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Antimicrobial Susceptibilities of Enterobacteriaceae in Community-Acquired Urinary Tract Infections during a 5-year Period: A Single Hospital Study in Korea

BACKGROUND: Through investigating antimicrobial susceptibility patterns of Enterobacteriaceae in community-acquired urinary tract infection (CA-UTI), we provide basic evidence for the use of empirical antibiotics in CA-UTI. MATERIALS AND METHODS: We retrospectively reviewed the medical records of pa...

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Autores principales: Park, Jin Ju, Seo, Yu Bin, Lee, Jacob
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society of Infectious Diseases and Korean Society for Chemotherapy 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5620385/
https://www.ncbi.nlm.nih.gov/pubmed/29027385
http://dx.doi.org/10.3947/ic.2017.49.3.184
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author Park, Jin Ju
Seo, Yu Bin
Lee, Jacob
author_facet Park, Jin Ju
Seo, Yu Bin
Lee, Jacob
author_sort Park, Jin Ju
collection PubMed
description BACKGROUND: Through investigating antimicrobial susceptibility patterns of Enterobacteriaceae in community-acquired urinary tract infection (CA-UTI), we provide basic evidence for the use of empirical antibiotics in CA-UTI. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients over the age of 19 years who visited a hospital in Seoul between January 2012 and December 2016 for a CA-UTI. Urine cultures were used to identify causative organisms. We investigated extended-spectrum β-lactamase (ESBL) production and the antimicrobial susceptibility of Enterobactereiaceae. We evaluated recommended empirical antibiotics numerically by calculating the syndrome-specific likelihood of inadequate therapy (LIT) for the last 2 years (interpretation of the LIT A value: 1 out of A people is likely to receive inadequate empirical antibiotics). RESULTS: Urine cultures were performed in 1,605 out of 2,208 patients who were diagnosed with CA-UTI, and causative pathogens were identified in 1,134 (70.7%) cases. There were 998 (88.0%) cases of Enterobacteriaceae and Escherichia coli was the most common pathogen, accounting for 80.3% of cases (911 cases). The overall resistance rates to trimethoprim-sulfamethoxazole, fluoroquinolones, and cefotaxime were 31.7%, 23.2%, and 13.5%, respectively. There were 128 (10.8%) cases of ESBL-producing Entererobacteriaceae with an increasing but non-significant trend (P = 0.255). The LIT for CA-UTI in the past two years was highest for ertapenem and imipenem. Fluoroquinolones ranked 11th, with a LIT of 8.2, and cefotaxime ranked higher, at 10.5. In ESBL-producing Enterobacteriaceae, except for carbapenems, amikacin and piperacillin-tazobactam showed the highest susceptibility rates at 99.2% and 94.3%, respectively. CONCLUSION: Empiric treatment with fluoroquinolones in CA-UTI should be carefully considered, given the high resistance rate. The proportion of ESBL-producing Entererobacteriaceae in CA-UTI has increased to a high level in Korea. Amikacin and piperacillin-tazobactam could be considered for empiric treatment in patients at risk for ESBL-producing Entererobacteriaceae when considering alternatives to carbapenems.
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spelling pubmed-56203852017-10-02 Antimicrobial Susceptibilities of Enterobacteriaceae in Community-Acquired Urinary Tract Infections during a 5-year Period: A Single Hospital Study in Korea Park, Jin Ju Seo, Yu Bin Lee, Jacob Infect Chemother Original Article BACKGROUND: Through investigating antimicrobial susceptibility patterns of Enterobacteriaceae in community-acquired urinary tract infection (CA-UTI), we provide basic evidence for the use of empirical antibiotics in CA-UTI. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients over the age of 19 years who visited a hospital in Seoul between January 2012 and December 2016 for a CA-UTI. Urine cultures were used to identify causative organisms. We investigated extended-spectrum β-lactamase (ESBL) production and the antimicrobial susceptibility of Enterobactereiaceae. We evaluated recommended empirical antibiotics numerically by calculating the syndrome-specific likelihood of inadequate therapy (LIT) for the last 2 years (interpretation of the LIT A value: 1 out of A people is likely to receive inadequate empirical antibiotics). RESULTS: Urine cultures were performed in 1,605 out of 2,208 patients who were diagnosed with CA-UTI, and causative pathogens were identified in 1,134 (70.7%) cases. There were 998 (88.0%) cases of Enterobacteriaceae and Escherichia coli was the most common pathogen, accounting for 80.3% of cases (911 cases). The overall resistance rates to trimethoprim-sulfamethoxazole, fluoroquinolones, and cefotaxime were 31.7%, 23.2%, and 13.5%, respectively. There were 128 (10.8%) cases of ESBL-producing Entererobacteriaceae with an increasing but non-significant trend (P = 0.255). The LIT for CA-UTI in the past two years was highest for ertapenem and imipenem. Fluoroquinolones ranked 11th, with a LIT of 8.2, and cefotaxime ranked higher, at 10.5. In ESBL-producing Enterobacteriaceae, except for carbapenems, amikacin and piperacillin-tazobactam showed the highest susceptibility rates at 99.2% and 94.3%, respectively. CONCLUSION: Empiric treatment with fluoroquinolones in CA-UTI should be carefully considered, given the high resistance rate. The proportion of ESBL-producing Entererobacteriaceae in CA-UTI has increased to a high level in Korea. Amikacin and piperacillin-tazobactam could be considered for empiric treatment in patients at risk for ESBL-producing Entererobacteriaceae when considering alternatives to carbapenems. The Korean Society of Infectious Diseases and Korean Society for Chemotherapy 2017-09 2017-09-14 /pmc/articles/PMC5620385/ /pubmed/29027385 http://dx.doi.org/10.3947/ic.2017.49.3.184 Text en Copyright © 2017 by The Korean Society of Infectious Diseases and Korean Society for Chemotherapy http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Park, Jin Ju
Seo, Yu Bin
Lee, Jacob
Antimicrobial Susceptibilities of Enterobacteriaceae in Community-Acquired Urinary Tract Infections during a 5-year Period: A Single Hospital Study in Korea
title Antimicrobial Susceptibilities of Enterobacteriaceae in Community-Acquired Urinary Tract Infections during a 5-year Period: A Single Hospital Study in Korea
title_full Antimicrobial Susceptibilities of Enterobacteriaceae in Community-Acquired Urinary Tract Infections during a 5-year Period: A Single Hospital Study in Korea
title_fullStr Antimicrobial Susceptibilities of Enterobacteriaceae in Community-Acquired Urinary Tract Infections during a 5-year Period: A Single Hospital Study in Korea
title_full_unstemmed Antimicrobial Susceptibilities of Enterobacteriaceae in Community-Acquired Urinary Tract Infections during a 5-year Period: A Single Hospital Study in Korea
title_short Antimicrobial Susceptibilities of Enterobacteriaceae in Community-Acquired Urinary Tract Infections during a 5-year Period: A Single Hospital Study in Korea
title_sort antimicrobial susceptibilities of enterobacteriaceae in community-acquired urinary tract infections during a 5-year period: a single hospital study in korea
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5620385/
https://www.ncbi.nlm.nih.gov/pubmed/29027385
http://dx.doi.org/10.3947/ic.2017.49.3.184
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