Estudio de sensibilidad de Escherichia coli productores de infecciones del tracto urinario comunitarias en Galicia. Período: 2016-2017

Abstract

Resumen Objetivo Escherichia coli (E. coli) es el responsable de la mayoría de las infecciones del tracto urinario comunitarias. El objetivo del estudio es conocer el espectro de sensibilidad de E. coli en infecciones del tracto urinario para recomendar el tratamiento antibiótico empírico adecuado. Diseño Estudio transversal, multicéntrico, retrospectivo. Emplazamiento Ocho hospitales públicos gallegos, prácticamente toda la población de Galicia (España). Participantes Cuarenta y tres mil ciento treinta y siete pacientes ambulatorios con infección del tracto urinario por E. coli aislados en orina en 2016/2017. Mediciones principales Variables analizadas: demográficas, concentración mínima inhibitoria e interpretación de la sensibilidad según criterios de CLSI y mecanismos de resistencia. Los antibióticos estudiados fueron: ampicilina, amoxicilina-ácido clavulánico, ciprofloxacino, cefotaxima, cefepime, gentamicina, nitrofurantoína, fosfomicina, cotrimoxazol, imipenem y ertapenem. La identificación y sensibilidad se hicieron principalmente por sistemas automatizados. Resultados Los porcentajes de no sensibilidad de los aislamientos de E. coli fueron: ampicilina 49,2%, amoxicilina-ácido clavulánico 17,8%, cefotaxima 6,7%, cefepime 5,7%, ertapenem 0,04%, imipenem 0,05%, gentamicina 9,1%, ciprofloxacino 26,2%, fosfomicina 3,3%, nitrofurantoína 2,4% y cotrimoxazol 23,9%. Las no sensibilidades fueron superiores en hombres y a medida que aumenta la edad. El 6% fueron productores de betalactamasas de espectro extendido. Conclusiones El tratamiento empírico en Galicia para cistitis no complicadas producidas por E. coli en mujeres continúa siendo nitrofurantoína y fosfomicina. En hombres menores de 15 años se indica fosfomicina y en hombres mayores de 15 años el tratamiento en nuestro medio debe incluir la realización de cultivo y administrar una cefalosporina de 3. a generación oral empíricamente. No se recomienda cotrimoxazol ni ciprofloxacino como tratamiento empírico por sus altos porcentajes de resistencia.

Uropathogens antibiotic susceptibility as an indicator for the empirical therapy used for urinary tract infections: a retrospective observational study

“…Fosfomycin and nitrofurntion showed a comparable susceptibility against E. coli to the other countries, the susceptibility profile of both E. coli , and K. pneumoniae showed higher rates of resistance for several antibiotics including third-generation cephalosporins as ceftazidime, and cefepime, quinolones as ciprofloxacin, and trimethoprim/sulfamethoxazole than other studies conducted recently in Saudi Arabia ( 18 ), Ethiopia ( 19 ), Poland ( 20 ), Swiss ( 21 ), Belgium, Germany, and Spain ( 22 ), Portugal ( 23 ), in addition to Jordan ( 14 ), South Korea ( 24 ), and Spain ( 25 ), and in six European countries including Russia ( 26 ) for only E. coli . Another interesting finding is that amikacin has a notable higher susceptibility rate than gentamicin against the first and second most frequent Gram-negative isolates E. coli and K. pneumoniae .…”

Community-Acquired Uropathogenic Escherichia coli, Antimicrobial Susceptibility, and Extended-Spectrum Beta-Lactamase Detection

“…[27] The results of this study reaffi rm this proposal and coincide with reports by other authors who say that most community-acquired UTI-causing ESBL-producing E. coli are susceptible to these two antibiotics. [4,26,28] This could be due to the infrequent use of nitrofurantoin and fosfomycin trometamol in recent years, considering that the latter is not available in Cuba. However, due to bacterial capacity for mutation and continued adaptation to the environment, resistance surveillance and rational antibiotic use should be maintained.…”

Trends in Incidence and Outcomes of Hospitalizations for Urinary Tract Infection among Older People in Spain (2001–2018)

“…Unfortunately, the Spanish National Hospital Discharge Database (SNHDD) does not include information on the antibiotic sensitivities of the organisms. In Spain like in other countries, antimicrobial resistance in common urinary pathogens is increasing at an alarming rate, as a result of the overuse and misuse of antibiotics [ 43 , 44 , 45 ]. The most recent Spanish paper reported that for E. coli , which continues to be the most frequent microorganism in UTIs, the sensitivity to amoxicillin, amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole, or quinolones has increased over the last years while the rate of sensitivity to fosfomycin and nitrofurantoin remained stable and above 95%.…”

“…The most recent Spanish paper reported that for E. coli , which continues to be the most frequent microorganism in UTIs, the sensitivity to amoxicillin, amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole, or quinolones has increased over the last years while the rate of sensitivity to fosfomycin and nitrofurantoin remained stable and above 95%. The non-sensitivities were higher in men and as age increased with 6% of E. coli identified as producers of extended-spectrum beta-lactamases [ 43 , 44 , 45 ].…”