Antimicrobial resistance patterns in outpatient urinary tract infections - the constant need to revise prescribing habits

Antimicrobial susceptibility of organisms causing community-acquired urinary tract infections in Gauteng Province, South Africa

“…the development of further bacterial antimicrobial resistance over time due to selection pressure. [10] Maartens and Oliver [11] undertook a similar microbiological study of community-acquired UTI pathogens to determine the prevalence of antimicrobial resistance in Cape Town, SA. Their study, performed over a decade ago with different methodology, reported an almost identical prevalence of resistance to trimethoprim/sulphamethoxazole (47.3%), but a relatively low level of resistance to ciprofloxacin (2.8%).…”

“…This differential susceptibility of cephalosporins on the basis of Gramstain morphotype has been described previously in SA. [10] Although cefixime, an oral third-generation cephalosporin, may be used as a single 400 mg dose for the treatment of UTI, it is presently only available for the treatment of gonorrhoea in the SA public sector. Oral cephalosporins have the advantage of being safe to prescribe in pregnancy and induce few side-effects.…”

Relationship between Urinary Tract Infection Categorization and Pathogens’ Antimicrobial Susceptibilities

“…Maki and Tambyah [21] stated that catheterized UTI should be dealt with as a different type of UTI and our data likewise revealed significantly less susceptibility to LVFX in E. faecalis in catheterized UTI than non-catheterized UTI (p = 0.0153) as mentioned above. Moreover, recent reports of complicated UTI in general show less antibiotic susceptibility than uncomplicated UTI [22] . Our data demonstrated that the susceptibilities to GM (p = 0.0293) and LVFX (p = 0.0453) in E. coli , and to LVFX in E. faecalis (p = 0.0391) were significantly lower in complicated than in uncomplicated UTI.…”

Misconceptions in interpretation of antimicrobial resistance data

“…In their article on urinary tract infections among outpatient attendees in Bloemfontein, Bosch et al 1 provide no details of the type or quality of urine samples submitted and do not indicate quantitative counts, which are standard methods developed to increase accuracy in the diagnosis of urinary tract infections. No information about clinical symptoms is provided, despite asymptomatic bacteriuria requiring treatment only in certain specified circumstances, such as pregnancy or before urological surgery.…”

“…To the Editor: Recent articles [1][2][3] indicate the increasing awareness of antimicrobial resistance and the need for antibiotic stewardship, but also illustrate misconceptions that adversely affect patient management and antibiotic prescribing.…”