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Fromer DL, Cheng WY, Gao C, Mahendran M, Hilts A, Duh MS, Joshi AV, Mulgirigama A, Mitrani-Gold FS. Likelihood of Antimicrobial Resistance in Urinary E. coli Isolates Among US Female Patients with Recurrent Versus Non-Recurrent uUTI. Urology 2024; 190:1-10. [PMID: 38467284 DOI: 10.1016/j.urology.2024.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/20/2024] [Accepted: 02/29/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE To assess the relative likelihood of antimicrobial resistance (AMR) and multi-drug resistance (MDR) among E. coli isolates from outpatients with recurrent versus non-recurrent uncomplicated urinary tract infection (uUTI). METHODS In this retrospective observational US cohort study, female outpatients (≥12 years) with uUTI, positive E. coli culture, and treated with ≥1 oral antibiotic within ±5 days of diagnosis were grouped into recurrent and non-recurrent uUTI cohorts per their UTI history (past 12 months). AMR to specific drug classes was evaluated at index. Univariable and multivariable logistic regression models estimated the likelihood of not-susceptible E. coli isolates (AMR/MDR) among patients with recurrent uUTI versus non-recurrent uUTI. RESULTS Recurrent (N = 12,234) and non-recurrent (N = 68,033) uUTI cohorts had similar distributions (race, ethnicity, region). Patients with recurrent uUTI had a higher prevalence of E. coli resistance to trimethoprim-sulfamethoxazole (21.8% vs 18.7%) and fluoroquinolones (14.2% vs 8.6%), and more isolates were extended-spectrum β-lactamase-producing (5.9% vs 4.1%) compared to non-recurrent uUTI patients. Patients with recurrent uUTI had a higher likelihood (odds ratio [95% confidence interval]) of any AMR (1.28 [1.22-1.34]), single drug-class resistance (1.18 [1.12-1.24]), and resistance to 2 (1.53 [1.41-1.67]) or ≥3 drug classes (1.70 [1.48-1.96]) (all P <.001). CONCLUSION This study delineated the likelihood of AMR and MDR among E. coli isolates from patients with recurrent versus non-recurrent uUTI. While some treatment guidelines support empiric therapy in recurrent uUTI, the increased likelihood of resistance among these patients suggests that culture and susceptibility testing should be undertaken to inform recurrent uUTI treatment.
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Affiliation(s)
- Debra L Fromer
- Hackensack University Medical Center, Hackensack, NJ, USA.
| | | | - Chi Gao
- Analysis Group, Inc., Boston, MA, USA
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Laffont-Lozes P, Larcher R, Salipante F, Leguelinel-Blache G, Dunyach-Remy C, Lavigne JP, Sotto A, Loubet P. Usefulness of dynamic regression time series models for studying the relationship between antimicrobial consumption and bacterial antimicrobial resistance in hospitals: a systematic review. Antimicrob Resist Infect Control 2023; 12:100. [PMID: 37697357 PMCID: PMC10496333 DOI: 10.1186/s13756-023-01302-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUNG Antimicrobial resistance (AMR) is on the rise worldwide. Tools such as dynamic regression (DR) models can correlate antimicrobial consumption (AMC) with AMR and predict future trends to help implement antimicrobial stewardship programs (ASPs). MAIN BODY We carried out a systematic review of the literature up to 2023/05/31, searching in PubMed, ScienceDirect and Web of Science. We screened 641 articles and finally included 28 studies using a DR model to study the correlation between AMC and AMR at a hospital scale, published in English or French. Country, bacterial species, type of sampling, antimicrobials, study duration and correlations between AMC and AMR were collected. The use of β-lactams was correlated with cephalosporin resistance, especially in Pseudomonas aeruginosa and Enterobacterales. Carbapenem consumption was correlated with carbapenem resistance, particularly in Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii. Fluoroquinolone use was correlated with fluoroquinolone resistance in Gram-negative bacilli and methicillin resistance in Staphylococcus aureus. Multivariate DR models highlited that AMC explained from 19 to 96% of AMR variation, with a lag time between AMC and AMR variation of 2 to 4 months. Few studies have investigated the predictive capacity of DR models, which appear to be limited. CONCLUSION Despite their statistical robustness, DR models are not widely used. They confirmed the important role of fluoroquinolones, cephalosporins and carbapenems in the emergence of AMR. However, further studies are needed to assess their predictive capacity and usefulness for ASPs.
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Affiliation(s)
- Paul Laffont-Lozes
- Department of Pharmacy, Nimes University Hospital, Nimes, France
- Infectious and Tropical Diseases Department, Nimes University Hospital, Nimes, France
| | - Romaric Larcher
- Infectious and Tropical Diseases Department, Nimes University Hospital, Nimes, France.
- PhyMedExp, INSERM U1046, CNRS, University of Montpellier, Montpellier, France.
- Service des Maladies Infectieuses et Tropicales, Hôpital Caremeau - CHU de Nimes, 1 Place Robert Debre, Nîmes, 30000, France.
| | - Florian Salipante
- Department of Biostatistics, Epidemiology, Public Health, and Innovation in Methodology (BESPIM), University of Montpellier, Nîmes University Hospital, Nimes, France
| | - Geraldine Leguelinel-Blache
- Department of Pharmacy, Nimes University Hospital, Nimes, France
- Department of Biostatistics, Epidemiology, Public Health, and Innovation in Methodology (BESPIM), University of Montpellier, Nîmes University Hospital, Nimes, France
| | - Catherine Dunyach-Remy
- Department of Microbiology and Hospital Hygiene, Nimes University Hospital, Nimes, France
- VBIC, INSERM U1047, University of Montpellier, Nimes, France
| | - Jean-Philippe Lavigne
- Department of Microbiology and Hospital Hygiene, Nimes University Hospital, Nimes, France
- VBIC, INSERM U1047, University of Montpellier, Nimes, France
| | - Albert Sotto
- Infectious and Tropical Diseases Department, Nimes University Hospital, Nimes, France
- VBIC, INSERM U1047, University of Montpellier, Nimes, France
| | - Paul Loubet
- Infectious and Tropical Diseases Department, Nimes University Hospital, Nimes, France
- VBIC, INSERM U1047, University of Montpellier, Nimes, France
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Shafrir A, Oster Y, Shauly-Aharonov M, Strahilevitz J. Real-Life Comparison of Fosfomycin to Nitrofurantoin for the Treatment of Uncomplicated Lower Urinary Tract Infection in Women. Biomedicines 2023; 11:biomedicines11041019. [PMID: 37189635 DOI: 10.3390/biomedicines11041019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/19/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
In this study, we compared the failure rates of fosfomycin and nitrofurantoin for uncomplicated urinary tract infections. We used Meuhedet Health Services’ large database to collect data on all female patients, older than 18 years, who were prescribed either antibiotic during 2013–2018. Treatment failure was a composite endpoint of hospitalization, emergency-room visit, IV antibiotic treatment, or prescription of a different antibiotic, within seven days of the initial prescription. Reinfection was considered when one of these endpoints appeared 8–30 days following the initial prescription. We found 33,759 eligible patients. Treatment failure was more common in the fosfomycin group than the nitrofurantoin group (8.16% vs. 6.87%, p-value < 0.0001). However, reinfection rates were higher among patients who received nitrofurantoin (9.21% vs. 7.76%, p-value < 0.001). Among patients younger than 40 years, patients treated with nitrofurantoin had more reinfections (8.68% vs. 7.47%, p value = 0.024). Treatment failure rates were mildly higher in patients treated with fosfomycin, despite having less reinfections. We suggest that this effect is related to a shorter duration of treatment (one vs. five days) and encourage clinicians to be more patient before declaring fosfomycin failure and prescribing another antibiotic.
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Abbara S, Guillemot D, Brun-Buisson C, Watier L. From Pathophysiological Hypotheses to Case-Control Study Design: Resistance from Antibiotic Exposure in Community-Onset Infections. Antibiotics (Basel) 2022; 11:201. [PMID: 35203803 PMCID: PMC8868523 DOI: 10.3390/antibiotics11020201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
Antimicrobial resistance is a global public health concern, at least partly due to the misuse of antibiotics. The increasing prevalence of antibiotic-resistant infections in the community has shifted at-risk populations into the general population. Numerous case-control studies attempt to better understand the link between antibiotic use and antibiotic-resistant community-onset infections. We review the designs of such studies, focusing on community-onset bloodstream and urinary tract infections. We highlight their methodological heterogeneity in the key points related to the antibiotic exposure, the population and design. We show the impact of this heterogeneity on study results, through the example of extended-spectrum β-lactamases producing Enterobacteriaceae. Finally, we emphasize the need for the greater standardization of such studies and discuss how the definition of a pathophysiological hypothesis specific to the bacteria-resistance pair studied is an important prerequisite to clarify the design of future studies.
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Affiliation(s)
- Salam Abbara
- Anti-Infective Evasion and Pharmacoepidemiology Team, Inserm, UVSQ, University Paris-Saclay, CESP, 78180 Montigny-Le-Bretonneux, France; (S.A.); (D.G.); (C.B.-B.)
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), 75015 Paris, France
| | - Didier Guillemot
- Anti-Infective Evasion and Pharmacoepidemiology Team, Inserm, UVSQ, University Paris-Saclay, CESP, 78180 Montigny-Le-Bretonneux, France; (S.A.); (D.G.); (C.B.-B.)
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), 75015 Paris, France
- Public Health, Medical Information, Clinical Research, AP-HP, University Paris Saclay, 94270 Le Kremlin-Bicêtre, France
| | - Christian Brun-Buisson
- Anti-Infective Evasion and Pharmacoepidemiology Team, Inserm, UVSQ, University Paris-Saclay, CESP, 78180 Montigny-Le-Bretonneux, France; (S.A.); (D.G.); (C.B.-B.)
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), 75015 Paris, France
| | - Laurence Watier
- Anti-Infective Evasion and Pharmacoepidemiology Team, Inserm, UVSQ, University Paris-Saclay, CESP, 78180 Montigny-Le-Bretonneux, France; (S.A.); (D.G.); (C.B.-B.)
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), 75015 Paris, France
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5
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Delory T, Le Bel J, Lariven S, Peiffer-Smadja N, Lescure FX, Bouvet E, Jeanmougin P, Tubach F, Boëlle PY. Computerized decision support system (CDSS) use for surveillance of antimicrobial resistance in urinary tract infections in primary care. J Antimicrob Chemother 2021; 77:524-530. [PMID: 34747446 DOI: 10.1093/jac/dkab392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/05/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hospital-based surveillance of antimicrobial resistance may be irrelevant as a guide to antimicrobial use for urinary tract infections (UTIs) in primary care. OBJECTIVES To highlight the value of online computerized decision support systems (CDSS) in providing information on the surveillance of antimicrobial resistance in community-acquired UTIs. METHODS We collected the susceptibility profile for key antibiotics by type of UTI involving Escherichia coli from 2017 to 2020, using queries for UTI (Q-UTI) submitted to a French CDSS. We compared these results with those from the MedQual French surveillance system for community-acquired UTI and the European Antimicrobial Resistance Surveillance Network (EARS-NET) for invasive infections. RESULTS We collected 43 591 Q-UTI, of which 10 192 (23%) involved E. coli: 40% cystitis, 32% male-UTI, and 27% pyelonephritis. Resistance was 41.3% (95% CI, 40.3%-42.2%) for amoxicillin, 16.6% (95% CI, 15.9%-17.3%) for fluoroquinolones, 6.6% (95% CI, 6.1%-7.0%) for third-generation cephalosporins (3GC), and 5.7% (95% CI, 5.2%-6.1%) for aminoglycosides. Resistance to amoxicillin was lower than that reported in MedQual (42.7%, P value = 0.004), and in EARS-NET (55.2%, P value < 0.001). For fluoroquinolones, resistance was higher than in MedQual (12.0%, P value < 0.001) and EARS-NET (15.8%, P value = 0.041). In complicated pyelonephritis and male UTI, fluoroquinolone resistance peaked at ∼20%. For 3GC, all UTI had higher resistance than in MedQual (3.5%, P value < 0.001), but lower than in EARS-NET (9.5%, P value < 0.001). Aminoglycoside resistance was not reported by MedQual, and was lower than in EARS-NET (7.1%, P value < 0.001). CONCLUSIONS CDSS can inform prescribers in real-time about the ecology and surveillance of E. coli resistance in community-acquired UTI. In complicated upper UTIs, they can underline the risk of empirical use of fluoroquinolones and suggest preferential use of 3GC.
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Affiliation(s)
- Tristan Delory
- Antibioclic Steering Committee, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, F-75012 Paris, France.,Annecy-Genevois Hospital (CHANGE), DRCI, F-74370 Epagny-Metz-Tessy, France
| | - Josselin Le Bel
- Antibioclic Steering Committee, Paris, France.,Department of General Practice, Université de Paris, F-75018 Paris, France.,UMR 1137, INSERM, IAME, F-75018 Paris, France
| | - Sylvie Lariven
- Antibioclic Steering Committee, Paris, France.,Department of Infectious and Tropical Diseases, AP-HP, Bichat Hospital, F-75018 Paris, France
| | - Nathan Peiffer-Smadja
- Antibioclic Steering Committee, Paris, France.,UMR 1137, INSERM, IAME, F-75018 Paris, France.,Department of Infectious and Tropical Diseases, AP-HP, Bichat Hospital, F-75018 Paris, France
| | - François-Xavier Lescure
- Antibioclic Steering Committee, Paris, France.,UMR 1137, INSERM, IAME, F-75018 Paris, France.,Department of Infectious and Tropical Diseases, AP-HP, Bichat Hospital, F-75018 Paris, France
| | - Elisabeth Bouvet
- Antibioclic Steering Committee, Paris, France.,French National Authority for Health (HAS), Paris, France
| | - Pauline Jeanmougin
- Antibioclic Steering Committee, Paris, France.,Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, F-75012 Paris, France.,Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, F-75013 Paris, France
| | - Pierre-Yves Boëlle
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, F-75012 Paris, France.,Public Health Unit, AP-HP, Saint Antoine Hospital, F-75012, Paris, France
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6
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Gancz A, Kondratyeva K, Cohen-Eli D, Navon-Venezia S. Genomics and Virulence of Klebsiella pneumoniae Kpnu95 ST1412 Harboring a Novel Incf Plasmid Encoding Blactx-M-15 and Qnrs1 Causing Community Urinary Tract Infection. Microorganisms 2021; 9:microorganisms9051022. [PMID: 34068663 PMCID: PMC8151138 DOI: 10.3390/microorganisms9051022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 01/02/2023] Open
Abstract
The emergence of extended-spectrum β-lactamase (ESBL)-producing multidrug resistant Klebsiella pneumoniae causing community urinary tract infections (CA-UTI) in healthy women undermines effective treatment and poses a public health concern. We performed a comprehensive genomic analysis (Illumina and MinION) and virulence studies using Caenorhabditis elegans nematodes to evaluate KpnU95, a blaCTX-M-15-producing CA-UTI K. pneumoniae strain. Whole genome sequencing identified KpnU95 as sequence type 1412 and revealed the chromosomal and plasmid-encoding resistome, virulome and persistence features. KpnU95 possess a wide virulome and caused complete C. elegans killing. The strain harbored a single novel 180.3Kb IncFIB(K) plasmid (pKpnU95), which encodes ten antibiotic resistance genes, including blaCTX-M-15 and qnrS1 alongside a wide persistome encoding heavy metal and UV resistance. Plasmid curing and reconstitution were used for loss and gain studies to evaluate its role on bacterial resistance, fitness and virulence. Plasmid curing abolished the ESBL phenotype, decreased ciprofloxacin MIC and improved bacterial fitness in artificial urine accompanied with enhanced copper tolerance, without affecting bacterial virulence. Meta-analysis supported the uniqueness of pKpnU95 and revealed plasmid-ST1412 lineage adaptation. Overall, our findings provide translational data on a CA-UTI K. pneumoniae ST1412 strain and demonstrates that ESBL-encoding plasmids play key roles in multidrug resistance and in bacterial fitness and persistence.
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Affiliation(s)
- Ayala Gancz
- Molecular Biology Department, Faculty of Life Sciences, Ariel University, Ariel 40700, Israel; (A.G.); (K.K.); (D.C.-E.)
| | - Kira Kondratyeva
- Molecular Biology Department, Faculty of Life Sciences, Ariel University, Ariel 40700, Israel; (A.G.); (K.K.); (D.C.-E.)
| | - Dorit Cohen-Eli
- Molecular Biology Department, Faculty of Life Sciences, Ariel University, Ariel 40700, Israel; (A.G.); (K.K.); (D.C.-E.)
| | - Shiri Navon-Venezia
- Molecular Biology Department, Faculty of Life Sciences, Ariel University, Ariel 40700, Israel; (A.G.); (K.K.); (D.C.-E.)
- The Miriam and Sheldon Adelson School of Medicine, Ariel University, Ariel 40700, Israel
- Correspondence:
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Li X, Tian T, Shang X, Zhang R, Xie H, Wang X, Wang H, Xie Q, Chen J, Kadokami K. Occurrence and Health Risks of Organic Micro-Pollutants and Metals in Groundwater of Chinese Rural Areas. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:107010. [PMID: 33124919 PMCID: PMC7598030 DOI: 10.1289/ehp6483] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Groundwater is a main drinking-water source for Chinese rural residents. The overall pollution status of organic micropollutants (OMPs) and metals in the groundwater and corresponding health risks are unknown. OBJECTIVES Our objective was to comprehensively screen for and assess the health risks of OMPs and metals in groundwater of rural areas in China where groundwater is used for drinking so as to provide a benchmark for monitoring and improving groundwater quality in future developments. METHODS One hundred sixty-six groundwater samples were collected in the rural areas of China, and 1,300 OMPs and 25 metals were screened by GC-MS, LC-QTOF/MS, and ICP-MS analysis. To assess the noncarcinogenic and carcinogenic risks of the detected pollutants, missing toxicity threshold values were extrapolated from existing databases or predicted by quantitative structure-activity relationship (QSAR) models. Monte Carlo simulation was performed to account for uncertainties in the exposure parameters and toxicity thresholds. RESULTS Two hundred thirty-three OMPs and 25 metals were detected from the 166 samples. The concentration summation for the detected OMPs ranged from 2.9 to 1.7×105ng/L among the different sampling sites. Cumulative noncarcinogenic risks for the OMPs were estimated to be negligible. However, high metal risks were calculated in 23% of the sites. Forty-two carcinogens (including 38 OMPs) were identified and the cumulative carcinogenic risks in 34% of the sites were calculated to be >10-4 (i.e., one excess cancer case in a population of 10 thousand people). The carcinogenic risks were estimated to be mainly associated with exposures to the metals, which were calculated to contribute 79% (0-100%) of the cumulative carcinogenic risks. DISCUSSION The overall status of OMPs and metals pollution in the groundwater and the corresponding health risks were determined preliminarily, which may provide a benchmark for future efforts in China to ensure the safety of drinking water for the local residents in rural areas. The joint application of QSARs and Monte Carlo simulation provided a feasible way to comprehensively assess the health risks of the large and ever-increasing number of pollutants detected in the aquatic environment. https://doi.org/10.1289/EHP6483.
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Affiliation(s)
- Xuehua Li
- Key Laboratory of Industrial Ecology and Environmental Engineering, School of Environmental Science and Technology, Dalian University of Technology, Dalian, China
| | - Tian Tian
- Key Laboratory of Industrial Ecology and Environmental Engineering, School of Environmental Science and Technology, Dalian University of Technology, Dalian, China
| | - Xiaochen Shang
- Key Laboratory of Industrial Ecology and Environmental Engineering, School of Environmental Science and Technology, Dalian University of Technology, Dalian, China
| | - Ruohan Zhang
- Key Laboratory of Industrial Ecology and Environmental Engineering, School of Environmental Science and Technology, Dalian University of Technology, Dalian, China
| | - Huaijun Xie
- Key Laboratory of Industrial Ecology and Environmental Engineering, School of Environmental Science and Technology, Dalian University of Technology, Dalian, China
| | - Xuejian Wang
- Key Laboratory of Industrial Ecology and Environmental Engineering, School of Environmental Science and Technology, Dalian University of Technology, Dalian, China
| | - Hanwei Wang
- Key Laboratory of Industrial Ecology and Environmental Engineering, School of Environmental Science and Technology, Dalian University of Technology, Dalian, China
| | - Qing Xie
- Key Laboratory of Industrial Ecology and Environmental Engineering, School of Environmental Science and Technology, Dalian University of Technology, Dalian, China
| | - Jingwen Chen
- Key Laboratory of Industrial Ecology and Environmental Engineering, School of Environmental Science and Technology, Dalian University of Technology, Dalian, China
| | - Kiwao Kadokami
- Institute of Environmental Science and Technology, University of Kitakyushu, Kitakyushu, Fukuoka, Japan
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Bruyndonckx R, Latour K, Atud GA, Dubovy P, Jaspers S, Hens N, Catry B, Goossens H, Coenen S. Time trend of prevalence and susceptibility to nitrofurantoin of urinary MDR Escherichia coli from outpatients. J Antimicrob Chemother 2020; 74:3264-3267. [PMID: 31377782 DOI: 10.1093/jac/dkz323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/27/2019] [Accepted: 06/29/2019] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To assess the time trend of the prevalence of urinary MDR Escherichia coli in Belgian outpatients (2005 versus 2011-12), the antibiotic susceptibility of urinary MDR E. coli, and the time trend of non-susceptibility to nitrofurantoin, i.e. first-line treatment for uncomplicated urinary tract infections (UTIs), of urinary MDR E. coli (2005 versus 2011-12). METHODS In this secondary analysis of a multicentre study, which collected a convenience sample of voluntary participating laboratories (15 and 8 in 2005 and 2011-12, respectively), we analysed antimicrobial susceptibilities (ampicillin, amoxicillin/clavulanate, cefalotin, ciprofloxacin, nitrofurantoin and trimethoprim/sulfamethoxazole) of urinary E. coli. MDR was defined as resistance to three or more of these agents. The prevalence of MDR E. coli and its non-susceptibility to nitrofurantoin was compared between 2005 and 2011-12 using a generalized estimating equation model. RESULTS MDR status could be determined for 9704 and 12512 urinary E. coli isolates from 7911 and 9441 patients in 2005 and 2011-12, respectively, with most patients being women (79% in both study periods). The prevalence of MDR increased from 28.4% (2758/9704) in 2005 to 34.3% (4286/12512) in 2011-12 (adjusted OR 1.305; 95% CI 1.220-1.397). Within the MDR isolates, the prevalence of nitrofurantoin non-susceptibility decreased from 23.2% (623/2684) in 2005 to 10.7% (455/4253) in 2011-12 (adjusted OR 0.424; 95% CI 0.363-0.494). CONCLUSIONS Despite a high prevalence of MDR E. coli in urinary samples from Belgian outpatients, nitrofurantoin could still be recommended as first-line empirical treatment in uncomplicated UTIs.
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Affiliation(s)
- Robin Bruyndonckx
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University, Hasselt, Belgium.,Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Katrien Latour
- Healthcare-Associated Infection & Antimicrobial Resistance (NSIH), Scientific Directorate Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | | | - Patrick Dubovy
- Faculty of Sciences, Hasselt University, Hasselt, Belgium
| | - Stijn Jaspers
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University, Hasselt, Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University, Hasselt, Belgium.,Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium.,Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Boudewijn Catry
- Healthcare-Associated Infection & Antimicrobial Resistance (NSIH), Scientific Directorate Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Samuel Coenen
- Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.,Faculty of Sciences, Hasselt University, Hasselt, Belgium.,Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium
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Katongole P, Bulwadda Kisawuzi D, Kyobe Bbosa H, Patrick Kateete D, Florence Najjuka C. Phylogenetic groups and antimicrobial susceptibility patterns of uropathogenic Escherichia coli clinical isolates from patients at Mulago National Referral Hospital, Kampala, Uganda. F1000Res 2019. [DOI: 10.12688/f1000research.20930.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction: Uropathogenic Escherichia coli (UPEC) remains the most common cause of urinary tract infections (UTIs). They account for over 80-90% of all community-acquired and 30-50% of all hospital-acquired UTIs. E. coli strains have been found to belong to evolutionary origins known as phylogenetic groups. In 2013, Clermont classified E. coli strains into eight phylogenetic groups using the quadruplex PCR method. The aim of this study was to identify the phylogenetic groups of UPEC strains in Uganda using Clermont’s quadruplex PCR method and to assess their antibiotic susceptibility patterns in Uganda. Methods: In this cross-sectional study, 140 stored uropathogenic E. coli isolates from the Clinical Microbiology Laboratory, Department of Medical Microbiology, College of Health Sciences Makerere University were subjected to phylogenetic typing by a quadruplex PCR method. Antimicrobial susceptibility testing was performed by disk diffusion method according to Clinical & Laboratory Standards Institute (CLSI) guidelines. Phenotypic detection of extended-spectrum beta-lactamase, AmpC and carbapenemases was done according to CLSI guidelines and Laboratory SOPs. Results: Phylogenetic group B2 (40%) was the most predominant, followed by A (6.23%), clade I and II (5%), D and E (each 2.14%), B1 (1.43%) and F and C (each 0.71%). The most common resistant antibiotic was trimethoprim-sulphamethoxazole (90.71%) and the least was imipenem (1.43%). In total, 73.57% of isolates were multi-drug resistant (MDR). Antibiotic resistance was mainly detected in phylogenetic group B2 (54%). Conclusions: Our findings showed the high prevalence of MDR E. coli isolates, with the dominance of phylogenetic group B2. About 9% of E. coli isolates belonged to the newly described phylogroups C, E, F, and clade I and II.
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