Correlation of cefpodoxime susceptibility with cephalothin and cefuroxime for urinary tract isolates.
ABSTRACT This study attempted to determine whether cefuroxime was superior to cephalothin as a surrogate marker for cefpodoxime among urinary tract isolates. The Microscan© system was used to determine susceptibility for cephalothin and cefuroxime on consecutive cultures with a colony count of > 50,000 organisms. Simultaneously, an E-test for cefpodoxime was conducted. The cefpodoxime interpretation was compared to that of the other 2 agents, and the categorical agreement was calculated, defined as the percentage of identical susceptibility interpretations. Cefuroxime (83%) had a significantly higher categorical agreement than cephalothin (63%) among 300 isolates (p < 0.01). The major error rate was 16% for cephalothin, and 3% for cefuroxime. The very major error rate was 7% for cephalothin and 14% for cefuroxime among the 14 cefpodoxime-resistant isolates. For E.coli. the major error rates were 15% and 1% for cephalothin and cefuroxime, respectively. Very major error rates were 9% for both agents. Cefuroxime was a better predictor of cefpodoxime susceptibility than cephalothin, and appears to be the preferred surrogate agent for the Microscan© system, particularly for E. coli.
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ABSTRACT: A Panel of International Experts was convened by the Infectious Diseases Society of America (IDSA) in collaboration with the European Society for Microbiology and Infectious Diseases (ESCMID) to update the 1999 Uncomplicated Urinary Tract Infection Guidelines by the IDSA. Co-sponsoring organizations include the American Congress of Obstetricians and Gynecologists, American Urological Association, Association of Medical Microbiology and Infectious Diseases-Canada, and the Society for Academic Emergency Medicine. The focus of this work is treatment of women with acute uncomplicated cystitis and pyelonephritis, diagnoses limited in these guidelines to premenopausal, non-pregnant women with no known urological abnormalities or co-morbidities. The issues of in vitro resistance prevalence and the ecological adverse effects of antimicrobial therapy (collateral damage) were considered as important factors in making optimal treatment choices and thus are reflected in the rankings of recommendations.Clinical Infectious Diseases 03/2011; 52(5):e103-20. DOI:10.1093/cid/ciq257 · 9.42 Impact Factor
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ABSTRACT: Because of high rates of trimethoprim-sulfamethoxazole resistance in Escherichia coli, Denver Health switched to levofloxacin as the initial therapy for urinary tract infections (UTIs) in 1999. We evaluated the effects of that switch 6 years later. Levofloxacin prescriptions per 1000 outpatient visits and levofloxacin resistance in outpatient E. coli were evaluated over time. E. coli isolated in 2005 were further characterized by specimen source and antimicrobial susceptibilities. Risk factors for levofloxacin-resistant E. coli UTI among nonpregnant adult outpatients were evaluated in a case-control study. Between 1998 and 2005, levofloxacin use increased from 3.1 to 12.7 prescriptions per 1000 visits (P<.01) and resistance in outpatients increased from 1% to 9% (P<.01). Although prescriptions for sulfonamide antibiotics decreased by half during the same period, E. coli resistance to trimethoprim-sulfamethoxazole increased from 26.1% to 29.6%. Levofloxacin-resistant E. coli were more likely resistant to other antibiotics than levofloxacin-susceptible isolates (90% vs 43%, P<.0001). Risk factors for levofloxacin-resistant E. coli UTI were hospitalization (odds ratio for each week of hospitalization, 2.0; 95% confidence interval, 1.0-3.9) and use of levofloxacin (odds ratio, 5.6; 95% confidence interval, 2.1-27.5) within the previous year. Fluoroquinolone prescriptions increased markedly after an institutional policy change for empiric treatment of UTI, and a rapid increase in fluoroquinolone resistance among outpatient E. coli followed. Risk factors for infection with resistant E. coli were recent hospitalization and levofloxacin use. Risk factors should be considered before initiating empiric treatment with a fluoroquinolone.The American journal of medicine 11/2008; 121(10):876-84. DOI:10.1016/j.amjmed.2008.04.039 · 5.30 Impact Factor
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ABSTRACT: Of 176 urine isolates from female students positive for Escherichia coli, 29.6% were trimethoprim-sulfamethoxazole resistant and none were nitrofurantoin resistant. Among students with a history of urinary tract infection (UTI) (n = 119), resistance to ciprofloxacin was 11.8%, compared to 1.8% among those without prior UTI. Nitrofurantoin should be considered for empirical therapy of lower tract UTI.Antimicrobial Agents and Chemotherapy 01/2009; 53(3):1285-6. DOI:10.1128/AAC.01188-08 · 4.45 Impact Factor