Appropriateness of Antibiotic Prescriptions for Urinary Tract Infections

Chardavoyne, Paige C.; Kasmire, Kathryn E.

doi:10.5811/westjem.2020.1.45944

Cited by 37 publications

(38 citation statements)

References 31 publications

(35 reference statements)

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“…Thirty percent of primary care antibiotic prescriptions were inadequate in a report from the United States [ 19 ]. Appropriate antibiotic treatment was reported in 68% of adult cystitis cases and only 46% of pyelonephritis cases in another survey [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Current antibiotic resistance patterns of rare uropathogens: survey from Central European Urology Department 2011–2019

2021

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Background While the resistance rates of commonly detected uropathogens are well described, those of less frequent Gram-negative uropathogenic bacteria have seldom been reported. The aim of this study was to examine the resistance rates of less frequent uropathogenic Gram-negatives in a population of patients treated in a Department of Urology of a tertiary referral centre in Central Europe over a period of 9 years. Methods Data on all positive urine samples from urological in- and out-patients were extracted form the Department of Clinical Microbiology database from 2011 to 2019. Numbers of susceptible and resistant isolates per year were calculated for these uropathogens: Acinetobacter spp. (n = 74), Citrobacter spp. (n = 60), Enterobacter spp. (n = 250), Morganella morganii (n = 194), Providencia spp. (n = 53), Serratia spp. (n = 82) and Stenotrophomonas maltophilia (n = 27). Antimicrobial agents selected for the survey included: ampicillin, amoxicillin/clavulanic acid, piperacillin/tazobactam; cefuroxime, cefotaxime, ceftazidime and cefepime; ciprofloxacin and ofloxacin; gentamicin and amikacin; ertapenem, meropenem and imipenem; trimethoprim-sulfamethoxazole (co-trimoxazole), nitrofurantoin and colistin. Results Penicillin derivatives have generally poor effect except piperacillin/tazobactam. Cefuroxime is not efficient unlike cefotaxime (except against Acinetobacter spp. and S. maltophilia). Susceptibility to fluoroquinolones is limited. Amikacin is somewhat more efficient than gentamicine but susceptibilities for both safely exceed 80%. Nitrofurantoin shows virtually no efficiency. Cotrimoxazole acts well against Citrobacter spp., Serratia spp. and it is the treatment of choice for S. maltophilia UTIs. Among carbapenems, ertapenem was less efficient than meropenem and imipenem except for S. maltophilia whose isolates were mostly not suceptible to any carbapenems. Conclusions Uropathogenic microorganisms covered in this report are noteworthy for their frequently multi-drug resistant phenotypes. Knowledge of resistance patterns helps clinicians choose the right empirical antibiotic treatment when the taxonomical assignment of the isolate is known but sensitivity results are pending.

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Section: Introductionmentioning

confidence: 99%

Current antibiotic resistance patterns of rare uropathogens: survey from Central European Urology Department 2011–2019

2021

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“…According to a survey from the United States, 30% of primary care antibiotic prescriptions were classified as inadequate [ 23 ]. Chardavoyne et al reported appropriate antibiotic treatment in 68% of adult cystitis cases and 46% of pyelonephritis cases [ 24 ]. Treatment in the absence of infection is common [ 24 ] and although not recommended in international guidelines for lower UTI management, fluoroquinolones are frequently prescribed [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Current Antibiotic Resistance Trends of Uropathogens in Central Europe: Survey from a Tertiary Hospital Urology Department 2011–2019

2020

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Monitoring of pathogen resistance profiles is necessary to guide empirical antibiotic therapy before culture and sensitivity results become available. The aim of this study was to describe current antibiotic resistance patterns of five most frequent causative uropathogens in a Department of Urology of a tertiary referral centre in Central Europe over a period of nine years. The Hospital Department of Clinical Microbiology database was used to extract data on all positive urine samples from inpatients in the Department of Urology between 2011 and 2019. Numbers of susceptible and resistant isolates per year were calculated for five most frequent uropathogens: Escherichia coli, Enterococcus spp., Klebsiella spp., Pseudomonas aeruginosa, and Proteus spp. Antimicrobial agents selected for the survey included: ampicillin, amoxicillin/clavulanic acid, piperacillin/tazobactam; cefuroxime, cefotaxime, ceftazidime and cefepime; ciprofloxacin and ofloxacin; gentamicin and amikacin; ertapenem, meropenem and imipenem; trimethoprim-sulfamethoxazole (co-trimoxazole), nitrofurantoin, colistin, and vancomycin. High resistance rates of Gram-negative uropathogens were demonstrated to most common antimicrobials, with statistically significant increasing or decreasing trends in some cases. No carbapenem-resistant Enterobacteriaceae were isolated. Vancomycin-resistant Enterococcus spp. strains were rare in our population.

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“…Highlighting this finding, due to the high incidence of ASB in elderly residents of long-term care facilities, one study found that routine submission of urinary cultures was almost arbitrary and urine culture and treatment did not have any appreciable functional improvement in resident activities of daily living (ADL) score [34]. However, despite these recommendations, frequent overtreatment of catheter-and non-catheter-associated ASB continue to occur with increases particularly notable in the ambulatory and telemedicine setting [35][36][37]. Concurrently, unnecessarily prolonged duration of antibiotics are often prescribed, occurring in over 60% of cases in some series [37].…”

Section: Introductionmentioning

confidence: 99%

Applying Diagnostic Stewardship to Proactively Optimize the Management of Urinary Tract Infections

Morado

Wong

2022

Antibiotics

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A urinary tract infection is amongst the most common bacterial infections in the community and hospital setting and accounts for an estimated 1.6 to 2.14 billion in national healthcare expenditure. Despite its financial impact, the diagnosis is challenging with urine cultures and antibiotics often inappropriately ordered for non-specific symptoms or asymptomatic bacteriuria. In an attempt to limit unnecessary laboratory testing and antibiotic overutilization, several diagnostic stewardship initiatives have been described in the literature. We conducted a systematic review with a focus on the application of molecular and microbiological diagnostics, clinical decision support, and implementation of diagnostic stewardship initiatives for urinary tract infections. The most successful strategies utilized a bundled, multidisciplinary, and multimodal approach involving nursing and physician education and feedback, indication requirements for urine culture orders, reflex urine culture programs, cascade reporting, and urinary antibiograms. Implementation of antibiotic stewardship initiatives across the various phases of laboratory testing (i.e., pre-analytic, analytic, post-analytic) can effectively decrease the rate of inappropriate ordering of urine cultures and antibiotic prescribing in patients with clinically ambiguous symptoms that are unlikely to be a urinary tract infection.

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Appropriateness of Antibiotic Prescriptions for Urinary Tract Infections

Cited by 37 publications

References 31 publications

Current antibiotic resistance patterns of rare uropathogens: survey from Central European Urology Department 2011–2019

Current antibiotic resistance patterns of rare uropathogens: survey from Central European Urology Department 2011–2019

Current Antibiotic Resistance Trends of Uropathogens in Central Europe: Survey from a Tertiary Hospital Urology Department 2011–2019

Applying Diagnostic Stewardship to Proactively Optimize the Management of Urinary Tract Infections

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