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Interaction between Antibiotic Resistance, Resistance Genes, and Treatment Response for Urinary Tract Infections in Primary Care
- Source :
- Journal of Clinical Microbiology
- Publication Year :
- 2019
- Publisher :
- American Society for Microbiology, 2019.
-
Abstract
- Given increasing antimicrobial resistance, we aimed to determine antibiotic susceptibility and presence of resistance genes in uropathogens in primary care, factors associated with resistance to commonly prescribed antibiotics, and effect of treatment on early symptom resolution. We conducted a prospective study of primary care patients with urinary tract infection (UTI) symptoms and culture-confirmed UTI in Singapore from 2015 to 2016.<br />Given increasing antimicrobial resistance, we aimed to determine antibiotic susceptibility and presence of resistance genes in uropathogens in primary care, factors associated with resistance to commonly prescribed antibiotics, and effect of treatment on early symptom resolution. We conducted a prospective study of primary care patients with urinary tract infection (UTI) symptoms and culture-confirmed UTI in Singapore from 2015 to 2016. Cohort characteristics and antimicrobial susceptibility of cultured isolates were analyzed. Among Enterobacteriaceae isolates, early symptom resolution (within 3 days) according to antibiotic prescribed and isolate susceptibility and factors associated with antibiotic resistance were evaluated. Of 695 symptomatic patients, 299 were urine culture positive; of these 299 patients, 259 (87%) were female. Escherichia coli was the most common uropathogen (76%). Enterobacteriaceae isolates (n = 283) were highly susceptible to amoxicillin-clavulanate (86%), nitrofurantoin (87%), and fosfomycin (98%), but >20% were resistant to ciprofloxacin and co-trimoxazole. Isolates resistant to appropriate indicator antibiotics were further tested to determine proportions positive for blaCTX-M (14/26, 54%), plasmid-mediated ampC (12/24, 50%), qnr (7/69, 10%), and fos (1/6, 17%) resistance genes. A total of 67% of patients given antibiotics with susceptible isolates reported early resolution versus 45% given antibiotics with nonsusceptible isolates (P = 0.001) and 27% not treated (P = 0.018). On multivariable analysis, Indian ethnicity and diabetes mellitus were associated with amoxicillin-clavulanate resistance. Genitourinary abnormalities, UTI in the past 12 months, and hospitalization in the past 6 months were associated with ciprofloxacin and co-trimoxazole resistance. Patients given active empirical antibiotics were most likely to report early symptom resolution, but correlation with in vitro susceptibility was imperfect. Factors associated with resistance may guide the decision to obtain initial urine culture.
- Subjects :
- microbial
Adult
Male
0301 basic medicine
Microbiology (medical)
medicine.medical_specialty
medicine.drug_class
Urinary system
030106 microbiology
Antibiotics
antibacterial agents
Microbial Sensitivity Tests
Drug resistance
Fosfomycin
Young Adult
03 medical and health sciences
0302 clinical medicine
Antibiotic resistance
Enterobacteriaceae
Internal medicine
Drug Resistance, Bacterial
therapeutics
Humans
Medicine
Prospective Studies
030212 general & internal medicine
Prospective cohort study
Aged
Aged, 80 and over
Singapore
drug resistance
Primary Health Care
business.industry
Enterobacteriaceae Infections
Bacteriology
Middle Aged
Anti-Bacterial Agents
Ciprofloxacin
Treatment Outcome
Genes, Bacterial
Nitrofurantoin
Urinary Tract Infections
Female
urinary tract infection
business
medicine.drug
Subjects
Details
- ISSN :
- 1098660X and 00951137
- Volume :
- 57
- Database :
- OpenAIRE
- Journal :
- Journal of Clinical Microbiology
- Accession number :
- edsair.doi.dedup.....0abb97f20e93e99dbe2fb5bd71c4b6d2
- Full Text :
- https://doi.org/10.1128/jcm.00143-19