Recurrent Urinary Tract Infection in the Gynecologic Practice: Time for Reviewing Concepts and Management

Filho, Agnaldo Lopes da Silva; Contreras, Susan; Haddad, Jorge Milhem

doi:10.1055/s-0036-1597324

Cited by 1 publication

(1 citation statement)

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“…Previously published guidelines for UTIs recommend the initiation of treatment after a complete clinical evaluation and performance of urine analysis and cultures, for a judicious use of antibiotics, following local information on resistance patterns. ere is also a general recommendation to avoid the use of antibiotics in asymptomatic bacteriuria; all of these measures will aid in a decreased exposition to antibiotics and avoid the rise in antimicrobial resistance rates [8,24]. In our study, the most common clinical finding was pollakiuria (64%), and only 13% reported the presence of fever, which is consistent with a previous study, where the most frequent clinical finding was bladder tenderness in 93%, followed by pollakiuria in 92%, and the least common was fever in 7% of cases [7].…”

Section: Discussionmentioning

confidence: 99%

The Clinical Significance of High Antimicrobial Resistance in Community-Acquired Urinary Tract Infections

Zavala-Cerna

Segura-Cobos

González

et al. 2020

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Background. Urinary tract infections (UTIs) affect up to 150 million individuals annually worldwide, mainly due to Escherichia coli (E. coli) and Klebsiella. The emergence and spread of multidrug-resistant (MDR) bacteria are increasing, representing one of the biggest threats for human health. The objective of our study was to describe antimicrobial patterns of resistance and identify risk factors associated with MDR uropathogens. Methods. We conducted a cross-sectional study in 296 patients with community-acquired UTI who underwent clinical and microbiologic analysis, and clinical associations to MDR uropathogens were investigated. Findings. Microbiological analysis included E. coli (55%), ESBL-E. coli (26%), Enterococcus (6%), Klebsiella (5%), and others (8%). Higher frequencies of MDR bacteria were found among ESBL-E. coli, with resistance to ampicillin (100%), ceftriaxone (96%), gentamicin (57%), ciprofloxacin (89%), and TMP/SMX (53%). However, they were sensitive to fosfomycin (6.6%), nitrofurantoin (1.3%), and carbapenems (0%). Fosfomycin MIC90 for ESBL-E. coli was 5.78 μg/mL. The only clinical variable with significant association to ESBL producers was the presence of comorbidities: hypertension and type 2 diabetes mellitus with an OR (95%CI) of 2.51.3−4.9p<0.01 and 2.81.2−6.7p<0.05, respectively. Conclusions. In the majority of cases, resistance rates to commonly prescribed antimicrobials in UTIs were high, except for fosfomycin, nitrofurantoin, and carbapenems. To provide appropriate treatment, both the identification of risk factors and the uropathogen would be important. An active surveillance in UTIs in the community is required since the proportion of ESBL producers is increasing.

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Section: Discussionmentioning

confidence: 99%