Escherichia coli resistance, treatment patterns and clinical outcomes among females with uUTI in Germany: a retrospective physician-based chart review study

Abstract

Real-world data were collected to examine antimicrobial resistance (AMR) prevalence, treatment patterns, and clinical outcomes among female patients with uncomplicated urinary tract infection (uUTI) in Germany. Data were from a retrospective physician-based chart review completed by physicians treating patients with uUTI. Non-pregnant women aged ≥ 12 years, with a uUTI diagnosis, an E. coli-positive urine culture between January 2017–December 2019, and susceptibility test results for ≥ 4 drug classes were eligible. Patients were stratified into three cohorts by drug class susceptibility: susceptible to all (SUS), resistant to one or two drug classes (DR1/2), and resistant to ≥ 3 (MDR) drug classes tested. Among 386 eligible patients [SUS (67.1%); DR1/2 (29.0%); MDR (3.9%)], AMR prevalence was highest for FMIs (18.3%) and lowest for fluoroquinolones (5.2%). The most prescribed drugs were fosfomycin in SUS (44.0%), DR1/2 (41.4%), and fluoroquinolones in MDR (40.0%). Treatment for uUTI failed for 8.8% of patients; failure was more likely in MDR versus SUS [adjusted odds ratio [95% CI] = 4.21 [1.14–1.50]; P = 0.031); incidence of recurrent infection in the 6-months post-index period was higher in DR1/2 versus SUS. These findings may have implications for empiric prescribing, suggesting an unmet need for new treatments.

Update on Urinary Tract Infection Antibiotic Resistance—A Retrospective Study in Females in Conjunction with Clinical Data

“…Also, it noted very low resistance to nitrofurantoin (<1%), similar to the current study (1.37%) [47]. Another large study on the female population published this year and developed in Germany that followed the bacterial resistance of Escherichia coli in UTIs [48] pointed out the highest resistance to trimethoprim-suflamethoxazole (18.3%), followed by mecillinam (12.4%) and cephalosporins (cefpodoxime, 9.5%). Compared to the present study, in which the resistance to fluoroquinolones is very high, the German study showed very low resistances regarding this pharmaceutical group (5.2%); however, it admitted that the most prescribed antibiotics in this population group are fosfomycin and fluoroquinolones.…”

Antimicrobial Susceptibilities of Clinical Bacterial Isolates from Urinary Tract Infections to Fosfomycin and Comparator Antibiotics Determined by Agar Dilution Method and Automated Micro Broth Dilution

“…Clinical studies have compared the efficacy of fosfomycin to comparator UTI first-line drugs and have shown it to be a valuable alternative option (24,42,(44)(45)(46)(47). In a study investigating treatment patterns and clinical outcomes among females with uncomplicated bUTI in Germany that were empirically treated, the incidence of recurrent infection in the 6-month post-index period was higher in patients with E. coli that were resistant to one of the first-line treatments (48). With antimicrobial susceptibility rates and epidemiology of bUTI pathogens different and rapidly changing from one region to another, robust research with well-designed double-blinded RCTs investigating the use of fosfomycin as a combination therapy for the treatment of bUTIs, especially in patients with recurrent infections, is warranted.…”

Treatment Patterns and Adherence to Guidelines for Uncomplicated Urinary Tract Infection in Germany: A Retrospective Cohort Study

“…Data on treatment patterns for uUTIs in the European Union are scarce; however, one study has analyzed uUTI treatment patterns in Germany using real-world data [ 9 ]. Our study used insurance claims data to evaluate adherence to antibiotic prescribing for female patients with uUTIs in Germany per German uUTI guidelines [ 10 , 11 ].…”