A global perspective on improving patient care in uncomplicated urinary tract infection: expert consensus and practical guidance

Wagenlehner, Florian M. E.; Nicolle, Lindsay E.; Bartoletti, Riccardo; Gales, Ana Cristina; Grigoryan, Larissa; Huang, Haihui; Hooton, Thomas M.; Lopardo, Gustavo; Naber, Kurt G.; Poojary, Aruna; Stapleton, Ann E.; Talan, David A.; Saucedo, José Tirán; Wilcox, Mark H.; Yamamoto, Shingo; Yang, Stephen Shei‐Dei; Lee, Seung‐Ju

doi:10.1016/j.jgar.2021.11.008

Cited by 29 publications

(24 citation statements)

References 121 publications

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“…2 Results based on a comparison between cefotaxime (tested in Germany) and ceftriaxone (tested in Tanzania). 3 Results based on a comparison between amoxicillin/clavulanic acid (tested in Germany) and ampicillin/sulbactam (tested in Tanzania).…”

Section: Resultsmentioning

confidence: 99%

“…While many UTIs have a relatively mild course and can be treated effectively, repetitive infections with considerable long-term consequences, as well as acute complications are possible, e.g., ascending pyelonephritis or bloodstream infections [2]. Females are more often affected than males, and comorbidities (e.g., diabetes) are associated with higher odds of UTIs [3]. While Gram-negative bacteria, such as Escherichia coli are the most frequent causes of UTIs worldwide, the aetiology and underlying antimicrobial susceptibility patterns vary across settings [4].…”

Section: Introductionmentioning

confidence: 99%

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Microbiological Characterisation of Community-Acquired Urinary Tract Infections in Bagamoyo, Tanzania: A Prospective Study

et al. 2022

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Urinary tract infections (UTIs) are among the most common infections in sub-Saharan Africa, but microbiological data to guide treatment decisions are limited. Hence, we investigated the bacterial aetiology and corresponding antimicrobial susceptibility patterns in outpatients with UTIs in Bagamoyo, Tanzania. Urine samples from symptomatic individuals were subjected to microbiological examinations for bacterial species identification using conventional methods and disc diffusion-based resistance testing. Subsequently, urine samples were transferred to Germany for confirmatory diagnostics using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry and automated resistance testing. Overall, 104 out of 270 (38.5%) individuals had a positive urine culture and 119 putative pathogens were identified. The most frequently detected bacteria were Escherichia coli (23%), Klebsiella spp. (7%), Enterobacter cloacae complex (3%) and Staphylococcus aureus (2%). E. coli isolates showed high resistance against cotrimoxazole (76%), ampicillin (74%), piperacillin (74%) and fluoroquinolones (37%), but widespread susceptibility to meropenem (100%), fosfomycin (98%), piperacillin/tazobactam (97%) and amoxicillin/clavulanic acid (82%). The agreement between E. coli susceptibility testing results in Tanzania and Germany was ≥95%, except for piperacillin/tazobactam (89%) and ciprofloxacin (84%). Given the considerable resistance to frequently prescribed antibiotics, such as cotrimoxazole and fluoroquinolones, future research should explore the potential of oral alternatives (e.g., fosfomycin) for the treatment of UTIs in Tanzania.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Microbiological Characterisation of Community-Acquired Urinary Tract Infections in Bagamoyo, Tanzania: A Prospective Study

et al. 2022

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“…Moreover, national guidelines in 15 European countries have great variability in the selection of antibiotics 30 ; e.g., 10 different antimicrobials were recommended as the first-line therapy. This discrepancy in national guidelines may be due in part to the unavailability of drugs in each nation; in fact, nitrofurantoin and pivmecillinam are currently unavailable in Japan 31 . Difference of antibiogram in each region should also influence on the recommendation and selection of the drugs.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial prescription practices for outpatients with uncomplicated cystitis in Japan

Takahashi

Hagiya

Higashionna

et al. 2022

Sci Rep

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To promote antimicrobial stewardship, we studied antimicrobial prescription rates for uncomplicated cystitis, a common outpatient disease requiring antibiotic treatment. This multicenter retrospective study was performed from January 1, 2018, to December 31, 2020, in Japan, targeting outpatients aged ≥ 20 years whose medical records revealed International Classification of Diseases (ICD-10) codes suggesting uncomplicated cystitis (N300). The data of 1445 patients were collected and that of 902 patients were analyzed. The overall median patient age was 71 years and a proportion of those aged less than 50 years was 18.8% with a female dominance (82.6%). Antimicrobials were prescribed for 884 patients (98.0%) and a total of 623 patients (69.1%) were treated with broad-spectrum drugs, including fluoroquinolones (36.0%), third-generation cephalosporins (29.9%) and faropenem (3.1%). A logistic regression model revealed that the broad-spectrum agents were significantly prescribed for the older patients, male patients, and those who visited internists. Recurrence was observed in 37 (4.1%) cases, and the multivariate analysis suggested any of age, sex, or antimicrobial types were not associated with the recurrence. Collectively, approximately two-thirds of antimicrobials prescribed for uncomplicated cystitis were broad-spectrum agents. The present data would be an indicator for antimicrobial prescriptions in uncomplicated cystitis in Japan.

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“…В ранних документах EAU приводился перечень рекомендованных для лечения цистита антибиотиков в алфавитном порядке, без указания какого-либо приоритета в выборе. Около 10 лет назад произошло принципиальное изменение позиции экспертов EAU, и рекомендованные антибиотики ранжировали по приоритету: средства [17]. Для того чтобы практикующие врачи-терапевты и урологи осознанно следовали рекомендациям, необходимо привести аргументы, обосновывающие выбор экспертами определенных антибиотиков для лечения цистита.…”

Section: актуальностьunclassified

Rationale for choosing an antibiotic for the treatment of cystitis: recommendations of clinical pharmacologists: A review

Yakovlev

Суворова²

2022

Terapevticheskii arkhiv

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In recent years, the harmonization of domestic and foreign clinical recommendations for the treatment of cystitis has been achieved. Nitrofurans and fosfomycin trometamol are recommended as first line therapy antibiotics, and oral 3rd generation of cephalosporins are recommended as alternative antibiotics; fluoroquinolones are excluded from the recommended medications due to an unfavorable safety profile. The main rationale for inclusion of antibiotics in the recommendations as a first line therapy of cystitis is the level of resistance of uropathogens to antibiotics, primarily Escherichia coli. Stable low level of resistance of E. coli in Russia was noted to nitrofurans and fosfomycin (5%), higher to cephalosporins. Among nitrofurans, furazidine is characterized by higher activity against E. coli compared to nitrofurantoin. The potassium salt of furazidine in dosage form with magnesium carbonate is preferred, since it is characterized by higher bioavailability and provides a therapeutic level of concentrations in urine above the MIC during the entire dosing period. Due to the global increase in the resistance of uropathogens observed in recent years, experts have begun to pay more and more attention to the ecological safety of antimicrobial therapy in order to minimize the risk of concomitant (collateral) damage, contributing to the selection of multi-drug resistant strains of microorganisms. In the latest WHO document of 2021, experts divided antibiotics into three groups (ACCESS, WATCH, RESERVE) according to the priority of choice. The ACCESS group of drugs for the treatment of cystitis includes nitrofurantoin and furazidine as agents with minimal collateral effect, while fosfomycin trometamol and cephalosporins are listed in the WATCH group. Thus, from the standpoint of ecological safety, WHO experts recommend prescribing nitrofurans in the treatment of cystitis in the first line of therapy.

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A global perspective on improving patient care in uncomplicated urinary tract infection: expert consensus and practical guidance

Cited by 29 publications

References 121 publications

Microbiological Characterisation of Community-Acquired Urinary Tract Infections in Bagamoyo, Tanzania: A Prospective Study

Microbiological Characterisation of Community-Acquired Urinary Tract Infections in Bagamoyo, Tanzania: A Prospective Study

Antimicrobial prescription practices for outpatients with uncomplicated cystitis in Japan

Rationale for choosing an antibiotic for the treatment of cystitis: recommendations of clinical pharmacologists: A review

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