Antimicrobial Resistance of Escherichia coli Causing Uncomplicated Urinary Tract Infections: A European Update for 2014 and Comparison with 2000 and 2008

Abstract

IntroductionThe objective of this study was to provide an update on the resistance of Escherichia coli in women with acute uncomplicated urinary tract infections (UTIs) in France, Germany, Spain, Sweden, and the United Kingdom (UK) to mecillinam [amdinocillin (United States Adopted Name)], amoxicillin–clavulanic acid, cefadroxil, nitrofurantoin, ciprofloxacin, and trimethoprim, and to compare the results with resistance in the ECO.SENS I and II surveys in 2000 and 2008, respectively.MethodsThe susceptibility of E. coli in France (166 isolates), Germany (133 isolates), Spain (169 isolates), Sweden (137 isolates), and the UK (124 isolates) was determined by disc diffusion according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints and methodology. Resistance rates were compared using Fisher’s exact test, 2-tailed, with P < 0.05 indicating statistical significance.ResultsSince 2000, there has been a significant increase in resistance to cefadroxil in Germany (1% to 12%) and Spain (3% to 8%), to ciprofloxacin in Germany (2% to 21%), Spain (15% to 31%), Sweden (0% to 7%), and the UK (1% to 15%), to trimethoprim in Germany (23% to 37%), Spain (25% to 37%), Sweden (9% to 17%), and the UK (13% to 46%), to mecillinam in Spain (1% to 6.5%), and to nitrofurantoin in the UK (0% to 6%); there was also a significant decrease in resistance to nitrofurantoin in Spain (4% to 0%). Since 2008, there has been a significant increase in resistance to ciprofloxacin in Sweden (3% to 15%) and the UK (1% to 15%), and to trimethoprim (13% to 46%) and nitrofurantoin (0% to 6%) in the UK.ConclusionE. coli isolates from women with acute uncomplicated UTIs have increasing antimicrobial resistance, particularly to ciprofloxacin and trimethoprim. However, resistance to mecillinam and nitrofurantoin mostly remains low.FundingLEO Pharma.Electronic supplementary materialThe online version of this article (doi:10.1007/s40121-015-0095-5) contains supplementary material, which is available to authorized users.

Rapid and Simultaneous Quantitation of Amoxicillin and Clavulanic Acid in Human Plasma and Urine by Ultra-Performance Liquid Chromatography Tandem Mass Spectrometry and Its Application to a Pharmacokinetic Study

“…5 A series of combination ratios (2:1, 4:1, 7:1, or 8:1) are commercially available. Increasing antibiotics resistance leads to less clinical efficacy, 6,7 which needs optimization of the dose regimen in the clinical treatment of old and new antibiotics. 8 Increasing proportion of amoxicillin in the combination can achieve a better bactericidal effect, especially for Penicillinresistant streptococcus pneumoniae (PRSP).…”

Diagnosing antimicrobial resistance

“…Another example is the switch from using ciprofloxacin to cephalosporins for the treatment of gonorrhoea, as cephalosporins are less effective for the treatment of pharyngeal infection. Trimethoprim or ciprofloxacin could still be used in the approximately 60% of infections caused by susceptible pathogens 5,6 , if these could be identified in a timely fashion using rapid diagnostics. PCR tests, particularly more recent sample-to-answer multiplex PCR technologies (for example, Biofire Filmarray and Curetis Unyvero panels), are becoming more commonly used in clinical microbiology.…”

Tackling antimicrobial resistance in lower urinary tract infections: treatment options

“…However, in the intervening period, treatment approaches have become more complicated because of the steady rise in antimicrobial resistance amongst uropathogens, particularly E. coli [57][58][59][60][61], requiring the IDSA and the ESMID to update their conjoint guidelines in 2010 [62]. Although ampicillin was initially the recommended treatment of choice for uncomplicated lower UTI, this is no longer the case because of the very high prevalence of antimicrobial resistance to both amoxicillin and ampicillin worldwide [63][64][65]. However, other B-lactams including cefdinir, cefaclor, amoxicillin-clavulanate and cefpodoxime-proxetil in 3-7 day regimens continue to be recommended for treatment of uncomplicated cystitis when susceptibility is confirmed, and other agents cannot be used [62].…”