Empiric antibiotic therapy in acute uncomplicated urinary tract infections and fluoroquinolone resistance: a prospective observational study

Aypak, Cenk; Altunsoy, Adalet; Düzgün, Nurşen

doi:10.1186/1476-0711-8-27

Cited by 72 publications

(80 citation statements)

References 29 publications

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“…In general, fluoroquinolone use should be limited whenever possible because of the high probability of de novo resistance arising from simple chromosomal point mutations. There is also growing evidence of proliferation of quinolone resistance in Nigeria including detection of horizontally transmitted resistance traits (Aypak et al, 2009;Fortini et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

Escherichia coli from Nigeria exhibit a high prevalence of antibiotic resistance where reliance on antibiotics in poultry production is a potential contributing factor

Nsofor¹,

Olatoye²,

Amosun³

et al. 2013

Afr. J. Microbiol. Res.

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To assess the prevalence of antibiotic resistance in Nigeria, single Escherichia coli isolates were collected from a geographically diverse panel of fecal samples collected from human clinical and nonclinical donors (n=77), livestock (cattle, swine, and goats) and chickens (n=71 total). There was no difference in the proportion of isolates resistant to ≥1 antibiotics from human clinical and non-clinical samples, but overall, this was significantly higher for human (85.7%) compared to animal (53.5%) isolates (P<0.0001). The average number of resistance phenotypes per isolate was significantly higher for human (5.0), goat (4.0), and poultry (3.4) compared with cattle (2.4) and swine (2.0) (P<0.05). There were 25 different resistance phenotypes with more diversity from animal compared with human isolates. A survey of management practices at 30 poultry farms in the vicinity of Ibadan found that all respondents self-milled feed and most (87.7%) routinely added antibiotics to feed. Tetracyclines were the dominant antibiotics of choice followed by tylosin and gentamicin and some use of chloramphenicol, ciprofloxacin, and enrofloxacin. If this pattern of antibiotic resistance and use is repeated across the different sectors of food-animal production and in multiple developing countries, then trade and travel are likely to disseminate resistance traits to other countries potentially negating local policies that are designed to limit selection for antibiotic resistant bacteria.

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Section: Discussionmentioning

confidence: 99%

Escherichia coli from Nigeria exhibit a high prevalence of antibiotic resistance where reliance on antibiotics in poultry production is a potential contributing factor

Nsofor¹,

Olatoye²,

Amosun³

et al. 2013

Afr. J. Microbiol. Res.

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“…However, in recent years, a worrisome increase in resistance to FQs has been addressed worldwide (4,5). Bacterial resistance to FQs is achieved mainly through the acquisition of sequential mutations in genes encoding DNA gyrase and topoisomerase IV (6,7).…”

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confidence: 99%

Plasmidic qnr Genes Confer Clinical Resistance to Ciprofloxacin under Urinary Tract Physiological Conditions

Martín-Gutiérrez

Rodríguez-Martínez

Pascual

et al. 2017

Antimicrob Agents Chemother

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Escherichia coli variants expressing plasmid-mediated qnr genes are usually susceptible to fluoroquinolones by standard susceptibility testing. Here we show that, under specific urinary tract physiological conditions, susceptible laboratory and clinical strains harboring qnr determinants become fully resistant to ciprofloxacin (CIP). Therefore, physiological conditions, mainly urine pH values, should be considered when performing susceptibility testing of CIP activity against E. coli in treating urinary tract infection (UTI) and for selecting appropriate antibiotics for UTI treatment.KEYWORDS ciprofloxacin, Escherichia coli, MIC, pH, qnr, urinary tract infection F luoroquinolones (FQs) are broad-spectrum antibiotics commonly used for urinary tract infection (UTI) (1-3). However, in recent years, a worrisome increase in resistance to FQs has been addressed worldwide (4, 5). Bacterial resistance to FQs is achieved mainly through the acquisition of sequential mutations in genes encoding DNA gyrase and topoisomerase IV (6, 7). The presence of some of these highly prevalent mutations (8, 9) often confers a low-level quinolone resistance (LLQR) phenotype with an MIC lower than the clinical breakpoint but higher than the epidemiological cutoff (10, 11). Therefore, low-level quinolone-resistant Escherichia coli mutants have been traditionally considered to be susceptible according to standard susceptibility testing. However, we recently found that growth under physiological urinary tract conditions (i.e., growth in urine, at low pH values, and under anaerobiosis) conferred clinical levels of resistance to the fluoroquinolone ciprofloxacin (CIP) (12). This situation may provide a selective scenario for the evolution of high-level quinolone resistance and could lead to therapeutic failure in patients with urinary tract infection (UTI).In contrast, plasmid-mediated low-level resistance mechanisms may also compromise the efficacy of quinolones (13). The first report ofplasmid-mediated quinolone resistance described the presence of a 218-amino-acid protein termed Qnr that protects DNA from quinolone binding to topoisomerases (14). Since then, five groups of plasmidic Qnr determinants (encoded by the genes qnrA, qnrB, qnrC, qnrD, qnrS, and qnrVC) have been described (15). Due to their plasmidic nature, qnr genes can be horizontally transferred, which confers an LLQR phenotype (15,16). Furthermore, qnr genes are often associated with extended-spectrum ␤-lactamases and aminoglycosideresistance-encoding genes on the same plasmid (17), mutually increasing the probability of dissemination (18).

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“…Bu durumun önemli nedenlerinden biri tüm dünyada olduğu gibi ülkemizde de artan kinolon direncidir. [14] Bunun yanı sıra ülkemizde yapılan diğer çalışmalar, seçilecek ajanlar hakkındaki önerilere, uygun ajanların rasyonel doz ve tedavi sürelerine sıklıkla uygun davranılmadığını ve sıklıkla polifarmasiye başvurulduğunu göstermektedir. [7] İlaçların kullanım kolaylığı hasta uyumu açısından önemlidir.…”

Section: Discussionunclassified

Comparison of Fosfomysin Trometamol and Ciprofloxacin in Uncomplicated Urinary Tract Infections

et al. 2011

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SUMMARY Objectives Acute urinary tract infection (UTI) is one of the most common infections requiring empirical antibiotic therapy. Selection of efficient and safe antimicrobial agent is important in the emergency department (ED). The aim of this study is to compare the microbiological and clinical efficiency of single-dose fosfomycin trometamol (FT) therapy with a 3-day course of ciprofloxacin (CP) for the treatment of uncomplicated UTI. Methods ÖZET AmaçAkut komplike olmayan alt üriner sistem enfeksiyonları en sık ampirik antibiyotik reçete edilen enfeksiyonlardır. Acil serviste (AS) gü-venilir ve etkin bir antimikrobiyal ajan seçimi önemlidir. Bu çalış-manın amacı, acil servise başvuran akut komplike olmayan üriner sistem enfeksiyonu olan hastalarda tek doz fosfomisin trometorol (FT) ve 3 gün siprofloksasinin (CP) klinik ve mikribiyolojik etkinliği-nin karşılaştırılmasıdır. Gereç ve YöntemBu randomize, tek kör, prospektif çalışmada AS'ye semptomları son 72 saat içinde başlayan, dizüri, idrara sıkışma hissi ve sık idrara gitme şikayeti ile başvuran 18-65 yaş kadın hastalar değerlen-dirildi. Bir grup hasta tek doz FT, diğer grup 3 günlük CP tedavisi aldı. İlk idrar kültürlerinde üreme olan hastalar çalışma grubunu oluşturdu. Tedaviden sonraki 7.-10. günlerde klinik ve mikrobiyolojik kür değerlendirildi. Tedavi rejimlerinin etkinliği ki-kare testi ile karşılaştırıldı. BulgularÇalışmadaki 81 kadının yaş ortalaması 30±2 idi. FT grubunda 40, CP grubunda 41 hasta vardı. En sık izole edilen üropatojen 50 ör-nekte bulunan E. coli idi (%61.3). Klinik olarak iyileşme CP grubunda 38 (%93), FT grubunda 38 (%96) hastada saptandı (χ²: 0,347, df: 1, p=0.275). Bakteriyolojik eradikasyon CP grubundaki hastaların 27 (%65,8), FT grubundaki hastaların 32'sinde (%80) elde edildi (χ²: 0.1591, df: 1, p=0.207). FT grubunda yalnızca 3 hastada (%7.5) pirozis görülürken CP grubunda 4 hastada (%10) pirozis, 5 hastada (%12) bulantı görüldü. SonuçKomplike olmayan üriner sistem enfeksiyonu olan kadın hastalarda tek doz FT ampirik antibiyotik olarak CP kadar etkin ve güvenlidir.Anahtar sözcükler: Ampirik tedavi; fosfomisin trometamol; idrar yolu infeksiyonu; siprofloksasin. 104

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Empiric antibiotic therapy in acute uncomplicated urinary tract infections and fluoroquinolone resistance: a prospective observational study

Cited by 72 publications

References 29 publications

Escherichia coli from Nigeria exhibit a high prevalence of antibiotic resistance where reliance on antibiotics in poultry production is a potential contributing factor

Escherichia coli from Nigeria exhibit a high prevalence of antibiotic resistance where reliance on antibiotics in poultry production is a potential contributing factor

Plasmidic qnr Genes Confer Clinical Resistance to Ciprofloxacin under Urinary Tract Physiological Conditions

Comparison of Fosfomysin Trometamol and Ciprofloxacin in Uncomplicated Urinary Tract Infections

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