In Vitro Antimicrobial Resistance of Urinary Escherichia coli Isolates among U.S. Outpatients from 2000 to 2010

School of Public Health and Health Services, George Washington University, Washington, DC, USA.
Antimicrobial Agents and Chemotherapy (Impact Factor: 4.48). 01/2012; 56(4):2181-3. DOI: 10.1128/AAC.06060-11
Source: PubMed


This study examines in vitro antimicrobial resistance data from Escherichia coli isolates obtained from urine samples of U.S. outpatients between 2000 and 2010 using The Surveillance Network (TSN). Antimicrobial
susceptibility results (n = 12,253,679) showed the greatest increases in E. coli resistance from 2000 to 2010 for ciprofloxacin (3% to 17.1%) and trimethoprim-sulfamethoxazole (TMP-SMX) (17.9% to 24.2%),
whereas nitrofurantoin (0.8% to 1.6%) and ceftriaxone (0.2% to 2.3%) showed minimal change. From 2000 to 2010, the antimicrobial
resistance of urinary E. coli isolates to ciprofloxacin and TMP-SMX among outpatients increased substantially.

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    • "The increase in rates of antibiotic resistance among Enterobacteriaceae has posed challenges in choosing empiric regimens , especially when infections due to multidrug-resistant Enterobacteriaceae (MDRE) are suspected or endemic [3]. In the past decade, emerging resistance among the Enterobacteriaceae due to extended-spectrum beta-lactamases (ESBL) has been reported worldwide, including in Chicago [4]. "
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    ABSTRACT: Background. Selection of empiric antibiotics for urinary tract infections (UTIs) has become more challenging because of the increasing rates of multidrug-resistant Enterobacteriaceae (MDRE) infections. Methods. This retrospective study was conducted to determine antibiotic resistance patterns, risk factors, and appropriate empiric antibiotic selection for MDRE UTIs. Adult patients seen in the Emergency Department (ED) with Enterobacteriaceae UTIs during 2008-2009 were identified from review of microbiology records. MDRE were defined as organisms resistant to at least 3 categories of antibiotics. Results. There were 431 eligible patients; 83 (19%) had MDRE UTIs. Resistance rates for individual antibiotics among MDRE UTIs were significantly greater than non-MDRE UTIs: levofloxacin, 72% versus 14%; TMP-SMX, 77% versus 12%; amoxicillin-clavulanate, 35% versus 4%; nitrofurantoin, 21% versus 12%, and ceftriaxone, 20% versus 0%. All Enterobacteriaceae isolates were susceptible to ertapenem (MIC ≤ 2 mg/L). Independent risk factors for MDRE UTI were prior fluoroquinolone use within 3 months (adjusted odds ratio (aOR) 3.64; P = 0.001), healthcare-associated risks (aOR 2.32; P = 0.009), and obstructive uropathy (aOR 2.22; P = 0.04). Conclusion. Our study suggests that once-daily intravenous or intramuscular ertapenem may be appropriate for outpatient treatment of ED patients with MDRE UTI.
    Full-text · Article · Oct 2013
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    ABSTRACT: Objective: The aim of this study was investigation of ASB prevalence and the relation for development of UTI in the people aged over 65 living in three nursing homes in Izmir province, Turkey. Methods: The people aged over 65 in three nursing homes in Izmir, who did not suffer from any urinary system symptoms, on whom no urinary catheterizations were applied within the last 15 days, and who had not received any antibacterial treatments for the last one week for any reason, were included in the study between 2003 and 2004. First urine specimens were collected in the morning and the second were collected 24 to 48 hours later. ASB were included in clinical follow-up for six months and whether or not any UTI developed was recorded at intervals. At the third month, however, it was investigated whether ASB continued in patients or not. Patients were also examined in terms of ASB facilitating factors at same time. Results: ASB was detected in 146 (24.1%) of 606 patients and more frequent in females than males (%27.8 vs. %18.6; p=0.009). The prevalence of ASB increased by age and length of stay in the nursing home. UTI was not developed and no death occurred in any of the patients during the follow-up period. At the third follow up month, it was observed that the ASB except Proteus spp. continued likewise. Conclusion: The ASB prevalence was found as quite high in elderly in our country. Direct or indirect relationship be-tween ASB and UTI has not been established. J Microbiol Infect Dis 2013; 3(1): 18-23 Yaşlılarda asemptomatik bakteriüri prevalansı ve üriner sistem enfeksiyonları ile ilişkisi ÖZET Giriş: Ülkemizde 65 yaş üstü popülasyonda üriner sistem enfeksiyonu (ÜSİ) gelişmesinde önemli yeri olan asemptoma-tik bakteriüri (ASB) prevelansı iyi tanımlanmamıştır. Bu çalışmanın amacı İzmir, Türkiye'deki 65 yaş üzeri huzurevi popü-lasyonunda ASB prevelansı ile üriner sistem enfeksiyonu gelişmesi arasındaki bağlantının araştırılmasıdır. Metot: Bu çalışma İzmir'de üç büyük huzurevindeki 65 yaş üstü üriner sistem semptomu olmayan, son 15 gün içinde üriner kateterizasyon uygulanmamış ve herhangi bir nedenle son bir haftadır antibakteriyel tedavi almayanlar ve 2003 ile 2004 yılları arasında yapıldı. Hastalardan sabah ilk orta akım idrar örnekleri ve 24-48 saat sonra ikinci idrar örnekleri alındı. ASB tespit edilenler ve edilmeyenler altı ay klinik takibe alınarak aralıklarla üriner sistem enfeksiyonu gelişip ge-lişmediği kayıt edildi. Üçüncü ayda ise hastalarda ASB'nin devam edip etmediği araştırıldı. Hastalar aynı zamanda ASB'yi kolaylaştırıcı etkenler açısından da incelendi. Bulgular: Toplam 606 hastadan 146'sında ASB tespit edildi (% 24,1). ASB sıklığı kadınlarda erkeklere göre daha sık idi (% 27,8 vs. % 18,6; p=0,009). ASB görülme oranının yaş ve huzurevindeki kalış süresiyle arttığı sonucuna varıldı. Takipte hastaların hiçbirisinde üriner sistem enfeksiyonu ve ölüm gelişmedi. Üçüncü aydaki kontrollerde Proteus spp. dışındaki ASB etkenlerinin aynen devam ettiği görüldü. Sonuç: ASB prevelansı ülkemizde de yaşlılarda oldukça yüksektir. ASB ile üriner sistem enfeksiyonu arasında dolaylı veya doğrudan bir ilişki kurulamamıştır. Anahtar kelimeler: Asemptomatik bakteriüri, huzurevi, üriner sistem enfeksiyonu Şener A, et al. Asymptomatic bacteriuria and UTI in the elderly 19 J Microbiol Infect Dis www.jmidonline.
    Full-text · Dataset · Jan 2012
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    ABSTRACT: Introduction: This review summarizes data on the fluoroquinolone resistance epidemiology published in the previous 5 years. Materials and methods: The data reviewed are stratified according to the different prescription patterns by either primary- or tertiary-care givers and by indication. Global surveillance studies demonstrate that fluoroquinoloneresistance rates increased in the past several years in almost all bacterial species except Staphylococcus pneumoniae and Haemophilus influenzae causing community-acquired respiratory tract infections (CARTIs), as well as Enterobacteriaceae causing community-acquired urinary tract infections. Geographically and quantitatively varying fluoroquinolone resistance rates were recorded among Gram-positive and Gram-negative pathogens causing healthcare-associated respiratory tract infections. One- to two-thirds of Enterobacteriaceae producing extendedspectrum b-lactamases (ESBLs) were fluoroquinolone resistant too, thus, limiting the fluoroquinolone use in the treatment of community- as well as healthcare-acquired urinary tract and intra-abdominal infections. The remaining ESBL-producing or plasmid-mediated quinolone resistance mechanisms harboring Enterobacteriaceae were low-level quinolone resistant. Furthermore, 10-30 % of H. influenzae and S. pneumoniae causing CARTIs harbored first-step quinolone resistance determining region (QRDR) mutations. These mutants pass susceptibility testing unnoticed and are primed to acquire high-level fluoroquinolone regulatory authorities, and the pharmaceutical industry have diverse interests, which, however, are not addressed by different designs of a surveillance study. Tools should be developed to provide customer-specific datasets. Conclusion: Consequently, most surveillance studies suffer from well recognized but uncorrected biases or inaccuracies. Nevertheless, they provide important information that allows the identification of trends in pathogen incidence and antimicrobial resistance.
    Full-text · Article · Mar 2012 · Infection
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