Antimicrobial Stewardship Initiative in Treatment of Urinary Tract Infections at a Rehabilitation and Complex Continuing Care Hospital

Cheung, Anne; Karmali, Gulzar; Noble, Sandina; Song, Howard K.

doi:10.4212/cjhp.v70i2.1648

Cited by 6 publications

(11 citation statements)

References 5 publications

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“…This is why the use of ampicillin in empirical therapy of UTI as a single agent is neither appropriate nor recommended. Amoxicillin-clavulanic acid was recommended as an alternative empiric therapy for uncomplicated cystitis or a first-line therapy for moderate pyelonephritis [ 14 ]. In this study, more than one-third of the E. coli isolates were resistant to a combination of amoxicillin-clavulanic acid (34.3%), and higher resistance rates were observed in cases of K. pneumoniae (75.0%) and P. mirabilis (60.0%).…”

Section: Discussionmentioning

confidence: 99%

“…Amoxicillin plus clavulanic acid (AMC) is recommended as first-line-therapy for mild and moderate pyelonephritis or complicated UTI and as alternative empiric therapy for uncomplicated cystitis. In the case of complicated UTI or severe pyelonephritis, amoxicillin with gentamicin or a second-generation cephalosporin with an aminoglycoside are recommended as first-line empiric therapy, and third-generation cephalosporin applied intravenously as alternative empiric therapy [ 13 , 14 ]. Uropathogens change, and their antibiotic resistance has increased over the past years, becoming an important problem worldwide.…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic Resistance of Uropathogens Isolated from Patients Hospitalized in District Hospital in Central Poland in 2020

et al. 2021

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The aim of this study was to determine antibiotic resistance patterns and the prevalence of uropathogenes causing urinary tract infections (UTIs) in patients hospitalized in January–June 2020 in central Poland. Antimicrobial susceptibility testing was performed using the disk-diffusion method. Escherichia coli (52.2%), Klebsiella pneumoniae (13.7%), Enterococcus faecalis (9.3%), E. faecium (6.2%), and Proteus mirabilis (4,3%) were most commonly isolated from urine samples. E. coli was significantly more frequent in women (58.6%) (p = 0.0089) and in the age group 0–18, while K. pneumoniae was more frequent in men (24.4%) (p = 0.0119) and in individuals aged 40–60 and >60. Gram-negative species showed resistance to ampicillin. K. pneumoniae were resistant to amoxicillin plus clavulanic acid (75.0%), piperacillin plus tazobactam (76.2%), cefotaxime (76.2%), cefuroxime (81.0%), ciprofloxacin (81.0%), and trimethoprim plus sulphamethoxazole (81.0%). Carbapenems were effective against all E. coli and P. mirabilis. Some K. pneumoniae (13.6%) produced metallo-β-lactamases (MBLs). E. coli (22.6%), K. pneumoniae (81.8%), and all E. faecium were multidrug-resistant (MDR). Some E. coli (26.2%), K. pneumoniae (63.6%), and P. mirabilis (14.3%) isolates produced extended-spectrum beta-lactamases (ESBL). Vancomycin-resistant E. faecium was also found. This study showed that the possibilities of UTIs therapy using available antibiotics become limited due to the increasing number of antibiotic-resistant uropathogens.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antibiotic Resistance of Uropathogens Isolated from Patients Hospitalized in District Hospital in Central Poland in 2020

et al. 2021

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“…Urinary tract infections (UTIs) are the commonest reported bacterial infections in long term care facilities and this leads to increased use of antibiotics of which 50% of cases are believed to signify asymptomatic bacteriuria [31]. The trend of routine screening of asymptomatic bacteriuria is injurious to the patient as it increases the rates of recurrent infections with drug resistant bacteria due to increased selective pressure [32, 33]. In the current study, the increased number of urine specimens from inpatients (Fig 1D) may be the result of routine screening of asymptomatic bacteriuria perhaps due to the increased number of student interns working in these inpatient departments at NTH but the trend could reduce if or when UTI routine screening targets symptomatic patients.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of antibiotic susceptibility patterns of pathogens isolated from routine laboratory specimens at Ndola Teaching Hospital: A retrospective study

et al. 2019

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Periodic monitoring of antibiotic susceptibility patterns in clinical settings is vital to ascertain the potency as well as re-establishing empirical therapy. This retrospective study aimed to evaluate the antibiotic susceptibility patterns of pathogens isolated from routine laboratory specimens at Ndola Teaching Hospital. A retrospective study was conducted on routine specimens received between May 2016 and July 2018. Specimens were cultured on standard media and Kirby-Bauer disc diffusion method was used for susceptibility testing in accordance with the Clinical and Laboratory Standard Institute’s recommendations. A total of 693 specimens were analyzed, of which 65.9% (457) specimens came from inpatient departments and 49.1% (340) came from female patients. The commonest specimens were urine (58.6%), blood (12.7%) and wound swabs (8.5%), and the most common microorganisms were coliform (29.3%), Staphylococcus aureus (15.4%), coagulase negative Staphylococci (CoNS, 13.4%), and Escherichia coli (13%). The highest percentage of resistance to any particular antibiotic was co-trimoxazole (91.7%, 33) followed by nalidixic acid (75.2%, 279), norfloxacin (69.0%, 100), ceftazidime (55.7%, 185), nitrofurantoin (46.6%, 191), chloramphenicol (43%, 111) and ciprofloxacin (8.6%, 271). Furthermore, patient location had resistance effect on coliform (p = 0.014), CoNS (p = 0.031), Streptococcus species (p = 0.024) and Klebsiella species (p = 0.004) to nitrofurantoin, ceftazidime, nitrofurantoin and chloramphenicol, respectively. Besides coliform, resistance of Enterobacter species to ceftazidime and Proteus species to nalidixic acid were more from female patients. Generally, the most effective antibiotics were chloramphenicol and nitrofurantoin with addition of ceftazidime on blood pathogens and ciprofloxacin on wound swab pathogens. The common isolates were coliform, S. aureus, coagulase negative Staphylococci and Escherichia coli. The resistance of most bacteria to ceftazidime and nitrofurantoin were influenced by both gender and location. Our study presents a broad overview of the resistance profiles of bacterial isolates. However, more nosocomial prevalence and antibiogram studies on individual routine specimens are required to provide a more detailed picture of resistance patterns.

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“…Other mechanisms of E. coli resistance to quinolones and fluoroquinolones are related to the presence of efflux pumps and decreased uptake of the antibiotics due to changes in the outer membrane porin proteins (Asadi Karam et al 2019). Abdelhamid and Abozahra (2017) showed that the increased expression of the efflux pump-coding genes acrA and mdfA was related to the growing resistance to levofloxacin, which confirms that efflux pump systems contribute to fluoroquinolone resistance in urinary E. coli isolates.…”

Section: Mechanisms Of Upec Resistance To Antibioticsmentioning

confidence: 92%

“…UPEC producing ESBL are particularly often detected in developing countries (Iran -37.1%, Nepal -38.9%, Pakistan Kot B. 4 410 -40%, and Jordan -about 50%) (Ali et al 2016;Parajuli et al 2017;Shakhatreh et al 2018). Prasada et al (2019) revealed that in India the percentage of ESBL-producing UPEC increased from 45.2 to 59.6% over 5 years (2013)(2014)(2015)(2016)(2017). The frequency of ESBL-producing E. coli isolates is different in various parts of the world and sometimes even in various hospitals within the country.…”

Section: Mechanisms Of Upec Resistance To Antibioticsmentioning

confidence: 99%

Antibiotic Resistance Among Uropathogenic Escherichia coli

Kot

2019

Polish Journal of Microbiology

206

131

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Urinary tract infections (UTIs) belong to the most common community-acquired and nosocomial infections. A main etiological factor of UTIs is uropathogenic Escherichia coli (UPEC). This review describes the current state of knowledge on the resistance of UPEC to antibiotics recommended for the treatment of UTIs based on the available literature data. Nitrofurantoin and fosfomycin are recommended as first-line therapy in the treatment of uncomplicated cystitis, and the resistance to these antimicrobial agents remains low between UPEC. Recently, in many countries, the increasing resistance is observed to trimethoprim-sulfamethoxazole, which is widely used as the first-line antimicrobial in the treatment of uncomplicated UTIs. In European countries, the resistance of UPEC to this antimicrobial agent ranges from 14.6% to 60%. The widespread use of fluoroquinolones (FQs), especially ciprofloxacin, in the outpatients is the cause of a continuous increase in resistance to these drugs. The resistance of UPEC to FQs is significantly higher in developing countries (55.5–85.5%) than in developed countries (5.1–32.0%). Amoxicillin-clavulanic acid is recommended as first line-therapy for pyelonephritis or complicated UTI. Resistance rates of UPEC to amoxicillin-clavulanic acid are regionally variable. In European countries the level of resistance to this antimicrobial ranges from 5.3% (Germany) to 37.6% (France). Increasing rates of UPEC resistance to antimicrobials indicate that careful monitoring of their use for UTI treatment is necessary.

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Antimicrobial Stewardship Initiative in Treatment of Urinary Tract Infections at a Rehabilitation and Complex Continuing Care Hospital

Abstract: -

Cited by 6 publications

References 5 publications

Antibiotic Resistance of Uropathogens Isolated from Patients Hospitalized in District Hospital in Central Poland in 2020

Antibiotic Resistance of Uropathogens Isolated from Patients Hospitalized in District Hospital in Central Poland in 2020

Evaluation of antibiotic susceptibility patterns of pathogens isolated from routine laboratory specimens at Ndola Teaching Hospital: A retrospective study

Antibiotic Resistance Among Uropathogenic Escherichia coli

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