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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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Autores principales: Zavala-Cerna, Maria G., Segura-Cobos, Midrori, Gonzalez, Ricardo, Zavala-Trujillo, Isidro G., Navarro-Perez, Silvia F., Rueda-Cruz, Jose A., Satoscoy-Tovar, Fernando A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293720/
https://www.ncbi.nlm.nih.gov/pubmed/32566057
http://dx.doi.org/10.1155/2020/2967260
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author Zavala-Cerna, Maria G.
Segura-Cobos, Midrori
Gonzalez, Ricardo
Zavala-Trujillo, Isidro G.
Navarro-Perez, Silvia F.
Rueda-Cruz, Jose A.
Satoscoy-Tovar, Fernando A.
author_facet Zavala-Cerna, Maria G.
Segura-Cobos, Midrori
Gonzalez, Ricardo
Zavala-Trujillo, Isidro G.
Navarro-Perez, Silvia F.
Rueda-Cruz, Jose A.
Satoscoy-Tovar, Fernando A.
author_sort Zavala-Cerna, Maria G.
collection PubMed
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 2.5(1.3 − 4.9)(p < 0.01) and 2.8(1.2 − 6.7)(p < 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 pubmed-72937202020-06-19 The Clinical Significance of High Antimicrobial Resistance in Community-Acquired Urinary Tract Infections Zavala-Cerna, Maria G. Segura-Cobos, Midrori Gonzalez, Ricardo Zavala-Trujillo, Isidro G. Navarro-Perez, Silvia F. Rueda-Cruz, Jose A. Satoscoy-Tovar, Fernando A. Can J Infect Dis Med Microbiol Research Article 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 2.5(1.3 − 4.9)(p < 0.01) and 2.8(1.2 − 6.7)(p < 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. Hindawi 2020-06-04 /pmc/articles/PMC7293720/ /pubmed/32566057 http://dx.doi.org/10.1155/2020/2967260 Text en Copyright © 2020 Maria G. Zavala-Cerna et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Zavala-Cerna, Maria G.
Segura-Cobos, Midrori
Gonzalez, Ricardo
Zavala-Trujillo, Isidro G.
Navarro-Perez, Silvia F.
Rueda-Cruz, Jose A.
Satoscoy-Tovar, Fernando A.
The Clinical Significance of High Antimicrobial Resistance in Community-Acquired Urinary Tract Infections
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
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293720/
https://www.ncbi.nlm.nih.gov/pubmed/32566057
http://dx.doi.org/10.1155/2020/2967260
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