Revival of older antibiotics for the therapy of urinary tract infections: old, but gold Part 1: Antimicrobial susceptibility of extended-spectrum β-lactamase-producing and AmpC β-lactamase-producing Escherichia coli isolates

Abstract

The most prevalent causative agent of urinary tract infections (UTIs) is uropathogenic Escherichia coli, corresponding to 50-90% of uncomplicated, around 30-70% of nosocomial UTIs. There has been renewed interest toward the clinical value of older, nonb-lactam antibiotics (including fosfomycin, nitrofurantoin, trimethoprim/sulfamethoxazole) used for the therapy UTIs caused by drug resistant bacteria, including AmpCproducing or an extended-spectrum b-lactamases (ESBL)-producing Gram-negative strains. The aim of our study was to determine the resistance levels of AmpC-producing or ESBL-producing E. coli strains, against the relevant ancillary antibiotics that may be used in the treatment of UTIs. Isolates were collected from the time period between 1 January 2013 and 31 December 2017 from patients with uncomplicated and complicated UTIs treated at the Albert Szent-Gy€ orgyi Clinical Center (Szeged, Hungary). Antibiotic susceptibility testing was carried out using the Kirby-Bauer method. Out of the 10 837 isolates, n ¼ 2010 (18.5%; 402 AE 43 isolates/year) E. coli isolates were either AmpC-producers or ESBL-producers, whereas n ¼ 1398 (12.8%; 280 AE 12 isolates/year) produced the two groups of b-lactamases simultaneously. The highest levels of coresistance overall was seen for ciprofloxacin (68.2%), followed by trimethoprimsulfamethoxazole (58.6%), whereas resistance levels were lower in regards to gentamicin (39.0%), fosfomycin (20.3%) and considerably lower for nitrofurantoin (11.1%). Our analysis of urine-specific AmpC-producing or ESBL-producing E. coli isolates is a useful addition to the literature, as clinicians may rely on this data for empiric antibiotic selection for UTI.

Clinical Efficacy and Cost Analysis of Antibiotics for Treatment of Uncomplicated Urinary Tract Infections in the Emergency Department of a Tertiary Hospital in Saudi Arabia

“…This finding was consistent with other studies that reported nitrofurantoin presented the lowest resistance and trimethoprim–sulfamethoxazole produced the highest. 13 , 22 …”

“…Resistance development in common UTI pathogens (especially to fosfomycin, sulfamethoxazole-trimethoprim, fluoroquinolones, and third-generation cephalosporins), have seriously restricted therapeutic options, especially in outpatient settings. 22 …”

“…7 This finding was consistent with other studies that reported nitrofurantoin presented the lowest resistance and trimethoprim-sulfamethoxazole produced the highest. 13,22 Resistance development in common UTI pathogens (especially to fosfomycin, sulfamethoxazole-trimethoprim, fluoroquinolones, and third-generation cephalosporins), have seriously restricted therapeutic options, especially in outpatient settings. 22 Ciprofloxacin is an important antibiotic for treatment of more serious infections, and overuse of this antibiotic may have serious implications for the treatment of more serious infections.…”

“…13,22 Resistance development in common UTI pathogens (especially to fosfomycin, sulfamethoxazole-trimethoprim, fluoroquinolones, and third-generation cephalosporins), have seriously restricted therapeutic options, especially in outpatient settings. 22 Ciprofloxacin is an important antibiotic for treatment of more serious infections, and overuse of this antibiotic may have serious implications for the treatment of more serious infections. The Infectious Diseases Society of America (IDSA) guidelines have reduced fluoroquinolones from first-line therapy to alternative agents for uUTI treatment.…”

Challenges to Early Discharge of Patients with Upper Urinary Tract Infections by ESBL Producers: TMP/SMX as a Step-Down Therapy for Shorter Hospitalization and Lower Costs

“…15 In real clinical practice, this tendency is much clear, and clinicians are experiencing cases of improvement with oral conversion to TMP/SMX. 16 TMP/ SMX is available in oral form and can be used in UTIs caused by ESBL-producing bacteria, which are susceptible to it. The aim of this study was to obtain evidence that TMP/SMX therapy (initial or step-down) is comparable to the ertapenem treatment for ESBL-positive TMP/SMXsensitive Enterobacteriaceae.…”