Antibiotic resistance in outpatient urinary isolates: final results from the North American Urinary Tract Infection Collaborative Alliance (NAUTICA)

Zhanel, George G.; Hisanaga, Tamiko; Laing, Nancy M.; DeCorby, Mel; Nichol, Kim; Palatnick, Lorraine; Johnson, J.; Noreddin, Ayman M.; Harding, G. K. M.; Nicolle, Lindsay E.; Hoban, Daryl J.

doi:10.1016/j.ijantimicag.2005.08.003

Cited by 181 publications

(161 citation statements)

References 29 publications

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“…Conversely, we found that trimethoprim-sulfamethoxazole was prescribed consistently throughout the observation period for ϳ50% of UTI antibiotic visits, despite publication of numerous studies demonstrating that resistance rates to this antibiotic range from 20% to 40%. 14,[17][18][19] Broad-spectrum antibiotics were administered in approximately one third of UTI antibiotic visits. Whether this is an example of overprescribing of broad-spectrum antibiotics in the empiric treatment of UTI is difficult to establish.…”

Section: Summary Of Findingsmentioning

confidence: 99%

National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

Copp¹,

Shapiro

Hersh

2011

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:Urinary tract infections represent a significant source of exposure to antibiotics in the pediatric population and often physicians must select the antibiotic treatment empirically. No examination of ambulatory antibiotic prescribing patterns in the United States for children with urinary tract infections has been performed. WHAT THIS STUDY ADDS:Ambulatory care physicians commonly prescribe broad-spectrum antibiotics, especially third-generation cephalosporins, for the treatment of pediatric urinary tract infections. Given that narrower-spectrum alternatives are frequently appropriate options for the treatment of these infections, efforts are necessary to promote more judicious antibiotic prescribing for pediatric urinary tract infections.abstract OBJECTIVE: The goal of this study was to investigate patterns of ambulatory antibiotic use and to identify factors associated with broad-spectrum antibiotic prescribing for pediatric urinary tract infections (UTIs). METHODS:We examined antibiotics prescribed for UTIs for children aged younger than 18 years from 1998 to 2007 using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Amoxicillin-clavulanate, quinolones, macrolides, and second-and third-generation cephalosporins were classified as broad-spectrum antibiotics. We evaluated trends in broad-spectrum antibiotic prescribing patterns and performed multivariable logistic regression to identify factors associated with broad-spectrum antibiotic use. RESULTS: Antibiotics were prescribed for 70% of pediatric UTI visits. Trimethoprim-sulfamethoxazole was the most commonly prescribed antibiotic (49% of visits). Broad-spectrum antibiotics were prescribed one third of the time. There was no increase in overall use of broadspectrum antibiotics (P ϭ .67); however, third-generation cephalosporin use doubled from 12% to 25% (P ϭ .02). Children younger than 2 years old (odds ratio: 6.4 [95% confidence interval: 2.2-18.7, compared with children 13-17 years old]), females (odds ratio: 3.6 [95% confidence interval: 1.6 -8.5]), and temperature Ն100.4°F (odds ratio: 2.9 [95% confidence interval: 1.0 -8.6]) were independent predictors of broadspectrum antibiotic prescribing. Race, physician specialty, region, and insurance status were not associated with antibiotic selection. CONCLUSIONS: Ambulatory care physicians commonly prescribe broad-spectrum antibiotics for the treatment of pediatric UTIs, especially for febrile infants in whom complicated infections are more likely. The doubling in use of third-generation cephalosporins suggests that opportunities exist to promote more judicious antibiotic prescribing because most pediatric UTIs are susceptible to narrower alternatives. To our knowledge, no previous study has examined ambulatory antibiotic prescribing patterns in the United States for children with UTIs. Studies in the adult literature have demonstrated an increase in the use of broad-spectrum antibiotics for UTIs, 4-6 raising concerns that unnecessar...

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Section: Summary Of Findingsmentioning

confidence: 99%

National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

Copp¹,

Shapiro

Hersh

2011

Pediatrics

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“…Not surprisingly, the rates of resistance to these antibiotics in UPEC strains have steadily risen over the past few decades. In the United States, Canada, and elsewhere, ∼10-25% of uncomplicated UTI isolates are resistant to TMP-SMX (9)(10)(11). This trend is forcing physicians to reach for more expensive and sometimes less effective drugs to treat UTIs (10,12,13).…”

mentioning

confidence: 99%

Siderophore vaccine conjugates protect against uropathogenicEscherichia coliurinary tract infection

Mike

Smith

Sumner

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

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Uropathogenic Escherichia coli (UPEC) is the primary cause of uncomplicated urinary tract infections (UTIs). Whereas most infections are isolated cases, 1 in 40 women experience recurrent UTIs. The rise in antibiotic resistance has complicated the management of chronic UTIs and necessitates new preventative strategies. Currently, no UTI vaccines are approved for use in the United States, and the development of a highly effective vaccine remains elusive. Here, we have pursued a strategy for eliciting protective immunity by vaccinating with small molecules required for pathogenesis, rather than proteins or peptides. Small iron-chelating molecules called siderophores were selected as antigens to vaccinate against UTI for this vaccine strategy. These pathogen-associated stealth siderophores evade host immune defenses and enhance bacterial virulence. Previous animal studies revealed that vaccination with siderophore receptor proteins protects against UTI. The poor solubility of these integral outer-membrane proteins in aqueous solutions limits their practical utility. Because their cognate siderophores are water soluble, we hypothesized that these bacterial-derived small molecules are prime vaccine candidates. To test this hypothesis, we immunized mice with siderophores conjugated to an immunogenic carrier protein. The siderophore-protein conjugates elicited an adaptive immune response that targeted bacterial stealth siderophores and protected against UTI. Our study has identified additional antigens suitable for a multicomponent UTI vaccine and highlights the potential use of bacterial-derived small molecules as antigens in vaccine therapies.vaccine conjugate | urinary tract infection | siderophore | UPEC | iron acquisition

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“…Our findings are similar to other studies, although the prevalences vary. [9][10][11][12][13] In this research, most cases were complicated UTIs (72.8%), which was related to two factors, male gender (28.1%) and diabetes mellitus (25.9%). This research was performed in a tertiary care center where there was high pathogenic resistance, at 80.9% for ampicillin, 33.9% for ceftriaxone, 50.0% for norfloxacin, and 48.5% to cotrimoxazole, our first line drug, but all the pathogens studied were more than 70.0% susceptible to fosfomycin and nitrofurantoin so this research suggests treating UTIs with these agents.…”

Section: Discussionmentioning

confidence: 58%

Nitrofurantoin and Fosfomycin Susceptibility Among Outpatient Uropathogens in a Tertiary Care Center in Southern Thailand

Sangsuwan

Jamulitrat

Phengmak

2018

J Health Sci Med Res

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Abstract:Objective: To document susceptibility to fosfomycin and nitrofurantoin among uropathogens isolated from the Out Patient Department and Emergency Room of Songklanagarind Hospital. Material and Methods: From October 2011 to May 2012, bacteria isolated from urine specimens of outpatients with pyuria were evaluated for susceptibility to nitrofurantoin and fosfomycin. The medical records of the patients were reviewed for uropathogens and other antimicrobial susceptibilities. The urinary tract infections (UTIs) were classified into complicated and uncomplicated. Factors associated with fosfomycin and nitrofurantoin susceptibilities were also studied. Results: The study included 324 patients with positive urine cultures. Complicated UTIs and uncomplicated UTIs were found in 72.8% and 27.2%, respectively. The most common causative uropathogen was Escherichia coli (E. coli) (71.9%) followed by Klebsiella pneumoniae (16.7%). The susceptibility of E. coli to fosfomycin was 98.7%, and the susceptibilities of E. coli, K. pneumoniae, and overall pathogens to nitrofurantoin were 91.0%, 24.1% and 74.1% respectively. Conclusion: The uropathogens in Songklanagarind Hospital have higher susceptibilities to fosfomycin than to nitrofurantoin.

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Antibiotic resistance in outpatient urinary isolates: final results from the North American Urinary Tract Infection Collaborative Alliance (NAUTICA)

Cited by 181 publications

References 29 publications

National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

Siderophore vaccine conjugates protect against uropathogenicEscherichia coliurinary tract infection

Nitrofurantoin and Fosfomycin Susceptibility Among Outpatient Uropathogens in a Tertiary Care Center in Southern Thailand

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