Susceptibility to Antibiotics in Urinary Tract Infections in a Secondary Care Setting From 2005-2006 and 2010-2011, in São Paulo, Brazil: Data From 11,943 Urine Cultures

Abstract

Introduction: Urinary tract infection (UTI) has a high incidence and recurrence, therefore, treatment is empirical in the majority of cases. Objectives: The aim of this study was to analyze the urine cultures performed at a secondary hospital, during two periods, 2005-2006 and 2010-2011, and to estimate the microbial resistance. Patients and methods: We analyzed 11,943 aerobic urine cultures according to basic demographic data and susceptibility to antibiotics in accordance with the Clinical and Laboratory Standards Institute (CLSI) for Vitek 1 and 2. Results: Most of our cohort consisted of young adult females that were seen at the Emergency Department. E. coli was the most frequent (70.2%) among the 75 species isolated. Resistance of all isolates was ≥ 20% for trimethoprim/sulfamethoxazole (TMP/SMX), norfloxacin, nitrofurantoin, cefazolin and nalidixic acid. Although E. coli was more susceptible (resistance ≥ 20% for TMP/SMX and nalidixic acid) among all of the isolates, when classified by the number and percentage of antibiotic resistance. Global resistance to fluoroquinolones was approximately 12%. Risk factors for E. coli were female gender and an age less than 65 years. Men and patients older than 65 years of age, presented more resistant isolates. Extended spectrum beta-lactamases (ESBL) were identified in 173 out of 5,722 Gram-negative isolates (3.0%) between 2010 and 2011. Conclusion: E. coli was the most frequent microbe isolated in the urine cultures analyzed in this study. There was a significant evolution of bacterial resistance between the two periods studied. In particular, the rise of bacterial resistance to fluoroquinolones was concerning.

3D microfluidic gradient generator for combination antimicrobial susceptibility testing

“…5b) results indicated that the MIC value corresponded to the µ-drug cocktail from outlet 5. The µ-drug cocktail exhibited normalized growth of~5%, corresponding to a ciprofloxacin concentration of~50 µg/L, which is in agreement with the documented range for similar known multidrug AMR strains of E. coli 74,76 . Solutions containing higher concentrations of tetracycline showed roughly the same amount of growth, whereas those containing lower concentrations of ciprofloxacin show increased amounts of growth, ≤~50%.…”

“…Amikacin is a particularly effective antibiotic in combination treatments used to combat infections such as serious UTIs, tuberculosis and bacterial meningitis, and AST evaluation of amikacin is frequently performed in clinical and drug development settings 16,[76][77][78][79] . The results from the amkacin-buffer-buffer gradient (Fig.…”

Socioeconomic Determinants of Antibiotic Consumption in the State of São Paulo, Brazil: The Effect of Restricting Over-The-Counter Sales

“…This may be related to the fact that females between 15 and 64 years are the group most commonly affected by urinary tract infection, a major cause of empiric oral antibiotic use and thus of AMR. [26] Not only antibiotic consumption was greater, but the policy was also found to be more effective in those municipalities with a higher percentage of females, possibly reducing the OTC use of antibiotic for this infection.…”

“…[21] There are, however, few studies on variations in antibiotic use within SSP and their SED, with these studies usually focusing on single or few municipalities. [22–26] There are also little data about the levels and the evolution of AMR within SSP. Kiffer et al .…”

“…Miranda et al . (2014) [26] studied the rate of antibiotic resistance to urinary tract infections in the city of São Paulo during two periods: 2005–2006 and 2010–2011. They found a significant increase in bacterial resistance to most antibiotics between these two periods, particularly to fluoroquinolones (90.1% of infections were susceptible to ciprofloxacin in 2005–2006 vs 83.4% in 2010–2011).…”