scholarly journals Selection and co-selection of antibiotic resistances among Escherichia coli by antibiotic use in primary care: an ecological analysis

2019 ◽  
Author(s):  
Koen B Pouwels ◽  
Berit Muller-Pebody ◽  
Timo Smieszek ◽  
Susan Hopkins ◽  
Julie V Robotham
Keyword(s):  
Escherichia Coli ◽  
Primary Care ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Respiratory Tract ◽  
Urinary Tract Infections ◽  
Respiratory Tract Infections ◽  
Antibiotic Use ◽  
E Coli ◽  
Tract Infections

AbstractThe majority of studies that link antibiotic usage and resistance focus on simple associations between the resistance against a specific antibiotic and the use of that specific antibiotic. However, the relationship between antibiotic use and resistance is more complex. Here we evaluate which antibiotics, including those mainly prescribed for respiratory tract infections, are associated with increased resistance among Escherichia coli isolated from urinary samples.Monthly primary care prescribing data were obtained from National Health Service (NHS) Digital. Positive E. coli records from urine samples in English primary care (n=888,207) between April 2014 and January 2016 were obtained from the Second Generation Surveillance System. Elastic net regularization was used to evaluate associations between prescribing of different antibiotic groups and resistance against amoxicillin, cephalexin, ciprofloxacin, co-amoxiclav and nitrofurantoin at the clinical commissioning group (CCG) level. England is divided into 209 CCGs, with each NHS practice prolonging to one CCG.Amoxicillin prescribing (measured in DDD/ 1000 inhabitants / day) was positively associated with amoxicillin (RR 1.03, 95% CI 1.01 – 1.04) and ciprofloxacin (RR 1.09, 95% CI 1.04 – 1.17) resistance. In contrast, nitrofurantoin prescribing was associated with lower levels of resistance to amoxicillin (RR 0.92, 95% CI 0.84 – 0.97). CCGs with higher levels of trimethoprim prescribing also had higher levels of ciprofloxacin resistance (RR 1.34, 95% CI 1.10 – 1.59).Amoxicillin, which is mainly (and often unnecessarily) prescribed for respiratory tract infections is associated with increased resistance against various antibiotics among E. coli causing urinary tract infections. Our findings suggest that when predicting the potential impact of interventions on antibiotic resistances it is important to account for use of other antibiotics, including those typically used for other indications.Author summaryAntibiotic resistance is increasingly recognised as a threat to modern healthcare. Effective antibiotics are crucial for treatment of serious bacterial infections and are necessary to avoid that complicated surgical procedures and chemotherapy becoming life-threatening. Antibiotic use is one of the main drivers of antibiotic resistance. The majority of antibiotic prescriptions are prescribed in primary care, however, a large proportion of these antibiotic prescriptions are unnecessary. Understanding which antibiotics are causing antibiotic resistance to what extent is needed to prevent under- or over-investment in interventions lowering use of specific antibiotics, such as rapid diagnostic tests for respiratory tract infection.We have statistically evaluated which antibiotics are associated with higher and lower levels of antibiotic resistance against common antibiotics among Escherichia coli bacteria sampled from the urinary tract by comparing antibiotic prescribing and resistance in different geographical areas in England. Our model shows that amoxicillin, the most commonly used antibiotic in England and mainly used for respiratory tract infections, is associated with increased resistance against several other antibiotics among bacteria causing urinary tract infections. The methods used in this study, that overcome several of the limitations of previous studies, can be used to explore the complex relationships between antibiotic use and antibiotic resistance in other settings.

scholarly journals 1118. Trends of Paediatric Prescribing for Common Infections in British Columbia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S397-S397
Author(s):  
Ariana Saatchi ◽  
David M Patrick ◽  
James McCormack ◽  
Andrew Morris ◽  
Fawziah Marra
Keyword(s):  
Urinary Tract ◽  
Respiratory Tract ◽  
Urinary Tract Infections ◽  
Respiratory Tract Infections ◽  
Antibiotic Use ◽  
Pediatric Care ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Tract Infections

Abstract Background Antibiotic prescribing in pediatric care is highly prevalent, and quite often children are prescribed for conditions which are commonly self-limiting and viral in etiology. The purpose of this study was to examine the scope of pediatric antibiotic prescribing by indication, from 2013 to 2016, and identify potential new targets for provincial antimicrobial stewardship efforts. Methods Antibiotic prescription data for children were extracted from a provincial prescription database, and linked to physician billing data in order to obtain diagnostic information. Prescription rates were then calculated, and trends were examined by indication. Major categories included: upper respiratory tract infection, acute otitis media, lower respiratory tract, skin and soft tissue, and urinary tract infections. Results Our database included an average of 244,763 children per year, and 5,896,173 total antibiotic prescriptions. Increased indication-specific rates of prescribing were observed in children aged 0–2 years, for every category. Children aged 3–18 years experienced decreased prescribing across all indications, with the exception of urinary tract infections for those aged between 10–18 years. Urinary tract infections increased by 134% for children aged 0–2 years, and 75% for those aged 10–18 years, from 2013 to 2016. Although antibiotic use for upper respiratory tract infections decreased by 11% for all ages, these diagnoses continue to be prescribed for at rates 2 – 5 times higher than other conditions. Conclusion Although this study found a decrease in prescribing over time across all indications, antibiotic use continues to be a concern for upper respiratory tract infections in pediatric care. These diagnoses generally do not require antibiotics, and inappropriate prescribing is a major factor in antimicrobial resistance. The increased prescribing rates in the youngest age group (0–2 years) offers a new target for provincial stewardship efforts. Disclosures All authors: No reported disclosures.

scholarly journals Urine Microbial Landscape in Children with Urinary Tract Infections in Ryazan and Ryazan Region

Doctor Ru ◽  
2021 ◽  
Vol 20 (10) ◽  
pp. 48-53
Author(s):  
N.A. Belykh ◽  
◽  
S.V. Tereschenko ◽  
N.A. Anikeeva ◽  
S.S. Kantutis ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Klebsiella Pneumoniae ◽  
Urinary Tract Infections ◽  
Patient Specific ◽  
E Coli ◽  
Resistance Determinants ◽  
Study Results ◽  
Tract Infections

Study Objective: To study a spectrum of uropathogens and their sensitivity to antimicrobials in urinary tract infections (UTIs) in children in Ryazan and Ryazan Region. Study Design: retrospective study. Materials and Methods. We conducted a retrospective local laboratory monitoring of urinary microflora and analysed its sensitivity to antimicrobials in 111 patients aged 2 months to 17 years old who were undergoing traditional UI therapy in 2020. The study group comprised 75 (67.6%) girls and 36 (32.4%) boys. Pathogen isolation and type identification were performed using urine specimens collected in sterile disposable plastic containers prior to antimicrobial therapy. Material was delivered for analysis within 2 hours from collection. For testing of pathogen sensitivity to antimicrobials, we used the phenotyping diffusion test and an analytical test for carbapenems inactivation. Study Results. Prevailing causative agents of UIs were Escherichia coli (50.4%) and Klebsiella pneumoniae (14.4%). Resistance determinants were found in 9.0% and 2.7% of Е. соli and K. pneumoniae urological strains, respectively. The main mechanism of resistivity was production of wide spectrum plasmid β-lactamases. The highest activity in E. coli was demonstrated by generation III–IV cephalosporins, aminoglycosides, fosfomicin (100%), nitrofurantoin (91.3%), and aminopenicillins (76.1–86.9%). For K. pneumoniae, generation III–IV cephalosporins and aminoglycosides were most potent (100%). All resistant pathogens were sensitive to cefoperazone sulbactam, meropenem, imipenem, aminoglycosides (100%); tigecycline, nitrofurantoin, and fosfomicin were most potent against E. coli. Conclusion. Children with UIs in Ryazan Region had mostly gram-negative bacteria in their urine (85.6%), Enterobacteralеs (81.1%) being a prevailing type. Antimicrobials resistance determinants were quite rare (17.8%) in these urine isolates; all of them were class A ЕSBL producers. These characteristic features of antibiotic resistance of uropathogenic enterobacteria strains allow using β-lactam antibiotics in empiric initial treatment and emphasising the need in patient-specific selection of antimicrobials. Keywords: antibacterial therapy, antibiotic resistance, children, urinary tract infections, Escherichia coli, Klebsiella pneumoniae.

The Five Ds of Outpatient Antibiotic Stewardship for Urinary Tract Infections

2021 ◽  
Author(s):  
Melanie C. Goebel ◽  
Barbara W. Trautner ◽  
Larissa Grigoryan
Keyword(s):  
Primary Care ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Emergency Departments ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Outpatient Clinics ◽  
Tract Infections

Urinary tract infections (UTI) are one of the most common indications for antibiotic prescriptions in the outpatient setting. Given rising rates of antibiotic resistance among uropathogens, antibiotic stewardship is critically needed to improve outpatient antibiotic use, including in outpatient clinics (primary care and specialty clinics) and emergency departments.

ANTIBIOTIC SUSCEPTIBILITY OF BACTERIAL STRAINS, WITH SPECIAL REFERENCE TO ESCHERICHIA COLI ISOLATED FROM URINARY TRACT INFECTIONS IN RURAL MAHARASHTRA

2016 ◽  
Vol 10 (1) ◽  
pp. 202
Author(s):  
Sunil Shivaputrayya Gidamudi ◽  
Gaurav V Salunke
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Multiple Antibiotic Resistance ◽  
Bacterial Strains ◽  
Cross Sectional ◽  
E Coli ◽  
Sensitivity Pattern ◽  
Tract Infections

ABSTRACTObjective: The objective of this study was to find out the etiology of urinary tract infections (UTIs) in patients attending B.K.L. Walawalkar Hospital,Dervan and to determine their antibiotic sensitivity pattern to currently used antimicrobial agents.Methods: A cross-sectional study was conducted in a rural hospital of Konkan Maharashtra, and urine samples were collected from368 clinically - suspected cases of UTIs using the mid-stream “clean catch” method and was tested and cultured using standard procedures. Antimicrobialsusceptibility test (AST) was performed for the isolated pathogens according to the Clinical and Laboratory Standards Institute guidelines.Results: Escherichia coli (54.84%) was the most prevalent uropathogen. 76.47% of the isolated E. coli were found to be extended spectrum betalactamase producers. A higher prevalence rate of resistance was seen among E. coli to the commonly prescribed antibiotic agents. 32 (94.11%) of34 E. coli isolates recovered had multiple antibiotic resistance (MAR), with 16 isolates (50%) possessing MAR indices of 0.6.Conclusion: The study indicates the isolated microorganisms in UTI showed very high resistance to the commonly prescribed antimicrobial drugs.This suggests the monitoring and rational use of the antimicrobial agents.Keywords: Mid-stream, Culture, Uropathogen, Resistance, Multiple antibiotic resistance.

scholarly journals Antibiotic resistance pattern and phylogenetic groups of the uropathogenic Escherichia coli isolates from urinary tract infections in Hamedan, west of Iran

2020 ◽  
Author(s):  
Somayeh Bakhtiari ◽  
Hassan Mahmoudi ◽  
Sara Khosravi Seftjani ◽  
Mohammad Ali Amirzargar ◽  
Sima Ghiasvand ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Nalidixic Acid ◽  
Urinary Tract Infections ◽  
Diffusion Method ◽  
Phylogenetic Groups ◽  
E Coli ◽  
Group A ◽  
Tract Infections

Background and Objectives: Escherichia coli is the most common causative agent of urinary tract infections (UTIs) in 90-80% of patients in all age groups. Phylogenetic groups of these bacteria are variable and the most known groups are A, B1, B2 and D. The present study aimed to evaluate the phylogenetic groups of E. coli samples obtained from UTIs and their relation with antibiotic resistance patterns of isolates. Materials and Methods: In this study 113 E. coli isolates were isolated from distinct patients with UTIs referred to Hamadan hospitals. After biochemical and molecular identification of the isolates, typing and phylogenetic grouping of E. coli strains were performed using multiplex PCR targeting chu, yjaA and TSPE4.C2 genes. The anti-microbial susceptibility of the isolates to amikacin, ampicillin, trimethoprim-sulfamethoxazole, amoxicillin/clavulanic acid, ciprofloxacin, cefotaxime, imipenem, aztreonam, gentamicin, meropenem, nitrofurantoin, nalidixic acid and cefazolin was determined using disk diffusion method. Results: Of 113 isolates, 50 (44.2%), 35 (31%), 23 (20.4%) and 5 (4.4%) of samples belonged to group B2, group D, group A and group B1 phylogenetic groups respectively. All isolates were susceptible to meropenem, imipenem (100%), followed by amikacin (99.1%). The highest resistance rates were observed against ampicillin (74.3%) and nalidixic acid (70.8%). Correlation between phylogenetic groups and antibiotic susceptibilities was significant only with co-amoxiclav (P = 0.006), which had the highest resistance in phylogenetic group A. Conclusion: Prevalence of different phylogroup and resistance associated with them in E. coli samples could be variable in each region. Therefore, investigating of these items in E. coli infections, could be more helpful in selecting the appropriate antibiotic treatment and epidemiological studies.

scholarly journals Antibiotic resistance pattern of Escherichia coli isolates from outpatients with urinary tract infections in Somalia

2020 ◽  
Vol 14 (03) ◽  
pp. 284-289 ◽  
Author(s):  
Malyun Adam Mohamed ◽  
Omar Abdifetah ◽  
Fatima Abdullahi Hussein ◽  
Sa’adia Abdullahi Karie
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Resistance Rate ◽  
Resistance Pattern ◽  
E Coli ◽  
Antibiotic Resistance Pattern ◽  
History Of ◽  
Tract Infections

Introduction: Several studies suggest increasing rates of antibiotic resistance among adult populations with Urinary tract infections (UTI). Escherichia coli (E. coli), is the predominant bacterium both in the community and in hospital environments causing uropathogenic infections. This study aimed to estimate the common uropathogen bacteria that cause UTI among outpatients as well as to determine the antibiotic resistance pattern of E. coli isolates among outpatients with UTI infections at Shaafi hospital, Mogadishu, Somalia. Methodology: A cross-sectional study was conducted at Shaafi Hospital, Mogadishu, Somalia. A total of 128 samples were collected from outpatients suspected of UTI and tested through bacteriological investigations and antimicrobial susceptibility tests following the Kirby-Bauer agar disc diffusion method. Results: E. coli was isolated in 34 (41%) out of the total 83 samples that showed growth followed by Staphylococcus aureus 22 (26.5%), Pseudomonas aeruginosa, 13 (15.7%), Klebsiella pneumoniae 8 (9.6 %) and Proteus spp. 6 (7.2%). E. coli was highly sensitive to nitrofurantoin, 29 (85.3%), and ciprofloxacin (n = 23, 67.6%), and had the highest resistance rate of ceftriaxone, 33 (97.1%). The odds of having UTI were higher in patients with a history of UTI (Odds ratio OR = 0.211, 95% confidence interval CI: 0.080, 0.553) and history of antibiotic use (OR = 0.322, 95% CI: 0.113, 0.917). Increased resistance rate of E. coli against cephalosporins could be due to its excessive use as empirical therapy. Conclusion: The study indicates that outpatients with UTI could be at high risk of antibiotic resistance, suggesting regular surveillance and monitoring of antibiotics.

scholarly journals Community-Acquired Urinary Tract Infection byEscherichia coliin the Era of Antibiotic Resistance

2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Dong Sup Lee ◽  
Seung-Ju Lee ◽  
Hyun-Sop Choe
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract Infection ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Oral Antibiotics ◽  
Antibiotic Resistant ◽  
E Coli ◽  
Tract Infections

Urinary tract infections (UTIs) caused byEscherichia coli (E. coli)are the most common types of infections in women. The antibiotic resistance ofE. coliis increasing rapidly, causing physicians to hesitate when selecting oral antibiotics. In this review, our objective is to ensure that clinicians understand the current seriousness of antibiotic-resistantE. coli, the mechanisms by which resistance is selected for, and methods that can be used to prevent antibiotic resistance.

scholarly journals Molecular characterization and Antibiotic resistance profiles of Escherichia coli extended-spectrum β-lactamases producer strains isolated from urine samples in Benin

2018 ◽  
Vol 14 (30) ◽  
pp. 323
Author(s):  
Wassiyath Mousse ◽  
Haziz Sina ◽  
Mamadou Wele ◽  
Nicodeme Chabi ◽  
Durand Dah Nouvlessounon ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Hospitalized Patients ◽  
Urine Samples ◽  
E Coli ◽  
Tract Infections ◽  
Esbl Producers ◽  
Producer Strains

Urinary tract infections are the second common reason of medical consultations and antibiotics prescription. Escherichia coli is known to cause most urinary tract infections. The aim of this study was to characterize and determine the antibiotic resistance profile of E. coli extended-spectrum βlactamases (ESBL) producer strains isolated from urine samples. The urine samples collected came from hospitalized and non-hospitalized patient referred to Hubert Koutoukou Manga (HKM), National and University Hospital Center (Cotonou, Benin). The resistance to antibiotics was determined according to the disk diffusion method. The production of penicillinase and ESBLs was researched respectively by the acidimetric test and double disk synergy method. The presences of genes encoding βlactamases were detected by Polymerase Chain Reaction (PCR). Our data revealed that 60 % of E. coli strains (101) were isolated from female patients. Also, 69.31 % of the strains were isolated from non-hospitalized patients. The high resistance levels were recorded with amoxicillin (96.04 %) and amoxicillin + clavulanic acid (66.34 %). Twenty percent (20%) of strains were ESBLs. Among ESBLs strains, 70% comes from non-hospitalized patients. Eighty percent of E. coli strains produced penicillinase among which 25 % were ESBL producers. All the ESBL producers strains carried blaTEM gene whereas only 30 % carried the blaSHV gene. This study updates the data on the prevalence to antibiotic resistance of E. coli ESBL producers strains for better management of urinary tract infections.

scholarly journals Análise da resistência às quinolonas e sulfametoxazol-trimetoprim em uroculturas positivas para Escherichia coli em infecções do trato urinário comunitárias no período de 2010 a 2014 em Itajubá – MG / Analysis of quinolones and trimethoprim-sulfamethoxazole resistance in positive Escherichia coli urucultures in urinary tract infections in a community environment from 2010 to 2014 in Itajubá – MG

2017 ◽  
Vol 7 (1) ◽  
pp. 2-8
Author(s):  
Flávia Coura da Silva ◽  
Gabriela Soares Costa ◽  
José Hilário Ribeiro Grilo ◽  
Bruno Michel e Silva
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Antibiotic Therapy ◽  
Urinary Tract Infections ◽  
Therapy Resistance ◽  
Minas Gerais ◽  
Medical Community ◽  
E Coli ◽  
Tract Infections

Introdução: As infecções do trato urinário (ITU), de origem comunitária, são diagnósticos muito prevalentes a nível ambulatorial, sendo uma grande causa de uso de antibioticoterapia. Seus agentes etiológicos mais prevalentes são os bacilos gram-negativos da família Enterobacteriaceae, em especial a Escherichia coli (E. coli). Visando este agente, as terapias antimicrobianas empíricas mais utilizadas no Brasil são o sulfametoxazol-trimetoprim, quinolonas, cefalosporinas de 1º e 2º geração, amoxicilina e nitrofurantoína. Objetivos: Tendo em vista o aumento da antibioticorresistência a estes medicamentos, demonstrado na literatura médica mundial, e a importância do conhecimento deste dado pela comunidade médica local, este artigo pretende traçar o perfil de resistência às quinolonas e ao sulfametoxazol-trimetoprim pelas cepas de E. coli isoladas de uroculturas de ITU comunitária, encaminhadas para um laboratório de análises clínicas, de uma cidade do sul de Minas Gerais, no período de 2010 a 2014. Métodos: Estudo descritivo e retrospectivo por meio de pesquisa em banco de dados, no período de 2010 a 2014. Foram realizadas análises de urocultura e antibiograma, com cálculo estatístico utilizando-se o teste qui-quadrado. Resultados: Foram obtidas 14870 uroculturas, tendo crescimento bacteriano maior que 105 unidades formadoras de colônia (UFC) em 3073 amostras, das quais 2203 foram cepas de E. coli e 870 de outras bactérias. A taxa global de resistência nos 5 anos de todos os antibióticos foi de 24,46%, sendo que a de sulfametoxazol-trimetoprim em específico foi de 19,65% e a do grupo quinolonas, 19,2%. Observou-se aumento da resistência ao longo dos 5 anos (p<0,0001) e que é mais incidente em mulheres e em maiores de 65 anos. Conclusão: As taxas de resistência às quinolonas e ao sulfametoxazol-trimetoprim atingiram níveis próximos do limiar permitido para seu uso empírico. A idade e o gênero mostram-se fatores importantes na antibioticorresistência, especialmente nos maiores de 65 anos e no gênero feminino.Palavras-chave: Infecções urinárias; Farmacorresistência bacteriana; Infecções comunitárias adquiridas; Quinolonas; Trimetropima-sulfametoxazolABSTRACTIntroduction: Communitarian urinary tract infections are frequently diagnosed ambulatorily, and they are the most important cause for using antibiotic therapy. Its most common agents are gram-negative bacils from the enterobacteriaceae family, especially Escherichia coli (E. coli). Focusing on this bacterium, the empiric antibiotic therapies which are mostly used in Brazil are trimethoprim/sulfamethoxazole, quinolones, 1st and 2nd generation of cephalosporin, amoxicillin, and nitrofurantoin. Aims: Foreseeing the intense growth of antibiotic therapy resistance to these drugs shown in the world's medical literature and the importance of local medical community having knowledge of this data, this article proposes the research of quinolones and trimethoprim-sulfamethoxazole combination resistance to E. coli bacteria isolated in community-acquired UTI urocultures, from a clinical analysis laboratory, in the period from 2010 to 2014 in a southern city of the state of Minas Gerais. Methods: Retrospective and descriptive study by database research in the period from 2010 to 2014. Urocultures and antibiogram analysis were done, and the statistic calculous were made by using qui-square's test. Results: 14870 urocultures were studied. However, only 3073 samples had significant bacterial growth (bigger than 105CFU). From this result, 2203 were E. coli samples and 870 were from other bacteria. The global resistance in this 5 year study for all antibiotics was 24,46 %. Furthermore, trimethoprim-sulfamethoxazole combination resistance was 19,65% and the quinolones group was 19,2%. Through research, we have noticed an increasing resistance through these five years (p<0,0001), thus, having bigger incidence in woman and in people older than 65 years old. Conclusion: Antibiotic resistance rates almost reach unacceptable levels for therapeutic use. Age and gender demonstrated importance at antibiotic resistance, especially for people older than 65 years of age and the feminine gender.Keywords: Urinary tract infections; Drug resistance bacterial; Community-acquired infections; Quinolones; Trimethoprim-sulfamethoxazole

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