Management of Urinary Tract Infections in the Era of Increasing Antimicrobial Resistance

Shepherd, Amanda; Pottinger, Paul S.

doi:10.1016/j.mcna.2013.03.006

Cited by 61 publications

(45 citation statements)

References 84 publications

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“…Although definitive diagnosis of cystitis is made with clinical symptoms and bacteriuria, dysuria, frequency, and urgency have all been associated with the diagnosis of UTI [17, 18]. While the urine dipstick may be helpful in diagnosing UTI, it is unable to effectively rule it out with moderate clinical suspicion.…”

Section: Discussionmentioning

confidence: 99%

A single center observational study on emergency department clinician non-adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infections

et al. 2016

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BackgroundThe Emergency Department (ED) is a frequent site of antibiotic use; poor adherence with evidence-based guidelines and broad-spectrum antibiotic overuse is common. Our objective was to determine rates and predictors of inappropriate antimicrobial use in patients with uncomplicated urinary tract infections (UTI) compared to the 2010 International Clinical Practice Guidelines (ICPG).MethodsA single center, prospective, observational study of patients with uncomplicated UTI presenting to an urban ED between September 2012 and February 2014 that examined ED physician adherence to ICPG when treating uncomplicated UTIs. Clinician-directed antibiotic treatment was compared to the ICPG using a standardized case definition for non-adherence. Binomial confidence intervals and student’s t-tests were performed to evaluate differences in demographic characteristics and management between patients with pyelonephritis versus cystitis. Regression models were used to analyze the significance of various predictors to non-adherent treatment.Results103 cases met the inclusion and exclusion criteria, with 63.1 % receiving non-adherent treatment, most commonly use of a fluoroquinolone (FQ) in cases with cystitis (97.6 %). In cases with pyelonephritis, inappropriate antibiotic choice (39.1 %) and no initial IV antibiotic for pyelonephritis (39.1 %) where recommended were the most common characterizations of non-adherence. Overall, cases of cystitis were no more/less likely to receive non-adherent treatment than cases of pyelonephritis (OR 0.9, 95 % confidence interval 0.4–2.2, P = 0.90). In multivariable analysis, patients more likely to receive non-adherent treatment included those without a recent history of a UTI (OR 3.8, 95 % CI 1.3–11.4, P = 0.02) and cystitis cases with back or abdominal pain only (OR 11.4, 95 % CI 2.1–63.0, P = 0.01).ConclusionsPatients with cystitis with back or abdominal pain only were most likely to receive non-adherent treatment, potentially suggesting diagnostic inaccuracy. Physician education on evidence-based guidelines regarding the treatment of uncomplicated UTI will decrease broad-spectrum use and drug resistance in uropathogens.

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Section: Discussionmentioning

confidence: 99%

A single center observational study on emergency department clinician non-adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infections

et al. 2016

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“…Women with uncomplicated cystitis, by definition, should not have most of the exposures associated with an MDR organism. In this population, antimicrobial use, prior history of UTIs, recent international travel, and chronic medical conditions are factors associated with resistance that should be assessed [9,10].…”

Section: Risk Factors For Utis Caused By Mdr Uropathogensmentioning

confidence: 99%

Clinical Management of an Increasing Threat: Outpatient Urinary Tract Infections Due to Multidrug-Resistant Uropathogens: Table 1.

et al. 2016

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Urinary tract infections (UTIs) are among the most commonly treated bacterial infections. Over the past decade, antimicrobial resistance has become an increasingly common factor in the management of outpatient UTIs. As treatment options for multidrugresistant (MDR) uropathogens are limited, clinicians need to be aware of specific clinical and epidemiological risk factors for these infections. Based on available literature, the activity of fosfomycin and nitrofurantoin remain high for most cases of MDR Escherichia coli UTIs. Trimethoprim-sulfamethoxazole retains clinical efficacy, but resistance rates are increasing internationally. Beta-lactam agents have the highest rates of resistance and lowest rates of clinical success. Fluoroquinolones have high resistance rates among MDR uropathogens and are being strongly discouraged as first-line agents for UTIs. In addition to accounting for local resistance rates, consideration of patient risk factors for resistance and pharmacological principles will help guide optimal empiric treatment of outpatient UTIs.

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“…Treatment of UTI begins before the culture results are available and then changed to culture-specific therapy (4). Antimicrobial resistance of urinary pathogens is increasing worldwide and patients with risk factors for resistance may especially benefit from urine culture (5). Sensitivity and resistance of microorganisms to antibiotics have geographical variation and knowledge of these factors is important in determining the antimicrobial policies of hospitals.…”

Section: Introductionmentioning

confidence: 99%

Bacterial Uropathogens Causing Urinary Tract Infection and Their Resistance Patterns Among Children in Turkey

Yılmaz

Tazegun²,

Aydin

et al. 2016

Iran Red Crescent Med J

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BackgroundUrinary tract infection (UTI) is a common problem in infants and children, as well as adults.ObjectivesThe aim of this study was to assess the most common bacterial uropathogens, their susceptibility, and resistance to antibiotics in children with UTI.Materials and MethodsThis study included 7,365 urine samples sent from various departments to the Kars state hospital microbiology laboratory between January 2012 and May 2014. Bacterial isolation from clinical samples was made using standard microbiological methods. Antibiotic susceptibilities were determined by disk diffusion, according to CLSI recommendations.ResultsBacterial growth was obtained in 1,373 samples (18.5%). The percentage distributions of the isolates were as follows: Escherichia coli, 940 (68.5%); Proteus spp, 183 (13.3%); Staphylococcus spp, 85 (6.2%); Enterococcus spp, 65 (4.7%); Klebsiella, 62 (4.5%); Pseudomonas aeruginosa, 21 (1.5%); and other Gram-negative bacteria and Gram-positive bacteria, 17 (1.2%). UTIs were more prevalent, after two years of age, among females than males (P < 0.001).ConclusionsThe identification of the most common microorganisms causing infectious diseases and regional resistance patterns is important in order to determine the antimicrobial policies and infection control guidelines of hospitals.

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Management of Urinary Tract Infections in the Era of Increasing Antimicrobial Resistance

Cited by 61 publications

References 84 publications

A single center observational study on emergency department clinician non-adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infections

A single center observational study on emergency department clinician non-adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infections

Clinical Management of an Increasing Threat: Outpatient Urinary Tract Infections Due to Multidrug-Resistant Uropathogens: Table 1.

Bacterial Uropathogens Causing Urinary Tract Infection and Their Resistance Patterns Among Children in Turkey

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