary to the findings of Sharma et al [24] (33.3%).…”

Detection of virulence genes, phylogenetic group and antibiotic resistance of uropathogenic Escherichia coli in Mongolia

“…Several studies have shown that antibiotic resistance in UPEC is increasing year by year [14][15][16][17]. Cephalosporins, fluoroquinolones, and trimethoprim-sulfamethoxazole are often used to treat community and hospital infections caused by E. coli and resistance to these agents is responsible for delays of inappropriate therapy with subsequently increasing morbidity and mortality [18].…”