Cargando…

Uncomplicated urinary tract infections in Swedish primary care; etiology, resistance and treatment

BACKGROUND: Uncomplicated urinary tract infection (uUTI) is common and a majority of patients are prescribed antibiotics. There is little knowledge about antibiotic resistance in urine samples from patients with uUTI in primary health care (PHC). The aim was to describe antibiotic treatment, bacteri...

Descripción completa

Detalles Bibliográficos
Autores principales: Kornfält Isberg, Helena, Melander, Eva, Hedin, Katarina, Mölstad, Sigvard, Beckman, Anders
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375206/
https://www.ncbi.nlm.nih.gov/pubmed/30760219
http://dx.doi.org/10.1186/s12879-019-3785-x
_version_ 1783395334007816192
author Kornfält Isberg, Helena
Melander, Eva
Hedin, Katarina
Mölstad, Sigvard
Beckman, Anders
author_facet Kornfält Isberg, Helena
Melander, Eva
Hedin, Katarina
Mölstad, Sigvard
Beckman, Anders
author_sort Kornfält Isberg, Helena
collection PubMed
description BACKGROUND: Uncomplicated urinary tract infection (uUTI) is common and a majority of patients are prescribed antibiotics. There is little knowledge about antibiotic resistance in urine samples from patients with uUTI in primary health care (PHC). The aim was to describe antibiotic treatment, bacterial findings, the prevalence of resistant E.coli and factors associated with antibiotic resistance. The aim was also to compare the prevalence of resistant E.coli in clinical practice with the prevalence of resistant E.coli in routine microbiological laboratory data. METHODS: This observational study in PHC setting started in November 2014 and ended in March 2016. Women aged 17 years and older with symptoms indicating uUTI from eight PHCs were included. Questionnaires were used to retrieve anamnestic data. All urine samples were sent to the local laboratory of microbiology for diagnostic analysis and susceptibility testing. Proportions of resistant E.coli were compared with corresponding data from the regional laboratory. RESULTS: Urine cultures were analysed in 304 women with a median age of 46 (IQR 32–66) years. Bacterial growth was found in 243 (80%) of urine samples, and E.coli in 72% of the positive samples. A total of 80% of detected E.coli isolates were susceptible to all tested antimicrobials and resistance rates to ciprofloxacin were lower than reported from the local clinical laboratory. Antibiotic treatment within the last year was independently associated with antibiotic resistant E.coli in the urine sample adjusted OR 4.97 (95% CI 2.04–12.06). A total of 74% of the women were treated with antibiotics. The most prescribed was pivmecillinam followed by nitrofurantoin. CONCLUSIONS: Antibiotic resistance in E.coli was low. Antibiotic treatment within the last year was associated with antibiotic resistant E.coli. Data from the clinical microbiology laboratory indicates that laboratory data may overestimate antibiotic resistance and lead to an unnecessary change in empiric antibiotic treatment of uUTI in primary care. The empirically prescribed antibiotics, were inline with Swedish treatment recommendations for uUTI.
format Online
Article
Text
id pubmed-6375206
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-63752062019-02-26 Uncomplicated urinary tract infections in Swedish primary care; etiology, resistance and treatment Kornfält Isberg, Helena Melander, Eva Hedin, Katarina Mölstad, Sigvard Beckman, Anders BMC Infect Dis Research Article BACKGROUND: Uncomplicated urinary tract infection (uUTI) is common and a majority of patients are prescribed antibiotics. There is little knowledge about antibiotic resistance in urine samples from patients with uUTI in primary health care (PHC). The aim was to describe antibiotic treatment, bacterial findings, the prevalence of resistant E.coli and factors associated with antibiotic resistance. The aim was also to compare the prevalence of resistant E.coli in clinical practice with the prevalence of resistant E.coli in routine microbiological laboratory data. METHODS: This observational study in PHC setting started in November 2014 and ended in March 2016. Women aged 17 years and older with symptoms indicating uUTI from eight PHCs were included. Questionnaires were used to retrieve anamnestic data. All urine samples were sent to the local laboratory of microbiology for diagnostic analysis and susceptibility testing. Proportions of resistant E.coli were compared with corresponding data from the regional laboratory. RESULTS: Urine cultures were analysed in 304 women with a median age of 46 (IQR 32–66) years. Bacterial growth was found in 243 (80%) of urine samples, and E.coli in 72% of the positive samples. A total of 80% of detected E.coli isolates were susceptible to all tested antimicrobials and resistance rates to ciprofloxacin were lower than reported from the local clinical laboratory. Antibiotic treatment within the last year was independently associated with antibiotic resistant E.coli in the urine sample adjusted OR 4.97 (95% CI 2.04–12.06). A total of 74% of the women were treated with antibiotics. The most prescribed was pivmecillinam followed by nitrofurantoin. CONCLUSIONS: Antibiotic resistance in E.coli was low. Antibiotic treatment within the last year was associated with antibiotic resistant E.coli. Data from the clinical microbiology laboratory indicates that laboratory data may overestimate antibiotic resistance and lead to an unnecessary change in empiric antibiotic treatment of uUTI in primary care. The empirically prescribed antibiotics, were inline with Swedish treatment recommendations for uUTI. BioMed Central 2019-02-13 /pmc/articles/PMC6375206/ /pubmed/30760219 http://dx.doi.org/10.1186/s12879-019-3785-x Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Kornfält Isberg, Helena
Melander, Eva
Hedin, Katarina
Mölstad, Sigvard
Beckman, Anders
Uncomplicated urinary tract infections in Swedish primary care; etiology, resistance and treatment
title Uncomplicated urinary tract infections in Swedish primary care; etiology, resistance and treatment
title_full Uncomplicated urinary tract infections in Swedish primary care; etiology, resistance and treatment
title_fullStr Uncomplicated urinary tract infections in Swedish primary care; etiology, resistance and treatment
title_full_unstemmed Uncomplicated urinary tract infections in Swedish primary care; etiology, resistance and treatment
title_short Uncomplicated urinary tract infections in Swedish primary care; etiology, resistance and treatment
title_sort uncomplicated urinary tract infections in swedish primary care; etiology, resistance and treatment
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375206/
https://www.ncbi.nlm.nih.gov/pubmed/30760219
http://dx.doi.org/10.1186/s12879-019-3785-x
work_keys_str_mv AT kornfaltisberghelena uncomplicatedurinarytractinfectionsinswedishprimarycareetiologyresistanceandtreatment
AT melandereva uncomplicatedurinarytractinfectionsinswedishprimarycareetiologyresistanceandtreatment
AT hedinkatarina uncomplicatedurinarytractinfectionsinswedishprimarycareetiologyresistanceandtreatment
AT molstadsigvard uncomplicatedurinarytractinfectionsinswedishprimarycareetiologyresistanceandtreatment
AT beckmananders uncomplicatedurinarytractinfectionsinswedishprimarycareetiologyresistanceandtreatment