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...

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Main Authors: 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
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
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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.
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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
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