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

Abstract

Objective: Urinary tract infections (UTIs) are among the most frequently seen community-acquired infections worldwide. E. coli causes 90% of urinary system infections. To guide the empirical therapy, the resistance pattern of E. coli responsible for community-acquired UTI was evaluated throughout a seven-year period in this study. Material and methods:The urine cultures of patients with urinary tract infections admitted to outpatient clinics between 1 st January 2008 and 31 st December 2014 were analyzed. Presence of ≥10 5 colony-forming units/mL in urine culture media was considered as significant for UTI. Isolated bacteria were identified by standard laboratory techniques or automated system VITEK2 (BioMerieux, France) and BD PhoenixTM 100 (BD, USA), as required. Antibiotic susceptibility testing was performed by Kirby-Bauer disk diffusion method using Clinical Laboratory Standard Institute (CLSI) criteria.Results: A total of 13281 uropathogens were isolated. Overall E. coli accounted for 8975 (67%) of all isolates. Resistance rates of E. coli to antimicrobial agents was demonstrated to be as follows: ampicillin 66.9%, cefazolin 30.9%, cefuroxime 30.9%, ceftazidime 14.9%, cefotaxime 28%, cefepime 12%, amoxicillin-clavulanic acid 36.9%, trimethoprim-sulfamethoxazole (TMP-SXT) 20%, ciprofloxacin 49.9%, amikacin 0.3%, gentamycin 24%, nitrofurantoin 0.9%, and fosfomycin 4.3%. There was no resistance to imipenem nor meropenem. The frequency of ESBL-producing E. coli strains was 24%. Conclusion:It is concluded that fosfomycin and nitrofurantoin are appropriate empirical therapy for community-acquired UTI empirical therapy, but the fluoroquinolones and the TMP-SXT shall not be used in the emprical treatment of UTI at this stage. In conclusion, as resistance rates show regional differences, it is necessary to regularly examine regional resistance rates to determine the appropriate empiric antibiotic treatment and national antibiotic usage policies must be reorganized according to data obtained from these studies.

Retrospective analysis of fosfomycin combinational therapy for sepsis caused by carbapenem-resistant Klebsiella pneumoniae

“…This agent is well tolerated and has a few side effects. It has an increased role as a therapeutic option against multidrug-resistant Enterobacteriaceae (19,20,22,23). Cumulative susceptibility of fosfomycin against ESBL positive Enterobacteriaceae is reported as 87.7% according to CLSI criteria (24).…”

“…Cumulative susceptibility of fosfomycin against ESBL positive Enterobacteriaceae is reported as 87.7% according to CLSI criteria (24). However, lower susceptibility rates (<50%) was showed in some studies, and in a study this agent was shown to be active against only 50% of Klebsiella (22,25).…”

Clinical effect of discordance in empirical treatment of cases with urinary tract infection accompanied by bacteremia

“…[4,5,16] Based on the 2013 data released by National Antimicrobial Resistance Surveillance System (UAMDS) in Turkey, ESBL-producing strains were detected in 44.9% of E. coli, and 49.9% of K. pneumoniae isolates. In our study the most frequent microbial agent was E. coli (63.1%).…”

“…[4] In recent studies, extended-spectrum beta-lactamase (ESBL) producing strains have been detected in E.coli isolates at a higher frequency, both in the world, and in our country. [5,6] In the treatment of the infections caused by ESBL -producing strains, inadequacy of the antibiotics other than carbanepems in addition to their higher mortality rates have been also indicated. [7] However, together with increased resistance of members of Enterobacteriaceae family, and P. aeruginosa isolates against carbapenems, ways of using carbapenems at a lesser frequency have been investigated.…”

Can Sequential Use of Oral Antibiotics be an Alternative in Patients with Urosepsis Caused by ESBL-Producing Escherichia coli and Klebsiella pneumoniae?

“…Kimi zaman klinik gereklilik nedeniyle 21 güne kadar uzayabilmektedir (6) . GSBL üreten Gram negatif enterik çomakların hem toplum kaynaklı hem de hastane kaynaklı enfeksiyonlarındaki artış, aşırı karbapenem kullanımına neden olmaktadır ve buna bağlı olarak karbapenemlere dirençli Gram negatif enterik çomakların sıklığında artış saptanmaktadır (7)(8)(9) . Ayrıca ülkemizde karbapenemlerin yalnızca hastanede kullanımının ruhsatlı olması, hastanede yatış süresinin uzamasına ve maliyet artışına neden olmaktadır.…”