Antimicrobial resistance in uropathogens and appropriateness of empirical treatment: a population-based surveillance study in Indonesia

Abstract

Objectives: Urinary tract infections (UTIs) are a common reason for empirical treatment with broad-spectrum antibiotics worldwide. However, population-based antimicrobial resistance (AMR) prevalence data to inform empirical treatment choice are lacking in many regions, because of limited surveillance capacity. We aimed to assess the prevalence of AMR to commonly used antimicrobial drugs in Escherichia coli and Klebsiella pneumoniae isolated from patients with community- or healthcare-associated UTIs on two islands of Indonesia. Methods: We performed a cross-sectional patient-based study in public and private hospitals and clinics between April 2014 and May 2015. We screened patients for symptoms of UTIs and through urine dipstick analysis. Urine culture and susceptibility testing were supported by telemicrobiology and interactive virtual laboratory rounds. Surveillance data were entered in forms on mobile phones. Results: Of 3424 eligible patients, 3380 (98.7%) were included in the final analysis, and yielded 840 positive cultures and antimicrobial susceptibility data for 657 E. coli and K. pneumoniae isolates. Fosfomycin was the single oral treatment option with resistance prevalence <20% in both E. coli and K. pneumoniae in community settings. Tigecycline and fosfomycin were the only options for treatment of catheter-associated UTIs with resistance prevalence <20%, whilst the prevalence of resistance to meropenem was 21.3% in K. pneumoniae. Conclusions: Patient-based surveillance of AMR in E. coli and K. pneumoniae causing UTIs indicates that resistance to the commonly available empirical treatment options is high in Indonesia. Smart AMR surveillance strategies are needed to inform policy makers and to guide interventions.

Laboratory-based versus population-based surveillance of antimicrobial resistance to inform empirical treatment for suspected urinary tract infection in Indonesia

“…Population-based AMR surveillance data were collected in a cross-sectional survey of AMR in E. coli and K. pneumoniae isolated from urine samples from patients suspected of a UTI, carried out from 1 April 2014 until 31 May 2015, as described previously [7]. In brief, consecutive patients attending four public and private outpatient clinics of urology and obstetrics/ gynaecology, or all patients who were admitted to the internal medicine-, surgery-, obstetrics/ gynaecology-, or neurology wards, were actively screened for the presence of symptoms of UTI, according to CDC definitions [9].…”

“…Moreover, AST reports are not aggregated at national level, due to difficulties in networking of hospitals, district laboratories and research centers [1,6]. We previously performed a population-based survey of AMR in Escherichia coli and Klebsiella pneumoniae isolated from patients with symptoms of urinary tract infection (UTI) in Indonesia [7]. Comparing these results to routine laboratory results obtained in the same setting and period allowed us to assess the magnitude of bias of laboratory-based surveillance.…”

Anti-Microbial Resistance in Agents Causing Urinary Tract Infections

“…It was also stated that 40.5% strains of Klebsiella were resistant to Gentamicin, 5.4% to Carbepenams, 78.4% to Levofloxacin, 83.8% to Nitrofurantoin while according to our observations, resistance rates were 43.8%, 5.9%, 88.9% and 70.6% respectively. (14)…”

Metal-Organic Framework Encapsulated Whole-Cell Vaccines Enhance Humoral Immunity against Bacterial Infection

“…AMR is so widespread that treatment of even routine bacterial infections, such as urinary tract infection (UTI), has become problematic. 1 UTIs are the second most common adult bacterial infection worldwide, with ~80% of all community-acquired UTIs caused by uropathogenic Escherichia coli (UPEC). 2,3 Indeed, half of all women will develop a UTI in their lifetime, and more than 40% of these individuals will experience a recurrent infection.…”