The Clinical Significance of High Antimicrobial Resistance in Community-Acquired Urinary Tract Infections
Background. Urinary tract infections (UTIs) affect up to 150 million individuals annually worldwide, mainly due to Escherichia coli (E. coli) and Klebsiella. The emergence and spread of multidrug-resistant (MDR) bacteria are increasing, representing one of the biggest threats for human health. The o...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-01-01
|
| Series: | Canadian Journal of Infectious Diseases and Medical Microbiology |
| Online Access: | http://dx.doi.org/10.1155/2020/2967260 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832566320172892160 |
|---|---|
| author | Maria G. Zavala-Cerna Midrori Segura-Cobos Ricardo Gonzalez Isidro G. Zavala-Trujillo Silvia F. Navarro-Perez Jose A. Rueda-Cruz Fernando A. Satoscoy-Tovar |
| author_facet | Maria G. Zavala-Cerna Midrori Segura-Cobos Ricardo Gonzalez Isidro G. Zavala-Trujillo Silvia F. Navarro-Perez Jose A. Rueda-Cruz Fernando A. Satoscoy-Tovar |
| author_sort | Maria G. Zavala-Cerna |
| collection | DOAJ |
| description | Background. Urinary tract infections (UTIs) affect up to 150 million individuals annually worldwide, mainly due to Escherichia coli (E. coli) and Klebsiella. The emergence and spread of multidrug-resistant (MDR) bacteria are increasing, representing one of the biggest threats for human health. The objective of our study was to describe antimicrobial patterns of resistance and identify risk factors associated with MDR uropathogens. Methods. We conducted a cross-sectional study in 296 patients with community-acquired UTI who underwent clinical and microbiologic analysis, and clinical associations to MDR uropathogens were investigated. Findings. Microbiological analysis included E. coli (55%), ESBL-E. coli (26%), Enterococcus (6%), Klebsiella (5%), and others (8%). Higher frequencies of MDR bacteria were found among ESBL-E. coli, with resistance to ampicillin (100%), ceftriaxone (96%), gentamicin (57%), ciprofloxacin (89%), and TMP/SMX (53%). However, they were sensitive to fosfomycin (6.6%), nitrofurantoin (1.3%), and carbapenems (0%). Fosfomycin MIC90 for ESBL-E. coli was 5.78 μg/mL. The only clinical variable with significant association to ESBL producers was the presence of comorbidities: hypertension and type 2 diabetes mellitus with an OR (95%CI) of 2.51.3−4.9p<0.01 and 2.81.2−6.7p<0.05, respectively. Conclusions. In the majority of cases, resistance rates to commonly prescribed antimicrobials in UTIs were high, except for fosfomycin, nitrofurantoin, and carbapenems. To provide appropriate treatment, both the identification of risk factors and the uropathogen would be important. An active surveillance in UTIs in the community is required since the proportion of ESBL producers is increasing. |
| format | Article |
| id | doaj-art-1211e6aab46649b4bae35d1297a9fdf2 |
| institution | Kabale University |
| issn | 1712-9532 1918-1493 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Journal of Infectious Diseases and Medical Microbiology |
| spelling | doaj-art-1211e6aab46649b4bae35d1297a9fdf22025-02-03T01:04:28ZengWileyCanadian Journal of Infectious Diseases and Medical Microbiology1712-95321918-14932020-01-01202010.1155/2020/29672602967260The Clinical Significance of High Antimicrobial Resistance in Community-Acquired Urinary Tract InfectionsMaria G. Zavala-Cerna0Midrori Segura-Cobos1Ricardo Gonzalez2Isidro G. Zavala-Trujillo3Silvia F. Navarro-Perez4Jose A. Rueda-Cruz5Fernando A. Satoscoy-Tovar6Immunology Department, International Program of Medicine, Universidad Autonoma de Guadalajra, Guadalajara, Jal, MexicoImmunology Department, International Program of Medicine, Universidad Autonoma de Guadalajra, Guadalajara, Jal, MexicoFacultad de Biología, Instituto de Ciencias Exactas y Terrestres, Universidad Autonoma de Guadalajara, Guadalajara, Jal, MexicoInfectious Disease Division, Hospital Angel Leaño, Universidad Autonoma de Guadalajara, Guadalajara, Jal, MexicoImmunology Department, International Program of Medicine, Universidad Autonoma de Guadalajra, Guadalajara, Jal, MexicoMicrobiology Department, Unidad de Patología Clínica, Guadalajara, Jal, MexicoMicrobiology Department, Unidad de Patología Clínica, Guadalajara, Jal, MexicoBackground. Urinary tract infections (UTIs) affect up to 150 million individuals annually worldwide, mainly due to Escherichia coli (E. coli) and Klebsiella. The emergence and spread of multidrug-resistant (MDR) bacteria are increasing, representing one of the biggest threats for human health. The objective of our study was to describe antimicrobial patterns of resistance and identify risk factors associated with MDR uropathogens. Methods. We conducted a cross-sectional study in 296 patients with community-acquired UTI who underwent clinical and microbiologic analysis, and clinical associations to MDR uropathogens were investigated. Findings. Microbiological analysis included E. coli (55%), ESBL-E. coli (26%), Enterococcus (6%), Klebsiella (5%), and others (8%). Higher frequencies of MDR bacteria were found among ESBL-E. coli, with resistance to ampicillin (100%), ceftriaxone (96%), gentamicin (57%), ciprofloxacin (89%), and TMP/SMX (53%). However, they were sensitive to fosfomycin (6.6%), nitrofurantoin (1.3%), and carbapenems (0%). Fosfomycin MIC90 for ESBL-E. coli was 5.78 μg/mL. The only clinical variable with significant association to ESBL producers was the presence of comorbidities: hypertension and type 2 diabetes mellitus with an OR (95%CI) of 2.51.3−4.9p<0.01 and 2.81.2−6.7p<0.05, respectively. Conclusions. In the majority of cases, resistance rates to commonly prescribed antimicrobials in UTIs were high, except for fosfomycin, nitrofurantoin, and carbapenems. To provide appropriate treatment, both the identification of risk factors and the uropathogen would be important. An active surveillance in UTIs in the community is required since the proportion of ESBL producers is increasing.http://dx.doi.org/10.1155/2020/2967260 |
| spellingShingle | Maria G. Zavala-Cerna Midrori Segura-Cobos Ricardo Gonzalez Isidro G. Zavala-Trujillo Silvia F. Navarro-Perez Jose A. Rueda-Cruz Fernando A. Satoscoy-Tovar The Clinical Significance of High Antimicrobial Resistance in Community-Acquired Urinary Tract Infections Canadian Journal of Infectious Diseases and Medical Microbiology |
| title | The Clinical Significance of High Antimicrobial Resistance in Community-Acquired Urinary Tract Infections |
| title_full | The Clinical Significance of High Antimicrobial Resistance in Community-Acquired Urinary Tract Infections |
| title_fullStr | The Clinical Significance of High Antimicrobial Resistance in Community-Acquired Urinary Tract Infections |
| title_full_unstemmed | The Clinical Significance of High Antimicrobial Resistance in Community-Acquired Urinary Tract Infections |
| title_short | The Clinical Significance of High Antimicrobial Resistance in Community-Acquired Urinary Tract Infections |
| title_sort | clinical significance of high antimicrobial resistance in community acquired urinary tract infections |
| url | http://dx.doi.org/10.1155/2020/2967260 |
| work_keys_str_mv | AT mariagzavalacerna theclinicalsignificanceofhighantimicrobialresistanceincommunityacquiredurinarytractinfections AT midroriseguracobos theclinicalsignificanceofhighantimicrobialresistanceincommunityacquiredurinarytractinfections AT ricardogonzalez theclinicalsignificanceofhighantimicrobialresistanceincommunityacquiredurinarytractinfections AT isidrogzavalatrujillo theclinicalsignificanceofhighantimicrobialresistanceincommunityacquiredurinarytractinfections AT silviafnavarroperez theclinicalsignificanceofhighantimicrobialresistanceincommunityacquiredurinarytractinfections AT josearuedacruz theclinicalsignificanceofhighantimicrobialresistanceincommunityacquiredurinarytractinfections AT fernandoasatoscoytovar theclinicalsignificanceofhighantimicrobialresistanceincommunityacquiredurinarytractinfections AT mariagzavalacerna clinicalsignificanceofhighantimicrobialresistanceincommunityacquiredurinarytractinfections AT midroriseguracobos clinicalsignificanceofhighantimicrobialresistanceincommunityacquiredurinarytractinfections AT ricardogonzalez clinicalsignificanceofhighantimicrobialresistanceincommunityacquiredurinarytractinfections AT isidrogzavalatrujillo clinicalsignificanceofhighantimicrobialresistanceincommunityacquiredurinarytractinfections AT silviafnavarroperez clinicalsignificanceofhighantimicrobialresistanceincommunityacquiredurinarytractinfections AT josearuedacruz clinicalsignificanceofhighantimicrobialresistanceincommunityacquiredurinarytractinfections AT fernandoasatoscoytovar clinicalsignificanceofhighantimicrobialresistanceincommunityacquiredurinarytractinfections |