Resistance to Ciprofloxacin in urinary infections in patients hospitalized in the medicinainterna service (original) (raw)
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Postgraduate Medicine, 2019
Urinary tract infections (UTIs) caused by antibiotic-resistant Gram-negative bacteria are a growing concern due to limited treatment options. Knowledge of the common uropathogens in addition to local susceptibility patterns is essential in determining appropriate empiric antibiotic therapy of UTIs. The recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females is a 5-day course of nitrofurantion, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pevmecillinam. High rates of resistance for trimethoprim-sulfamethoxazole and ciprofloxacin preclude their use as empiric treatment of UTIs in several communities, particularly if patients who were recently exposed to them or in patients who are at risk of infections with extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriales. Second line options include oral cephalosporines such as cephalexin or cefixime, fluoroquinolones and β-lactams, such as amoxicillin-clavulanate. Current treatment options for UTIs due to AmpCβ-lactamase-producing Enterobacteriales include nitrofurantion, fosfomycin, pevmecillinam, fluoroquinolones, cefepime, piperacillin-tazobactam and carbapenems. Treatment oral options for UTIs due to ESBLs-E coli include nitrofurantoin, fosfomycin, pevmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin while pevmecillinam, fosfomycin, finafloxacin, and sitafloxacin are treatment oral options for ESBLs-Klebsiella pneumoniae. Parenteral treatment options for UTIs due to ESBLs-producing Enterobacteriales include A c c e p t e d M a n u s c r i p t Information Classification: General piperacillin-tazobactam (for ESBL-E coli only), carbapenems including meropenem/vaborbactam, imipenem/cilastatin-relebactam, and sulopenem, ceftazidime-avibactam, ceftolozane-tazobactam, aminoglycosides including plazomicin, cefiderocol, fosfomycin, sitafloxacin, and finafloxacin. Ceftazidimeavibactam, meropenem/vaborbactam, imipenem/cilastatin-relebactam, colistin, fosfomycin, aztreonam and ceftazidime-avibactam, aztreonam and amoxicillinclavulanate, aminoglycosides including plazomicin, cefiderocol, tigecycline are treatment options for UTIs caused by carbapenem resistant Enterobacteriales (CRE). Treatment options for UTIs caused by multidrug resistant (MDR)-Pseudomonas spp. include fluoroquinolones, ceftazidime, cefepime, piperacillintazobactam, carbapenems including imipenem-cilastatin/relebactam, meropenem and fosfomycin, ceftolozane-tazobactam, ceftazidime-avibactam, aminoglycosides including plazomicin, aztreonam and ceftazidime-avibactam, cefiderocol, and colistin. It is important to use the new antimicrobials wisely for treatment of UTIs caused by MDR-organisms to avoid resistance development.
Description Of Ciprofloxacin Sensitivity On Bacteria Causing UTI In T2DM Patients
THE JOURNAL OF MUHAMMADIYAH MEDICAL LABORATORY TECHNOLOGIST
Diabetes mellitus is a chronic metabolic disease characterized by a state of hyperglycemia due to a lack of insulin production by the pancreas or the body's inability to use the insulin produced or both. Uncontrolled hyperglycemia can suppress the immune system and making the body vulnerable to infection, especially urinary tract infections (UTIs). The main choice in UTI treatment is antibiotic therapy, one of the most frequently used is ciprofloxacin from the fluoroquinolone group.The research design used was descriptive method with prevalence studies. The research was done using antibiotic sensitivity tests with agar diffusion methods. The number of samples were taken using total sampling method.The results of ciprofloxacin sensitivity test were obtained as many as 22 isolates. Escherichia coli bacteria are sensitive to ciprofloxacin at 66.67%, intermediate and resistant 16.67% respectively. Pseudomonas aeruginosa are 60% sensitive and 40% intermediate. Enterobacter aerogenes ...
Objectives: To characterize the pattern of indication of antibiotic regimens for CA-UTI; to evaluate the adequacy of antibiotic empirical therapy in CA-UTI and the resistance profile of the bacterial isolates. Methods: An observational study was conducted, where the prevalence and resistance profiles of the microorganisms involved and the pattern of antibiotic indication were investigated through a cross-sectional approach. Patients presenting with UTI symptomatology and antibiotic indication were recruited through pharmacies in the Lisbon area. Upon inclusion, participants collected a urine sample and responded to a questionnaire characterizing the indication pattern and symptomatology presented. Samples were referred to a microbiology laboratory for urinalysis and antimicrobial susceptibility tests were performed according to EUCAST. Data were analyzed using IBM SPSS v20.0. Results: A sample of 33 patients was obtained. Given the indicated therapy, 55.2% (n=6) corresponded to first line therapy and 10.3% to fluoroquinolones. It was also found that 6 (22.2%) patients were treated with antibiotics and had no confirmed UTI. The most isolated microorganism was E. coli (84.2%), followed by P. mirabilis (5.3%), P. aeruginosa (5.3%) and Klebsiella sp. (5.3%). Finally, a low resistance to first-line therapy and quinolones was observed, whilst high resistance was found to amoxicillin clavulanate (n=10; 52.6%). Conclusion: This study revealed that most patients with UTI used nitrofurantoin and fosfomycin empirically (both included in first line therapy), and only a small number used quinolones. As expected, the most commonly isolated microorganism was E. coli. A worrisome finding was that nearly a quarter of patients were prescribed antibiotics without indication.
Journal of Family Medicine and Primary Care, 2015
Introduction: Uncomplicated but symptomatic urinary tract infections (UTIs) are a common problem seen in practice. The study was undertaken to assess the most common pathogens responsible for uncomplicated symptomatic UTIs and the antimicrobial resistance pattern in a hospital in Bangalore. The study also explores the issue of antibiotic usage for these patients. Materials and Methods: The study was conducted in the Medicine department of a tertiary hospital in Bangalore. In all, 196 patients presented with symptoms of UTI. Bacterial growth was determined by standard microbiology techniques on freshly voided mid-steam urine samples collected from recruited patients. Patients' demographic data, urine culture results, resistance rates to antimicrobial agents and prescribed empiric antimicrobial therapy were analyzed. Results: The prevalence of UTI was 32.1%; majority (67.9%) of the symptomatic did not have UTI based on culture report. Gram-negative bacteria constituted the largest group with a prevalence of 84.1% (53/63), with Escherichia coli being the most common (70%) uropathogen. Gram-negative isolates showed high level of sensitivity to amikacin (90.6%) and nitrofurantoin (77.4%). Most of the gram-positive organisms were susceptible to nitrofurantoin (70%) and gentamicin (50%). Uropathogens isolated demonstrated high resistance to cotrimoxazole, fluoroquinolones, and beta-lactam antibiotics. It was found out that 30.1% of the patients were wrongly managed of which 14.7% were over treated. Conclusion: UTI can be over diagnosed and over treated on the basis of clinical signs, symptoms and urine microscopy. In the era of emerging anti-microbial resistance, effective counseling and delay in antibiotic initiation or empirical therapy with a short course of nitrofurantoin is highly recommended. Empirical therapy guidelines should be updated periodically to reflect changes in antimicrobial resistance of uropathogens.
Trends in Antibiotic Resistance of Major Uropathogens
Background: Around the world, there is no population clear from urinary tract infection (UTI), particularly among women. UTI is considered the most predominant bacterial infection. This study aimed to detect the incidence of the most common major uropathogens in patients severe from UTI with antibiotic-sensitivity tests that assist urologist doctors for appropriate antimicrobial empirical therapy. Materials and Methods: This study was carried in a private laboratory in Babil city, Iraq, from May 2019 to May 2020. A total of 70 individuals suffring from the clear symptoms of UTI, as well as, 20 healthy persons participated in this study as a control group. Then, the standard microbiological methods carried out to isolate and identify the the bacterial species. Antimicrobial-susceptibility tests were performed using diffrent antimicrobial discs by applying the Kirby–Bauer disc-diffsion method. Results: Totally, 90 specimens were obtained from them 20 control group, 19 with no growth, and 51 patients with bacterial growth distributed as 43 (83%) females and 8 (17%) males. Escherichia coli were the most common predominant organisms. All isolates were showed a high rate of resistance to evaluated cephalosporins 100% and 82% to cefotaxime and ceftriaxone, respectively, while very low resistance recorded in aminoglycosides 20% and 13% to Gentamicin and amikacin, respectively. Most age group infected with UTI was 21–40 year-old. Conclusion: The current study showed an increasing burden of UTI caused by various bacteria implicated in UTI that causes changeable sensitivity to various antimicrobial agents. Therefore, in clinical use appropriate medications should be selected based on the data obtained from antimicrobial-susceptibility tests.
Treatment of Uncomplicated Urinary Tract Infections in an Era of Increasing Antimicrobial Resistance
Mayo Clinic Proceedings, 2004
In the past few years, notable advances have occurred in our understanding of the epidemiology and clinical importance of drug resistance among uropathogens that cause uncomplicated urinary tract infections (UTIs) or cystitis. Guidelines recommend trimethoprim-sulfamethoxazole for empirical treatment of uncomplicated UTI unless trimethoprim-sulfamethoxazole resistance in a community exceeds 10% to 20%. The rationale for this 10% to 20% cutoff appears to be related to clinical and economical considerations and to concerns about the emergence of fluoroquinolone-resistant bacteria. In patients with uncomplicated UTIs caused by uropathogens resistant to trimethoprim-sulfamethoxazole who were treated with this drug combination, clinical outcomes were clarified recently and found to be suboptimal (<60% clinical cure). Following guidelines for empirical treatment of uncomplicated UTIs is problematic. Surveillance of antimicrobial resistance among uropathogens that cause uncomplicated UTIs is performed rarely. Hospital antibiograms provide data on resistance among bacteria that cause community-associated UTIs; however, antibiograms overestimate drug resistance among uropathogens that cause UTIs and may mislead clinicians about the prevalence of local resistance. We review options for management of uncomplicated UTIs in light of these considerations. Mayo Clin Proc. 2004;79(8):1048-1054 IDSA = Infectious Diseases Society of America; UTI = urinary tract infection U rinary tract infections (UTIs) in women are a common problem in primary care settings.
Anti-Infective Treatment of Bacterial Urinary Tract Infections
Current Medicinal Chemistry, 2008
Antibiotic resistance nowadays plays an important role in the treatment of uncomplicated and complicated urinary tract infections (UTIs). In uncomplicated UTI efforts are made to use antibiotic substances exclusively for this indication. In complicated UTI substances with activity against bacteria harbouring common resistance mechanisms are investigated. Additionally pharmacokinetic/ pharmacodynamic parameters are used to improve dosing strategies.
Current Anti-Infective Treatment of Bacterial Urinary Tract Infections
Mini-Reviews in Medicinal Chemistry, 2008
Antibiotic resistance nowadays plays an important role in the treatment of uncomplicated and complicated urinary tract infections (UTIs). In uncomplicated UTI efforts are made to use antibiotic substances exclusively for this indication. In complicated UTI substances with activity against bacteria harbouring common resistance mechanisms are investigated. Additionally pharmacokinetic/ pharmacodynamic parameters are used to improve dosing strategies.