Antibiotics in Urology – New Essentials

Uncomplicated Urinary Tract Infections in Women in a Sao Paulo Quaternary Care Hospital: Bacterial Spectrum and Susceptibility Patterns

Uncomplicated urinary tract infections (UTI) in women are very common. Regular analysis of bacterial flora is important to formulate updated guidelines. The objective of this study is to determine and compare the microbiology of UTIs and their susceptibility patterns in a quaternary care hospital. In a seven-year review, the urine culture results of 480 female patients with uncomplicated UTIs were analyzed. Patients were divided into three groups according to their diagnosis and treatment characteristics: Group 1, cystitis at outpatient basis; group 2, cystitis at the Emergency Unit; and group 3, pyelonephritis. Group 1 included older patients, with a higher incidence of concomitant diabetes mellitus and recurrent UTIs. E. coli was the most common pathogen, responsible for 75.1% of cases, mainly for pyelonephritis (87.3%). Of the oral antimicrobials tested for cystitis, amoxicillin/clavulanate and nitrofurantoin had the highest susceptibility profiles (84.4% and 87.3%, respectively). For E. coli only, their susceptibility profiles were as high as 90.8% and 97.4%, respectively. For pyelonephritis treatment, fluoroquinoles had a susceptibility profile <90%, while ceftriaxone and gentamicin had susceptibility >90%. Uncomplicated UTI treatment is becoming more challenging because the susceptibility profiles of oral antimicrobials are increasingly resistant. In our environment, cystitis can still be managed with nitrofurantoin. Uncomplicated pyelonephritis should be managed with ceftriaxone or gentamicin.

Antimicrobial resistance in community-acquired urinary tract infections: results from the Korean Antimicrobial Resistance Monitoring System

The Korean Antimicrobial Resistance Monitoring System was established and the first nationwide surveillance of bacterial uropathogens was conducted during the period from January 2008 to June 2009. With the cooperation of 34 medical centers throughout South Korea, a total of 1994 strains belonging to clinically relevant bacterial uropathogens were collected from patients with community-acquired urinary tract infections (UTIs). To compare with past data, understand a trend of antimicrobial resistance, and ultimately determine new regimens for empirical treatment of uncomplicated cystitis, the antimicrobial susceptibilities against Escherichia coli in uncomplicated cystitis to commonly prescribed drugs were investigated. In uncomplicated cystitis, the most prevalent causative organism was E. coli (72.7%), followed by Enterococcus faecalis (10.7%) and Klebsiella pneumoniae (3.5%). Among E. coli isolates from acute uncomplicated cystitis, 38.5% were susceptible to ampicillin, 80.7% to amoxicillin/clavulanate, 67.3% to trimethoprim/sulfamethoxazole, 74.6% to ciprofloxacin, 77.5% to levofloxacin, 86.0% to cefazolin, 86.1% to cefuroxime, 93.6% to cefpodoxime, 94.7% to ceftriaxone, 99.5% to amikacin, 80.9% to tobramycin, and 76.6% to gentamicin. An increasing tendency of resistance to ciprofloxacin (24.8%) has been observed compared with the similar studies in 2006 (23.4%) and 2002 (15.2%) from patients with uncomplicated cystitis. These data provide much needed information on the prevalence of antimicrobial resistance in community-acquired UTIs in South Korea and will be a useful reference for future periodic surveillance studies.