Sex, drugs, bugs, and age: rational selection of empirical therapy for outpatient urinary tract infection in an era of extensive antimicrobial resistance

Abstract

A b s t r A c tBackground: optimal empirical therapy of urinary tract infection requires accurate knowledge of local susceptibility patterns, which may vary with organism and patient characteristics.Methods: Among 9,798 consecutive, non-duplicate, community-source urine isolates from ambulatory patients ≥ 13 years old, from clinical laboratory and an academic medical center in curitiba, brazil (May 1 st to December 1 st , 2009), susceptibility data for ampicillin, nitrofurantoin, trimethoprim-sulfamethoxazole, gentamicin, fluoroquinolones, and ceftriaxone/cefotaxime were compared with organism and patient gender and age.Results: the female-to-male ratio decreased with age, from 28.1 (among 20-29 year-olds) to 3.3 (among > 80 year-olds). overall, susceptibility prevalence varied widely by drug class, from unacceptably low levels (53.5% and 61.1%: ampicillin and trimethoprimsulfamethoxazole) to acceptable but suboptimal levels (81.2% to 91.7%: fluoroquinolones, ceftriaxone, nitrofurantoin, and gentamicin). E. coli isolates exhibited higher susceptibility rates than other isolates, from 3-4% higher (fluoroquinolones, gentamicin) to ≥ 30% (nitrofurantoin, ceftriaxone). Males exhibited lower susceptibility rates than females. Within each gender, susceptibility declined with increasing age. for females, only nitrofurantoin and gentamicin were suitable for empirical therapy (≥ 80% susceptibility) across all age cohorts; fluoroquinolones were suitable only through age 60, and ceftriaxone only through age 80. for males, only gentamicin yielded ≥ 80% susceptibility in any age cohort.Conclusion: few suitable empirical treatment options for community-source urinary tract infection were identified for women aged over 60 years or males of any age. Empirical therapy recommendations must consider the patient's demographic characteristics. sitespecific, age and gender-stratified susceptibility surveillance involving all uropathogens is needed.

Antimicrobial resistance in patients with urinary tract infections and the impact on empiric therapy in Serbia

“…According to our results, not one agent could be declared fit for empiric use in elderly patients. Our findings are in accordance with numerous studies which also encountered high resistance rates among older age groups [24][25][26][27].…”

“…Guidelines state that if resistance to an antimicrobial agent exceeds the 20% threshold, it should no longer be recommended for empiric therapy [5,13,23]. Resistance rates among different age groups were observed to increase as the age of the patient increased, which supports claims from other studies [24][25][26][27]. Pathogens isolated from patients within the age group 18-34 years showed low rates of resistance to several antimicrobial agents (<10%), most notably to amikacin (4.2%), ceftriaxone (7.7%), cefepime (8.0%), and norfloxacin (10.0%), which implies that these agents should be used as firstline therapy for this age group in our population.…”

“…There are more studies demonstrating high resistance rates to both agents [23,28,[31][32][33][34], which together with our findings, question the position of trimethoprimsulfamethoxazole and ciprofloxacin as first-line therapy for UTIs. Furthermore, neither gentamicin nor cephalosporins -including cefepime, ceftriaxone, cefuroxime, and cephalexin -could be used as empiric therapy in Serbia [5,16,26] due to high resistance rates observed in this study: 29.7% for gentamicin, and 20.2%, 26.5%, 29.8%, and 31.7% for the cephalosporins respectively. Pathogens isolated from neighbouring countries confirm our findings, with resistance rates to these drugs reaching more than 50% in some [35].…”

Tipagem molecular e resistência aos antimicrobianos em isolados de Escherichia coli de frangos de corte e de tratadores na Região Metropolitana de Curitiba, Paraná

“…As resistências em 30% (6/20) para sulfametaxozol-trimetoprim em isolados de E. coli de tratadores de frangos de criação intensiva e 35% (7/20) para isolados de E. coli de tratadores de subsistência, aproximaram-se aos 42% de Esparis et al (2006), no Rio de Janeiro e aos 34,2 % encontrados por Rocha, Tuon & Johnson (2012) em Curitiba. Todos os percentuais resultam de estudos com pacientes ambulatoriais.…”

“…Este fenômeno pode ocorrer por resistência cruzada. Em Curitiba Rocha, Tuon & Johnson (2012) encontraram 17,2% de resistência à ciprofloxacina e Levofloxacina. Braios (2009) constatou 14% de resistência à ciprofloxacina em cidade do interior paulista.…”