scholarly journals Creating an Outpatient-Specific Antibiogram to Guide Treatment for Urinary Tract Infections

2020 ◽  
Vol 41 (S1) ◽  
pp. s182-s183
Author(s):  
Larissa Grigoryan ◽  
Melanie Goebel ◽  
Samuel Willis ◽  
Lisa Danek ◽  
Jennifer Matas ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Urinary Tract ◽  
Central America ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
The United States ◽  
First Line ◽  
E Coli ◽  
Tract Infections

Background: Outpatients with uncomplicated urinary tract infections (UTIs) are often treated empirically without culture, whereas urine cultures are typically collected from patients with complicated UTI. Susceptibilities for fosfomycin (a first-line agent) are not routinely performed or reported in the antibiogram. Understanding the prevalence of antibiotic resistance for UTI is critical for empiric treatment and antibiotic stewardship in primary care. Methods: We developed a UTI-focused antibiogram from a prospective sample of outpatients (women and men) with UTIs from 2 public family medicine clinics in an urban area with a diverse, international population (November 2018 to present). During the study period, providers ordered a urine culture for any adult patient presenting with UTI symptoms, including uncomplicated and complicated infections. We estimated the prevalence of resistance to UTI-relevant antibiotics in the overall study population and compared it between patients born in the United States and other countries. Results: We collected 678 urine cultures from 644 unique patients (79% female). Of these cultures, 158 (23.3%) had no growth, 330 (48.7%) grew mixed urogenital flora, and 190 (28.0%) were positive (>10,000 CFU/mL). Patients with positive cultures were mostly female (88.2%), and their mean age was 46.6 ± 14.8 years. Among patients with positive cultures, 42.7% were born in the United States and 57.3% were born Mexico or Central America. Escherichia coli was the most commonly isolated organism (Fig. 1). Susceptibility results for E. coli and all gram-negative organisms combined are presented in Fig. 2. Susceptibility of uropathogens to TMP-SMX was significantly higher in patients born in the United States compared to patients from Mexico or Central America (82% vs 61%; P = .03). Susceptibility to ciprofloxacin was similar in patients born in the United States and other countries (79% vs 72%; P = .50). Of 77 E. coli isolates, 11 (14%) were positive for extended-spectrum β-lactamase production, including 8 isolates from patients whose country of origin was Mexico or a Central American country. Conclusions: More than 20% of outpatients presenting with UTI symptoms had a negative urine culture. Among outpatients with uncomplicated and complicated UTI, uropathogens had a high prevalence of resistance to ciprofloxacin and TMP-SMX, but susceptibility to fosfomycin (restricted in our system) was 100%. Resistance rates for TMP-SMX were higher in patients from Mexico and Central America. Our findings question whether TMP-SMX should remain a first-line agent in US primary-care settings.Funding: This project was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number UM1AI104681.Disclosures: None

scholarly journals 1675. Epidemiology of Urinary Tract Infections in the United States, 2009 - 2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S823-S823
Author(s):  
Kendra Foster ◽  
Linnea A Polgreen ◽  
Brett Faine ◽  
Philip M Polgreen
Keyword(s):  
United States ◽  
Urinary Tract ◽  
Klebsiella Pneumoniae ◽  
Urinary Tract Infections ◽  
Proteus Mirabilis ◽  
Antibiotic Use ◽  
The United States ◽  
Drug Resistant ◽  
E Coli ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are one of the most common bacterial infections. There is a lack of large epidemiologic studies evaluating the etiologies of UTIs in the United States. This study aimed to determine the prevalence of different UTI-causing organisms and their antimicrobial susceptibility profiles among patients being treated in a hospital setting. Methods We used the Premier Healthcare Database. Patients with a primary diagnosis code of cystitis, pyelonephritis, or urinary tract infection and had a urine culture from 2009- 2018 were included in the study. Both inpatients and patients who were only treated in the emergency department (ED) were included. We calculated descriptive statistics for uropathogens and their susceptibilities. Multi-drug-resistant pathogens are defined as pathogens resistant to 3 or more antibiotics. Resistance patterns are also described for specific drug classes, like resistance to fluoroquinolones. We also evaluated antibiotic use in this patient population and how antibiotic use varied during the hospitalization. Results There were 640,285 individuals who met the inclusion criteria. Females make up 82% of the study population and 45% were age 65 or older. The most common uropathogen was Escherichia Coli (64.9%) followed by Klebsiella pneumoniae (8.3%), and Proteus mirabilis (5.7%). 22.2% of patients were infected with a multi-drug-resistant pathogen. We found that E. Coli was multi-drug resistant 23.8% of the time; Klebsiella pneumoniae was multi-drug resistant 7.4%; and Proteus mirabilis was multi-drug resistant 2.8%. The most common antibiotics prescribed were ceftriaxone, levofloxacin, and ciprofloxacin. Among patients that were prescribed ceftriaxone, 31.7% of them switched to a different antibiotic during their hospitalization. Patients that were prescribed levofloxacin and ciprofloxacin switched to a different antibiotic 42.8% and 41.5% of the time, respectively. Conclusion E. Coli showed significant multidrug resistance in this population of UTI patients that were hospitalized or treated within the ED, and antibiotic switching is common. Disclosures All Authors: No reported disclosures

URINARY INFECTION AT DEPARTMENT OF UROLOGY OF HUE UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

2018 ◽  
pp. 100-108
Author(s):  
Dinh Khanh Le ◽  
Dinh Dam Le ◽  
Khoa Hung Nguyen ◽  
Xuan My Nguyen ◽  
Minh Nhat Vo ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Clinical Manifestations ◽  
University Hospital ◽  
E Coli ◽  
Positive Urine ◽  
Tract Infections

Objectives: To investigate clinical characteristics, bacterial characteristics, drug resistance status in patients with urinary tract infections treated at Department of Urology, Hue University Hospital. Materials and Method: The study was conducted in 474 patients with urological disease treated at Department of Urology, Hue Universiry Hospital from July 2017 to April 2018. Urine culture was done in the patients with urine > 25 Leu/ul who have symptoms of urinary tract disease or infection symptoms. Patients with positive urine cultures were analyzed for clinical and bacterial characteristics. Results: 187/474 (39.5%) patients had symptoms associated with urinary tract infections. 85/474 (17.9%) patients were diagnosed with urinary tract infection. The positive urine culture rate was 45.5%. Symptoms of UTI were varied, and no prominent symptoms. E. coli accounts for the highest proportion (46.67%), followed by, Staphycoccus aureus (10.67%), Pseudomonas aeruginsa (8,0%), Streptococcus faecali and Proteus (2.67%). ESBL - producing E. coli was 69.23%, ESBL producing Enterobacter spp was 33.33%. Gram-negative bacteria are susceptible to meropenem, imipenem, amikacin while gram positive are vancomycin-sensitive. Conclusions: Clinical manifestations of urinary tract infections varied and its typical symptoms are unclear. E.coli is a common bacterium (46.67%). Isolated bacteria have a high rate of resistance to some common antibiotics especially the third generation cephalosporins and quinolones. Most bacteria are resistant to multiple antibiotics at the same time. Gram (+) bacteria are susceptible to vancomycin, and gram (-) bacteria are susceptible to cefoxitin, amikacin, and carbapenem. Key words: urinary tract infection

Trends in Catheter-Associated Urinary Tract Infections in Adult Intensive Care Units—United States, 1990–2007

2011 ◽  
Vol 32 (8) ◽  
pp. 748-756 ◽  
Author(s):  
Deron C. Burton ◽  
Jonathan R. Edwards ◽  
Arjun Srinivasan ◽  
Scott K. Fridkin ◽  
Carolyn V. Gould
Keyword(s):  
United States ◽  
Intensive Care ◽  
Urinary Tract ◽  
Intensive Care Units ◽  
Urinary Tract Infections ◽  
Asymptomatic Bacteriuria ◽  
The United States ◽  
Symptomatic Urinary Tract Infection ◽  
Prevention Guidelines ◽  
Tract Infections

Background.Over the past 2 decades, multiple interventions have been developed to prevent catheter-associated urinary tract infections (CAUTIs). The CAUTI prevention guidelines of the Healthcare Infection Control Practices Advisory Committee were recently revised.Objective.To examine changes in rates of CAUTI events in adult intensive care units (ICUs) in the United States from 1990 through 2007.Methods.Data were reported to the Centers for Disease Control and Prevention (CDC) through the National Nosocomial Infections Surveillance System from 1990 through 2004 and the National Healthcare Safety Network from 2006 through 2007. Infection preventionists in participating hospitals used standard methods to identify all CAUTI events (categorized as symptomatic urinary tract infection [SUTI] or asymptomatic bacteriuria [ASB]) and urinary catheter–days (UC-days) in months selected for surveillance. Data from all facilities were aggregated to calculate pooled mean annual SUTI and ASB rates (in events per 1,000 UC-days) by ICU type. Poisson regression was used to estimate percent changes in rates over time.Results.Overall, 36,282 SUTIs and 22,973 ASB episodes were reported from 367 facilities representing 1,223 adult ICUs, including combined medical/surgical (505), medical (212), surgical (224), coronary (173), and cardiothoracic (109) ICUs. All ICU types experienced significant declines of 19%–67% in SUTI rates and 29%–72% in ASB rates from 1990 through 2007. Between 2000 and 2007, significant reductions in SUTI rates occurred in all ICU types except cardiothoracic ICUs.Conclusions.Since 1990, CAUTI rates have declined significantly in all major adult ICU types in facilities reporting to the CDC. Further efforts are needed to assess prevention strategies that might have led to these decreases and to implement new CAUTI prevention guidelines.

scholarly journals 1686. Microbiology of Community-Onset Urinary Tract Infections in the United States, 2012-2017

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S826-S827
Author(s):  
Leigh Ellyn Preston ◽  
Clifford McDonald ◽  
Babatunde Olubajo ◽  
Natalie McCarthy ◽  
Sujan Reddy ◽  
...  
Keyword(s):  
United States ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Relative Frequency ◽  
The United States ◽  
Antibiotic Prescribing ◽  
Factors Associated ◽  
Tract Infections ◽  
Community Onset

Abstract Background Community-onset urinary tract infections (coUTIs) are one of the most common indications for antibiotic prescribing. It is important to understand patient demographic factors associated with microorganisms causing coUTI and their antibiotic resistance profiles, to tailor antibiotic prescribing practices. We analyzed microbiology data to understand factors associated with coUTI in the United States (US). Methods CoUTIs were identified in the Premier Healthcare Database and Cerner Health Facts among patients treated at participating healthcare facilities in the US between 2012-2017. Cases were defined by urine cultures yielding a bacterial organism and were collected in outpatient settings or within three days of hospitalization. Only the first specimen for each encounter was included in the analysis. Data on the organisms isolated, patient’s age, sex, and US census regions of the submitting facilities were described and compared using chi-square tests for associations. Encounters were classified as inpatient (INPT), observation (OBS), emergency department (ED), and outpatient (OTPT) based on the setting in which the culture was submitted. Results Using data from 637 acute care hospitals, urine samples from 3,291,561 encounters were included, with 776,653 (25.7%) INPT, 1,063,219 (34.8%) ED, 107,760 (3.5%) OBS, and 1,092,658 (35.8%) OTPT. The pathogens most frequently associated with coUTIs were Escherichia coli (57.3%), Klebsiella pneumoniae (9.7%), Enterococcus faecalis (5.1%), Proteus mirabilis (4.9%), and Pseudomonas aeruginosa (2.9%). Female sex, age < 65y and OTPT and ED settings were associated with higher relative frequency of E. coli (all p < 0.0001). Male sex, INPT setting and age >65 y were associated with higher relative frequency of P. aeruginosa, P. mirabilis and E. faecalis (all p < 0.0001, Figure). K. pneumoniae was found at higher relative frequency in those >45y, and in INPT and OBS settings (all p < 0.0001). Figure. Distribution of pathogens most frequently associated with community onset urinary tract infections Conclusion Understanding patient factors associated with the microbiology of coUTIs is an important step in developing treatment recommendations and antibiotic stewardship efforts. Further analyses will include assessing the impact of major antibiotic resistance phenotypes, geographic and healthcare settings. Disclosures All Authors: No reported disclosures

scholarly journals Incidence of bacterial colonisation after indwelling of double-J ureteral stent

2016 ◽  
Vol 87 (4) ◽  
pp. 291 ◽  
Author(s):  
Hasan Riza Aydin ◽  
Lokman Irkilata ◽  
Mustafa Aydin ◽  
Selim Gorgun ◽  
Hüseyin Cihan Demirel ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Early Period ◽  
Stent Insertion ◽  
Bacterial Colonisation ◽  
E Coli ◽  
Double J Stent ◽  
Aseptic Conditions ◽  
Tract Infections

Objective: To determine the bacterial colonisation after double-J stent use and the risk factors for bacteriuria linked to the stent. Materials and Methods: A total of 102 patients (61 men and 41 women, mean age 47.5 ± 14.16) were examined. The stents were removed under aseptic conditions, and a urine culture was obtained before the removal of the stents. After the stents were removed, the upper, central and lower sections were separated, and washing water was sent through the stent. Results: Bacterial colonisation was found in 29.4% (30 of 102) of the stents. The most frequently observed microorganisms were determined as staphylococcus, coagulase negative (8 of 30) and E. coli (5 of 30). The washing fluid used to clean the interior of the catheter produced pathogens in 8 patients (7.8%), and these pathogens were observed to be the same microorganisms that colonised the outside of the stent. There was no statistical difference between the patients with colonisation and those without in terms of age, gender, duration of stenting and reason for stent insertion. Conclusions: Though stent colonisation does not always entail symptomatic urinary tract infections, as shown in our study, the pathogens in the urine culture are the same as those colonising the stent, confirming the reality that colonisation is the main factor in these events. Additionally, according to our study, significant colonisation may be found in the first 3 weeks, contrary to the literature, causing us to consider that urinary tract infections may develop even in the early period.

scholarly journals Prevalence of Urinary Tract Infections in Children and Changes in Sensitivity to Antibiotics of E. coli Strains

2019 ◽  
Vol 70 (11) ◽  
pp. 3788-3792
Author(s):  
Adrian Hasegan ◽  
Maria Totan ◽  
Elisabeta Antonescu ◽  
Adrian Gheorghe Bumbu ◽  
Carmen Pantis ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Disk Diffusion ◽  
Diffusion Method ◽  
Sensitivity Testing ◽  
Disk Diffusion Method ◽  
E Coli ◽  
Positive Urine ◽  
Tract Infections

Urinary tract infections (UTIs) are the most common bacterial pathologies in children, but they are difficult to spot. The diagnosis relies on urine culture in order to measure the prevalence of the infection, to identify the etiology and the sensitivity of the germs to different antibiotics. Escherichia coli (E. coli) strains are the most common uro-pathogen germs. The change in sensitivity to antibiotic of these uro-pathogen bacteria should be closely monitored because the physicians should be informed about the evolution of the antibiotic resistance of E coli, for a more effective treatment in their fight against diseases. The study aimed to determine the prevalence of UTIs and the evolution of antimicrobial sensitivity for E. coli. This retrospective study was performed over a period of 4 years, 2013-2016, and included all the patients admitted in the Children�s Hospital, aged 0-18 years, with the suspicion of UTIs; also, the standard culture techniques for urine samples, the modified Kirby-Bauer disk diffusion method for the antibiotic sensitivity testing, and the disk diffusion method to confirm the ESBL production by the clinical isolates of E. coli in urine were used. The statistical analysis was performed using the proportions of sensitive, resistant and intermediates. Descriptive statistics like the total, mean and percentage were performed using the Statistical Package for the Social Sciences (SPSS), version 15.0 and Microsoft Excel. From 15389 urine cultures processed in 4 years, 1530 were positive (9.9 %). Among these positive urine cultures, 1056 (69 %) were positive for E. coli. Testing the E. coli to a range of antibiotics, according to CLSI standard, a high resistance to Ampicillin (69-96%), Amoxicillin/Clavulanic acid (32-70%), Trimethoprim/Sulfamethoxazole (36-42%) was observed and low levels of resistance to Ceftazidime, Cefuroxime, Cefpodoxime, Gentamycin, Nalidixic acid. Among E. Coli strains, 9-9.6 % were ESBL positive. Despite the low number of positive urine cultures in a paediatric population, it is very important to perform the urine culture in order to correctly identify the etiology of UTIs, recommend the right antibiotic, and avoid the wrong use of the antibiotics in children.

scholarly journals A study of risk factors for bacteremia caused by urinary tract infections

2018 ◽  
Vol 9 (5) ◽  
pp. 25-30
Author(s):  
Muralidhar Varma ◽  
Sravan Kumar Peravali ◽  
Vandana KE ◽  
Asha Kamath ◽  
Rahul Singh
Keyword(s):  
Risk Factors ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Tertiary Care ◽  
Blood Cultures ◽  
Medical Sciences ◽  
E Coli ◽  
Tract Infections ◽  
Control Study

Background: Urinary tract infections are not only one of the most common infections, but also one of the most common sources of bacteremia in both the general population and hospitalized patients.Aims and Objectives: The objective of this study was to identify risk factors for bacteremia caused by urinary tract infections.Materials and Methods: This was a prospective case control study conducted from October 2012 to July 2014in a tertiary care teaching hospital in southern India. Urinary tract infections were diagnosed based on the CDC criteria.Patients witha set of blood cultures and urine culture isolating same organism were grouped as cases while patients with urine culture alone isolating organism with sterile blood cultures were identified as controls.Results: Out of the 198 patientsin the study, 66 were cases while 132 were controls. E coli was the most organism isolated (81% of cases and 66% of controls). Risk factors for bacteremia based on univariate and multivariate analysis were diabetes mellitus with uncontrolled sugars (univariate: p=0.001; OR=5.250 [2.044-13.582]; and multivariate: p=0.01; OR= 6.023 [1.52-23.51]) and pyelonephritis (univariate: p=0.001; OR=6.56 [2.87-1.48]; and multivariate: p=0.047; OR=4.95 [1.02-24.12]).Conclusion: Upper UTI and complicated UTI patients should be evaluated for bacteremia since prompt and targeted treatment may be required.Asian Journal of Medical Sciences Vol.9(5) 2018 25-30

scholarly journals Community-Acquired Antibiotic Resistance in Urinary Isolates from Adult Women in Canada

2006 ◽  
Vol 17 (6) ◽  
pp. 337-340 ◽  
Author(s):  
Warren J McIsaac ◽  
Tony Mazzulli ◽  
Joanne Permaul ◽  
Rahim Moineddin ◽  
Donald E Low
Keyword(s):  
British Columbia ◽  
Urinary Tract ◽  
Urine Culture ◽  
Multidrug Resistant ◽  
Adult Women ◽  
Limited Data ◽  
First Line ◽  
Acute Cystitis ◽  
E Coli ◽  
Tract Infections

BACKGROUND:There are currently limited data regarding the prevalence of antimicrobial-resistant organisms causing community-acquired urinary tract infections among adult women in Canada. Trimethoprim-sulfamethoxazole (TMP-SMX) is the recommended first-line empirical antibiotic treatment, unless resistance ofEscherichia colito TMP-SMX exceeds 20%.OBJECTIVE:To assess current levels of TMP-SMX-resistantE coliin community-acquired cases of urinary tract infection in adult women.METHOD:Assessment of urine culture reports obtained from 21 laboratories across Canada, submitted by family physicians for women aged 16 years and older.RESULTS:In 2199 adult women with a positive urine culture, 1079 (49.1%) of pathogens isolated were resistant to at least one antibiotic and 660 (30.0%) were multidrug-resistant (resistant to two or more antibiotics). TMP-SMX resistance was seen in 245 of 1613 (15.2%)E coliisolates (95% CI 13.5 to 17.0). This proportion was higher in women 50 years of age and older (155 of 863 isolates [18.0%]; P=0.001), in British Columbia (70 of 342 isolates [20.5%]) and in Ontario (62 of 370 isolates [16.8%]) when compared with eastern provinces (65 of 572 isolates [11.4%]; P=0.001). Fluoroquinolone-resistantE colioccurred in 107 of 1557 (6.9%) isolates (95% CI 5.7 to 8.2), with the highest level found in British Columbia (54 of 341 isolates [15.8%]; P=0.001).CONCLUSION:TMP-SMX continues to be appropriate as first-line empirical treatment of acute cystitis in adult women in Canada, as resistance remains below 20%. However, TMP-SMX resistance is higher in older women and in some provinces. The level of fluoroquinolone-resistantE coliis highest in British Columbia.

Sign in / Sign up

Export Citation Format

Share Document