Treatment of Resistant Enterococcal Urinary Tract Infections

Swaminathan, Subramanian; Alangaden, George

doi:10.1007/s11908-010-0138-8

Cited by 49 publications

(28 citation statements)

References 67 publications

(79 reference statements)

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“…Indeed ertapenem is not approved for the treatment of infections caused by E. faecalis. However, the results were included in the present study since the combination of E. faecalis and penem antibiotics might occur during empiric antibiotic treatment in the hospital setting [21].…”

Section: Discussionmentioning

confidence: 99%

Impact of pH on Activity of Trimethoprim, Fosfomycin, Amikacin, Colistin and Ertapenem in Human Urine

et al. 2012

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Objective: Although major impairment of activity at lower pH values has been reported for fluoroquinolones, acidification is a widely recommended practice for the prophylaxis and treatment of uncomplicated urinary tract infections (UTIs). Until now, there is little evidence for the influence of pH on the activity on other antimicrobial classes in urine. Methods: Bacterial growth curves of Staphylococcus aureus (ATCC 29213), Klebsiella oxytoca (ATCC 700324), Proteus mirabilis (ATCC 14153), Escherichia coli (ATCC 25922) and Enterococcus faecalis (ATCC 29212) were performed in Mueller-Hinton broth and in pooled human urine with a pH of between 5.0 and 8.0. Bacterial killing of trimethoprim, fosfomycin, amikacin, colistin and ertapenem against the five strains (where appropriate) was determined consecutively at concentrations equal to the MIC. Results: While no difference in the bacterial growth of E. coli, S. aureus, P. mirabilis and K. oxytoca was observed at different pH values, bacterial growth of E. faecalis was significantly reduced at low pH. Acidification to pH 5 impaired the antimicrobial activity of all investigated antibiotics, i.e. the net effect of bacterial growth and killing resulted in increased colony-forming units/ml at the end of the experiment. Conclusion: The present in vitro findings indicate that acidification of urine during the treatment of UTIs should be carefully considered. While growth curves of one strain supports the concept of therapeutic or prophylactic acidification during UTIs, the most common pathogen, E. coli, was not affected by low pH. Independent of the investigated strain or antibiotic, pH values below 6 lead to a reduction of antimicrobial activity.

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Section: Discussionmentioning

confidence: 99%

Impact of pH on Activity of Trimethoprim, Fosfomycin, Amikacin, Colistin and Ertapenem in Human Urine

et al. 2012

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“…Escherichia coli is the most prevalent causative organism of both uncomplicated and complicated UTI. However, Grampositive bacteria, such as Enterococcus, have become a representative causative agent of complicated UTIs in adults (5,6). On the other hand, pediatric UTIs are somewhat different from adult UTIs partly because of underlying diseases such as vesicoureteral reflux (VUR) (7).…”

Section: Introductionmentioning

confidence: 99%

International Comparison of Causative Bacteria and Antimicrobial Susceptibilities of Urinary Tract Infections between Kobe, Japan, and Surabaya, Indonesia

Kitagawa¹,

Shigemura

Yamamichi

et al. 2018

Jpn J Infect Dis

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SUMMARY:Variation by country in urinary tract infection (UTI)-causative bacteria is partly due to the differences in the use of antibiotics. We compared their frequencies and antibiotic susceptibilities in the treatment of patients with UTI from 2 cities, Kobe, Japan, and Surabaya, Indonesia. We retrospectively analyzed 1,804 urine samples collected from patients with UTI in 2014 (1,251 collected in 11 months at Kobe University Hospital in Kobe and 544 collected in 2 months at Dr. Soetomo Hospital in Surabaya). Surabaya data were divided into adult and pediatric patients because a substantial number of specimens from pediatric-patients had been collected. The results indicated that Escherichia coli was the most common uropathogen (24.1 in Kobe and 39.3 in Surabaya) and was significantly resistant to ampicillin and substantially to first-and third-generation cephalosporins in Surabaya adults but not in Kobe adults (p ＜ 0.01). Enterococcus faecalis was often isolated in Kobe (14.0 ), but not in Surabaya (5.3 ). Klebsiella spp. were isolated at a higher rate in Surabaya pediatric patients (20.3 ) than in Surabaya adults (13.6 ) and Kobe adults (6.6 ). The antibiotic susceptibilities of the isolates form Surabaya isolates tended to be lower than the ones from Kobe. Extended-spectrum β-lactamaseproducing Gram-negative bacteria were detected at a significantly higher rate in Surabaya than in Kobe (p ＜ 0.001). These results showed that the antimicrobial resistance patterns of UTI-causative bacteria are highly variable among 2 countries, and the continuous surveillance of trends in antibiotic resistance patterns of uropathogens is necessary for the future revision of antibiotic use.

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“…Various antibiotics have been used, from low-cost agents, such as amoxicillin and nitrofurantoin, to expensive drugs such as linezolid and daptomycin. 2 …”

Section: Introductionmentioning

confidence: 99%

Vancomycin resistance has no influence on outcomes of enterococcal bacteriuria

Khair

Vantassell

Henderson

et al. 2013

Journal of Hospital Infection

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Summary Background Infections with vancomycin-resistant enterococci (VRE) are a growing concern in hospitals. The impact of vancomycin resistance in enterococcal urinary tract infection is not well-defined. Aim To describe the epidemiology of enterococcal bacteriuria in a hospital and compare the clinical picture and patient outcomes depending on vancomycin resistance. Methods This was a 6-month prospective cohort study of hospital patients who were admitted with or who developed enterococcal bacteriuria in a 1250-bed tertiary care hospital. We examined clinical presentation, diagnostic work-up, management, and outcomes. Findings We included 254 patients with enterococcal bacteriuria; 160 (63%) were female and median age was 65 years (range: 17–96). A total of 116 (46%) bacteriurias were hospital-acquired and 145 (57%) catheter-associated. Most patients presented with asymptomatic bacteriuria (ASB) (119;47%) or pyelonephritis (64; 25%); 51 (20%) had unclassifiable bacteriuria and 20 (8%) had cystitis. Secondary bloodstream infection was detected in 8 (3%) patients. Seventy of 119 (59%) with ASB received antibiotics (mostly vancomycin). There were 74 (29%) VRE bacteriurias. VRE and vancomycin-susceptible enterococci (VSE) produced similar rates of pyelonephritis [19 (25%) vs 45 (25%); P = 0.2], cystitis, and ASB. Outcomes such as ICU transfer [10 (14%) VRE vs 17 (9%) VSE; P = 0.3], hospital length of stay (6.8 vs 5.0 days; P = 0.08), and mortality [10 (14%) vs 13 (7%); P = 0.1] did not vary with vancomycin susceptibility. Conclusions Vancomycin resistance did not affect the clinical presentation nor did it impact patient outcomes in this cohort of inpatients with enterococcal bacteriuria. Almost half of our cohort had enterococcal ASB; more than 50% of these asymptomatic patients received unnecessary antibiotics. Antimicrobial stewardship efforts should address overtreatment of enterococcal bacteriurias.

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Treatment of Resistant Enterococcal Urinary Tract Infections

Cited by 49 publications

References 67 publications

Impact of pH on Activity of Trimethoprim, Fosfomycin, Amikacin, Colistin and Ertapenem in Human Urine

Impact of pH on Activity of Trimethoprim, Fosfomycin, Amikacin, Colistin and Ertapenem in Human Urine

International Comparison of Causative Bacteria and Antimicrobial Susceptibilities of Urinary Tract Infections between Kobe, Japan, and Surabaya, Indonesia

Vancomycin resistance has no influence on outcomes of enterococcal bacteriuria

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