Tackling antimicrobial resistance in lower urinary tract infections: treatment options

Abstract

Urinary tract infections (UTIs) are among the most common infectious diseases occurring in either the community or healthcare settings. A wide variety of bacteria are responsible for causing UTIs, however extra-intestinal pathogenic E. coli or ExPEC) remains the most common etiological agent. Since 2000, resistance to antibiotics emerged globally among ExPEC and is causing delays in appropriate therapy with subsequent increased morbidity and mortality. For patients with acute uncomplicated lower UTIs, nitrofurantoin, trimethoprim-sulfamethoxazole, fosfomycin or pivmecillinam should be prescribed for a 1-5 day course depending on the agent used. Single-dose fosfomycin is an excellent option for uncomplicated lower UTIs and has had similar clinical and/or bacteriological efficacy for 3-or 7-day regimens for alternate agents (i.e., ciprofloxacin, norfloxacin, cotrimoxazole or nitrofurantoin). The aim of this review article is to provide an overview on the definitions, etiology, treatment guidelines (including agents for 1 infections due to antimicrobial resistant bacteria) of lower UTIs and to highlight recent aspects on antimicrobial resistance of ExPEC.

The population structure of clinical extra-intestinal Escherichia coli in a teaching hospital from Nigeria

“…Extraintestinal pathogenic E. coli from this Nigerian study showed very high levels of resistance to ampicillin, trimethoprim-sulphamethoxazole, gentamicin, ceftriaxone and ciprofloxacin. These agents are often used to empirically treat infections due to ExPEC (Pitout et al, 2016). This may be partly related to the readily availability of these agents and more likely to be misused especially in African countries where stringent measures to ensure rational use of antimicrobial agents is still limited.…”

Uncomplicated urinary tract infections. Antimicrobial susceptibility study in Navarre

“…Esta tasa mantenida puede ser debida al buen uso que se ha realizado de este antibiótico. Su posología facilita una buena administración y su mecanismo de acción y resistencia no conlleva el desarrollo de resistencias cruzadas 2,3,11 . Se ha descrito buena sensibilidad a fosfomicina en cepas E. coli BLEE, siendo un fármaco útil en microorganismos con este mecanismo de resistencia 11 .…”

“…El principal microorganismo causante de ITU es Escherichia coli 1,2 , mientras que otros microorganismos capaces de causar ITU, con una frecuencia variable según la serie, son diferentes especies de Klebsiella, Proteus, Enterobacter, Morganella, Citrobacter, Serratia, Pseudomonas, Enterococcus, Streptococcus, Staphylococcus y levaduras 3,4 .…”

Untitled

“…ASB is defined as growth of more than 100 000 colony forming units per millilitre (cfu/ ml) in culture of midstream urine obtained from an individual without signs and symptoms of asymptomatic bacteriuria [1,2]. ASB prevalence generally ranges from 2% to 10% [3].…”

“…There is presently alarmingly increasing reports internationally about bacterial resistance among strains responsible for UTIs including ASB [10][11][12][13]. Antibiotic resistance was known in the world since 2000 and is currently believed to cause a delay in proper treatment, resulting in prenatal mortality and morbidity [1]. Knowledge of local sensitive and resistant pattern of uro-pathogens is therefore required for efficacy and prevention of resistant rates.…”