Evolution of the resistance to antibiotics of bacteria involved in urinary tract infections: A 7-year surveillance study

doi:10.1016/j.ajic.2014.06.013

American Journal of Infection Control

Volume 42, Issue 10, October 2014, Pages 1033-1038

https://doi.org/10.1016/j.ajic.2014.06.013 Get rights and content

Background

We conducted a retrospective analysis on the identification and antibiogram of all bacteria isolated from urine samples with microbiological confirmation of urinary tract infection (UTI) in a Spanish reference hospital over a 7-year period.

Methods

A retrospective analysis was performed of the identification and antibiogram data.

Results

A total of 31,758 uropathogens were isolated. Escherichia coli accounted for the majority (55.2%) of these, followed by Enterococcus faecalis (18.0%) and Klebsiella spp (10.3%). The highest E coli susceptibility rates were to imipenem (93.0%-99.8%), amikacin (97.3%-99.5%), nitrofurantoin (96.7%-98.9%), and fosfomycin (95.3%-100%), and the lowest were to cefuroxime (67.8%-86.4%), ciprofloxacin (61.2%-69.8%), and co-trimoxazole (55.0%-65.5%). We highlight the overall high activity of imipenem, piperacillin-tazobactam, nitrofurantoin, and fosfomycin on isolates versus the low activity of fluoroquinolones, co-trimoxazole, or cephalosporins. The activity of amoxicillin-clavulanic acid and fosfomycin decreased significantly over the 7-year study period.

Conclusions

Imipenem and piperacillin-tazobactam appear to be good options for the empiric treatment of UTI acquired in hospital or requiring hospitalization, whereas nitrofurantoin and fosfomycin can be first-choice antibiotics for the treatment of uncomplicated community-acquired cystitis. However, surveillance studies are required to detect resistance to these antibiotics, given that an increase in uropathogen resistance rates may contraindicate its future use in empiric UTI therapy.

Section snippets

Materials and methods

A retrospective analysis was performed of the identification and antibiogram data for all consecutive bacteria isolated from urine samples with microbiological confirmation of UTI at the Microbiology Department of Virgen de las Nieves Hospital Complex, Granada, in southern Spain, between January 2006 and December 2012.

All urine cultures were analyzed by calibrated loop seeding in usual media. A count ≥10⁵ colony-forming units (CFU)/mL was considered to indicate significant bacteriuria. A count

Results

The 31,758 bacteria identified included 24,813 (78.1%) gram-negative bacilli and 6945 (21.9%) gram-positive cocci. Over the 7-year study period, there was no significant change in the frequency of the types of bacteria identified, with E coli the most frequently identified UTI agent in each year (55.2% of all isolates; range, 50.1%-59.4%) in both community (55.6%; range, 51.5%-59.4%) and hospital (54.2%; range, 50.1%-57.4%) isolates, followed by E faecalis (18.0%; range, 14.7%-22.1%) and

Discussion

This retrospective study describes the distribution and antimicrobial susceptibility of bacterial species isolated from a large number of urine samples collected from the community and hospitalized patients over a 7-year period. Research into uropathogen resistance has centered mainly on E coli, the most frequently identified bacteria in UTIs, revealing a gradual increase in resistance that affects empiric treatment, especially in community-acquired cases.1, 3

A 2001 study of urine samples of

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Cited by (90)

Pharmacist recommendations for carbapenem de-escalation in urinary tract infection within an antimicrobial stewardship program
2020, Journal of Infection and Public Health
Citation Excerpt :
Gram-negative microorganisms are the predominant etiological agents of UTIs, specifically Enterobacteriaceae. Whereas, most UTIs are monomicrobial and are produced by Escherichia coli [10]. UTIs are considered complicated when present in patients with anatomic/functional alterations of the urinary tract, renal failure, or recurrent infections and in transplanted patients, those of advanced age, and male patients.
Carbapenem antibiotics are considered the treatment of choice for serious extended-spectrum beta-lactamase-producing Gram-negative bacteria infections. Our objectives were to analyze the results of carbapenem de-escalation therapy in complicated urinary tract infections (UTIs) attended in a third-level Spanish hospital and to evaluate the impact of pharmacist recommendation in this practice, the outcomes obtained, and associated factors.
This prospective observational study of carbapenem prescriptions and de-escalation performance was conducted in a third-level hospital between August 1 2013 and July 31, 2014. Data were gathered on carbapenem treatment duration, de-escalation, length of hospital stay, mortality rate, and associated re-admissions.
De-escalation, which was only ordered for patients with positive cultures, was conducted in 49.7% of the 163 patients with complicated UTI. More than half (69.1%) of pharmacist interventions were accepted. De-escalation reduced the median hospital stay by five days (p = 0.030). Crude hospital mortality was lower in the de-escalation group (7.4% vs. 29.3%, p < 0.001), although their exposure to carbapenems was lower (4 vs 6 days, p < 0.001).
Factors associated with de-escalation were ICU stay for at least 48 h, pharmacist recommendation and ESBL or AmpC producing Enterobacteriaceae. Factors associated with in-hospital mortality were age, previous admission and duration of hospital stay, but not pharmacist recommendation. Otherwise, carbapenem de-escalation was associated as a protective factor against in-hospital mortality.
Carbapenem de-escalation in accordance with pharmacist recommendation proved to be a safe approach in complicated UTI, reducing the hospital stay of patients without affecting the re-admission rate.
Susceptibility evolution to antibiotics of Enterobacter cloacae, Morganella morganii, Klebsiella aerogenes and Citrobacter freundii involved in urinary tract infections: an 11-year epidemiological surveillance study
2020, Enfermedades Infecciosas y Microbiologia Clinica
El objetivo fue la detección en urocultivos de Citrobacter freundii, Klebsiella aerogenes, Enterobacter cloacae, Serratia marcescens, Providencia stuartii y Morganella morganii (grupo CESPM) para el estudio de su perfil de sensibilidad a los antibióticos.
Entre 2006 y 2016 se analizaron todos los aislados de enterobacterias del grupo CESPM de urocultivos de centros de atención primaria o del complejo hospitalario Virgen de las Nieves (Granada). Se estudió la sensibilidad a aminoglucósidos, fosfomicina, nitrofurantoína, quinolonas, piperacilina/tazobactam, cefepime, imipenem y trimetoprim/sulfametoxazol, según normas del CLSI.
Se estudiaron 736 aislamientos (30,57% E. cloacae; 23,50% M. morganii; 20,38% K. aerogenes; 10,32% C. freundii; 8,83% S. marcescens y 6,38% P. stuartii). Se observó una disminución significativa de la sensibilidad. Para gentamicina, ciprofloxacino, imipenem y cefepime presentaron sensibilidad superior al 80%.
E. cloacae, M. morganii y K. aerogenes fueron las especies más frecuentemente aisladas. Cefepime e imipenem siguen siendo una buena alternativa terapéutica empírica por su actividad in vitro.
The objective of this study was to analyse the susceptibility to antibiotic of Citrobacter freundii, Klebsiella aerogenes, Enterobacter cloacae, Serratia marcescens, Providencia stuartii and Morganella morganii (CESPM group), detected in urine cultures.
Between 2006 and 2016 we analyzed CESPM group Enterobacteria isolated from urine cultures from both primary health-care centers and Hospital Virgen de las Nieves (Granada). We studied the susceptibility to aminoglycosides, fosfomycin, nitrofurantoin, quinolones, piperacillin/tazobactam, cefepime, imipenem and trimethoprim/sulfamethoxazole following CLSI interpretation criteria.
A total of 736 isolates were studied: 30.57% E. cloacae, 23.50% M. morganii, 20.38% K. aerogenes, 10.32% C. freundii, 8.83% S. marcescens and 6.38% P. stuartii. A significant decrease in the antibiotic susceptibility was observed. Gentamicin, ciprofloxacin, imipenem and cefepime showed susceptibility over 80%.
E. cloacae, M. morganii and K. aerogenes were the most common isolates. Cefepime and imipenem are still a good empiric therapeutic alternative given its activity in vitro.
Group B Streptococcus in surgical site and non-invasive bacterial infections worldwide: A systematic review and meta-analysis
2019, International Journal of Infectious Diseases
Citation Excerpt :
GBS prevalence in SSTI isolates from children (excluding neonatal omphalitis) was 1.05% (95% CI 0.15–7.09%), compared with 1.68% (95% CI 0.58–4.78%) in studies that included only adults, but this difference was unsupported by evidence of between-subgroup heterogeneity (p = 0.65). Forty-two sources reporting GBS in UTI were included (Weiner et al., 2016; European Centre for Disease Prevention and Control (ECDC), 2013; European Centre for Disease Prevention and Control (ECDC), 2017; Bouza et al., 2001a; Lee et al., 2004; Jodra et al., 2006; Phu et al., 2016; Sabra and Abdel-Fattah, 2012; Zhanel et al., 2010; Behzadnia et al., 2014; Agodi et al., 2013; Alvarez Lerma et al., 2005; Andreu et al., 2005; Bauserman et al., 2013; Bouza et al., 2001b; Brabazon et al., 2012; Choi et al., 2016; Greenhow et al., 2014; Guerreiro et al., 2012; Hanna-Wakim et al., 2015; Hayami et al., 2013; Hedin et al., 2002; Hooton et al., 2013; Karlowsky et al., 2011; Kazemier et al., 2014; Kiffer et al., 2007; Kronenberg et al., 2011; Laupland et al., 2007; Lee et al., 2011; Magliano et al., 2012; Malmartel and Ghasarossian, 2016; Matsumoto et al., 2011; Monsen et al., 2014; Moulton et al., 2017; Rodriguez et al., 2005; Sorlozano et al., 2014; Zajac-Spychala et al., 2016; Naber et al., 2008). GBS was found in 1.09% (95% CI 0.77–1.54%) of UTI isolates, with a higher prevalence for community (1.61%, 95% CI 1.13–2.30%) than hospital UTI (0.72%, 95% CI 0.43–1.22%) (between-subgroups p = 0.01) (Table 4, Figure 6).
The epidemiology of disease caused by group B Streptococcus (GBS; Streptococcus agalactiae) outside pregnancy and the neonatal period is poorly characterized. The aim of this study was to quantify the role of GBS as a cause of surgical site and non-invasive infections at all ages.
A systematic review (PROSPERO CRD42017068914) and meta-analysis of GBS as a proportion (%) of bacterial isolates from surgical site infection (SSI), skin/soft tissue infection (SSTI), urinary tract infection (UTI), and respiratory tract infection (RTI) was conducted.
Seventy-four studies and data sources were included, covering 67 countries. In orthopaedic surgery, GBS accounted for 0.37% (95% confidence interval (CI) 0.08–1.68%), 0.87% (95% CI 0.33–2.28%), and 1.46% (95% CI 0.49–4.29%) of superficial, deep, and organ/space SSI, respectively. GBS played a more significant role as a cause of post-caesarean section SSI, detected in 2.92% (95% CI 1.51–5.55%), 1.93% (95% CI 0.97–3.81%), and 9.69% (95% CI 6.72–13.8%) of superficial, deep, and organ/space SSI. Of the SSTI isolates, 1.89% (95% CI 1.16–3.05%) were GBS. The prevalence of GBS in community and hospital UTI isolates was 1.61% (1.13–2.30%) and 0.73% (0.43–1.23%), respectively. GBS was uncommonly associated with RTI, accounting for 0.35% (95% CI 0.19–0.63%) of community and 0.27% (95% CI 0.15–0.48%) of hospital RTI isolates.
GBS is implicated in a small proportion of surgical site and non-invasive infections, but a substantial proportion of invasive SSI post-caesarean section.
Urinary tract infections and antimicrobial resistance
2019, Revista Clinica Espanola
Evolution of the antibiotic-resistance of microorganisms causing urinary tract infections: A 4-year epidemiological surveillance study in a hospital population
2019, Revista Clinica Espanola
La infección del tracto urinario (ITU) es la primera causa de infección en pacientes con ingreso hospitalario. En este trabajo describimos los patógenos más frecuentemente implicados en el desarrollo de ITU en pacientes hospitalizados, su perfil de sensibilidad antibiótica y la evolución de la actividad de los antibióticos de uso habitual en el tratamiento de estas infecciones.
Se evaluaron retrospectivamente los resultados de los cultivos y antibiogramas de las muestras de orina procedentes de pacientes adultos ingresados en el Complejo Hospitalario Virgen de las Nieves (Granada, España) con confirmación microbiológica de ITU entre enero de 2013 y diciembre de 2016.
Se identificaron 4.347 microorganismos (3.969 bacterias y 378 levaduras). Durante los 4 años de estudio, y en ambos sexos, Escherichia coli fue la especie más frecuentemente aislada; sin embargo, el 62,9% de las ITU estuvieron causadas por microorganismos diferentes a este. La presencia de microorganismos multirresistentes como Acinetobacter spp. (1,2%) y de enterobacterias productoras de betalactamasas de espectro extendido (10,0%) y de carbapenemasas (0,3%) fueron también hallazgos relevantes. Imipenem, piperacilina-tazobactam y fosfomicina presentaron tasas de actividad por encima del 80%, considerando todos los microorganismos causantes de ITU, mientras que el resto de antibióticos ensayados presentaron porcentajes de actividad inferiores al 70%.
Imipenem y piperacilina-tazobactam fueron los antibióticos de uso hospitalario más activos, lo que los convierte en antibióticos de primera línea en el tratamiento empírico de la ITU en este ámbito sanitario. El uso de otros antibióticos debería estar limitado a situaciones de sensibilidad demostrada o muy probable.
Urinary tract infections (UTIs) are the leading cause of infection in hospitalised patients. In this study, we describe the most common pathogens involved in the development of UTIs in hospitalised patients, their antibiotic-sensitivity profile and the activity evolution of antibiotics in standard use for treating these infections.
We retrospectively assessed the results of cultures and antibiograms from urine samples from adult patients hospitalised in the Hospital Complex Virgen de la Nieves (Granada, Spain) with a microbiological confirmation of UTI between January 2013 and December 2016.
We identified 4,347 microorganisms (3,969 bacteria and 378 yeasts). During the 4 years of the study, Escherichia coli was the most common species isolated in both sexes; however, 62.9% of the UTIs were caused by other microorganisms. The presence of multiresistant microorganisms such as Acinetobacter spp. (1.2%) and extended-spectrum beta-lactamase-producing enterobacteria (10.0%) and carbapenemase-producing enterobacteria (0.3%) were also relevant findings. Imipenem, piperacillin-tazobactam and fosfomycin presented activity rates above 80%, considering all causal microorganisms of UTI, while the other tested antibiotics presented activity rates below 70%.
Imipenem and piperacillin-tazobactam were the most active antibiotics in hospital use, which makes them first-line antibiotics in the empiric treatment of UTIs in this healthcare setting. The use of other antibiotics should be limited to conditions of demonstrated or highly probable sensitivity.
Antimicrobial susceptibility of Escherichia coli producers of community urinary tract infections in Galicia (Spain). Period: 2016-2017
2020, Atencion Primaria
Escherichia coli (E. coli) es el responsable de la mayoría de las infecciones del tracto urinario comunitarias. El objetivo del estudio es conocer el espectro de sensibilidad de E. coli en infecciones del tracto urinario para recomendar el tratamiento antibiótico empírico adecuado.
Estudio transversal, multicéntrico, retrospectivo.
Ocho hospitales públicos gallegos, prácticamente toda la población de Galicia (España).
Cuarenta y tres mil ciento treinta y siete pacientes ambulatorios con infección del tracto urinario por E. coli aislados en orina en 2016/2017.
Variables analizadas: demográficas, concentración mínima inhibitoria e interpretación de la sensibilidad según criterios de CLSI y mecanismos de resistencia. Los antibióticos estudiados fueron: ampicilina, amoxicilina-ácido clavulánico, ciprofloxacino, cefotaxima, cefepime, gentamicina, nitrofurantoína, fosfomicina, cotrimoxazol, imipenem y ertapenem. La identificación y sensibilidad se hicieron principalmente por sistemas automatizados.
Los porcentajes de no sensibilidad de los aislamientos de E. coli fueron: ampicilina 49,2%, amoxicilina-ácido clavulánico 17,8%, cefotaxima 6,7%, cefepime 5,7%, ertapenem 0,04%, imipenem 0,05%, gentamicina 9,1%, ciprofloxacino 26,2%, fosfomicina 3,3%, nitrofurantoína 2,4% y cotrimoxazol 23,9%. Las no sensibilidades fueron superiores en hombres y a medida que aumenta la edad. El 6% fueron productores de betalactamasas de espectro extendido.
El tratamiento empírico en Galicia para cistitis no complicadas producidas por E. coli en mujeres continúa siendo nitrofurantoína y fosfomicina. En hombres menores de 15 años se indica fosfomicina y en hombres mayores de 15 años el tratamiento en nuestro medio debe incluir la realización de cultivo y administrar una cefalosporina de 3.^a generación oral empíricamente. No se recomienda cotrimoxazol ni ciprofloxacino como tratamiento empírico por sus altos porcentajes de resistencia.
Escherichia coli (E. coli) is responsible for the majority of community urinary tract infections. The objective of the study is to know the sensitivity spectrum of E. coli in urinary tract infections to be able to recommend the appropriate empirical antibiotic treatment.
Cross-sectional, multicentric, retrospective study.
Galician 8 public hospitals, practically the entire population of Galicia (Spain).
43,137 outpatients with urinary tract infection due to E. coli isolated in urine in 2016/2017.
Analyzed variables: demographic, minimum inhibitory concentration and interpretation of sensitivity according to CLSI criteria and resistance mechanisms. The antibiotics studied were: ampicillin, amoxicillin-clavulanic acid, ciprofloxacin, cefotaxime, cefepime, gentamicin, nitrofurantoin, fosfomycin, cotrimoxazole, imipenem and ertapenem. The identification and sensitivity were made mainly by automated methods.
The percentages of non-sensitivity of E. coli isolates were: ampicillin 49.2%, amoxicillin-clavulanic acid 17.8%, cefotaxime 6.7%, cefepime 5.7%, ertapenem 0.04%, imipenem 0.05%, gentamicin 9,1%, ciprofloxacin 26.2%, fosfomycin 3.3%, nitrofurantoin 2.4% and cotrimoxazole 23.9%. The non-sensitivities were higher in men and as age increases. Six percent of E. coli were producers of extended-spectrum beta-lactamases.
The empirical treatment in Galicia for uncomplicated cystitis produced by E. coli in women continues to be nitrofurantoin and fosfomycin. In men under 15 years of age, fosfomycin is indicated and in men older than 15 years, treatment in our environment should include culture and administer a 3rd generation oral cephalosporin empirically. Cotrimoxazole and ciprofloxacin are not recommended as empirical treatment because of their high resistance rates.

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Major articleEvolution of the resistance to antibiotics of bacteria involved in urinary tract infections: A 7-year surveillance study

Background

Methods

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

Enferm Infecc Microbiol Clin

Enferm Infecc Microbiol Clin

Int J Antimicrob Agents

Med Clin (Barc)

Diagn Microbiol Infect Dis

Med Clin (Barc)

J Microbiol Immunol Infect

Int J Antimicrob Agents

Microbiol Res

Int J Infect Dis

Rev Clin Esp

Enferm Infecc Microbiol Clin

Antimicrobial susceptibility of clinical Escherichia coli isolates from uncomplicated cystitis in women over a 1-year period in Spain

Rev Esp Quimioter

Changes in the antimicrobial susceptibility of Escherichia coli isolates from community-diagnosed urinary tract infections during the period 2003–2007: a multicenter study in Castilla la Mancha (Spain)

Rev Esp Quimioter

Performance standards for antimicrobial susceptibility testing; twenty-second informational supplement

Major article
Evolution of the resistance to antibiotics of bacteria involved in urinary tract infections: A 7-year surveillance study