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Wada K, Tsuboi I, Takahashi S, Yasuda M, Miyazaki J, Kobayashi K, Matsumoto M, Hayami H, Yamamoto S, Kiyota H, Sato J, Matsumoto T, Hasegawa N, Kobayashi I, Masumori N, Kimura T, Yamada H, Matsumoto K, Ishikawa K, Fujimoto K, Shigemura K, Sadahira T, Ito K, Yokoyama T, Izumitani M, Sumii T, Hosobe T, Hikosaka K, Kawahara M, Sato T, Ito S, Masue N, Sakurai T, Kokura K, Kadena H, Morikawa T, Minamidate Y, Yoh M, Hashimoto J, Maruyama T, Yoshioka M, Takashima K, Kawai S, Nishi S, Matsumoto T, Hirayama H, Okusa H, Uno S, Inoue Y, Kurimura Y, Shirane T, Takaoka E, Tojo T, Arakawa S, Hamasuna R, Tomioka A, Iihara K, Ishitoya S, Maeda H, Terado M. Third nationwide surveillance of bacterial pathogens in patients with acute uncomplicated cystitis conducted by the Japanese surveillance committee during 2020 and 2021: Antimicrobial susceptibility of Escherichia coli, Klebsiella pneumoniae, and Staphylococcus saprophyticus. J Infect Chemother 2024; 30:277-285. [PMID: 38242285 DOI: 10.1016/j.jiac.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 01/21/2024]
Abstract
The Japanese surveillance committee conducted a third nationwide surveillance of antimicrobial susceptibility of acute uncomplicated cystitis at 55 facilities throughout Japan between April 2020 and September 2021. In this surveillance, we investigated the susceptibility of Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), and Staphylococcus saprophyticus (S. saprophyticus) for various antimicrobial agents by isolating and culturing bacteria from urine samples. In total, 823 strains were isolated from 848 patients and 569 strains of target bacteria, including E. coli (n = 529, 92.9 %), K. pneumoniae (n = 28, 4.9 %), and S. saprophyticus (n = 12, 2.2 %) were isolated. The minimum inhibitory concentrations of 18 antibacterial agents were determined according to the Clinical and Laboratory Standards Institute manual. In premenopausal patients, there were 31 (10.5 %) and 20 (6.8 %) fluoroquinolone (FQ)-resistant E. coli and extended-spectrum β-lactamase (ESBL)-producing E. coli, respectively. On the other hand, in postmenopausal patients, there were 75 (32.1 %) and 36 (15.4 %) FQ-resistant E. coli and ESBL-producing E. coli, respectively. The rate of FQ-resistant E. coli and ESBL-producing E. coli in post-menopausal women was higher than that for our previous nationwide surveillance (20.7 % and 32.1 %: p = 0.0004, 10.0 % and 15.4 %; p = 0.0259). For pre-menopausal women, there was no significant difference in the rate of FQ-resistant E. coli and ESBL-producing E. coli between this and previous reports, but the frequency of FQ-resistant E. coli and ESBL-producing E. coli exhibited a gradual increase. For appropriate antimicrobial agent selection and usage, it is essential for clinicians to be aware of the high rate of these antimicrobial-resistant bacteria in acute uncomplicated cystitis in Japan.
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Affiliation(s)
- Koichiro Wada
- Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan; The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan.
| | - Ichiro Tsuboi
- Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Satoshi Takahashi
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Mitsuru Yasuda
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Jun Miyazaki
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Department of Urology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan; Department of Urology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Kanao Kobayashi
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Department of Urology, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Masahiro Matsumoto
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hiroshi Hayami
- The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Blood Purification Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Shingo Yamamoto
- The Surveillance Committee of JSC, JAID and JSCM, Tokyo, Japan; Department of Urology, Hyogo College of Medicine, Hyogo, Japan
| | - Hiroshi Kiyota
- The Surveillance Committee of JSC, JAID and JSCM, Tokyo, Japan; Department of Urology, School of Medicine, The Jikei University Katsushika Medical Center, Tokyo, Japan; Iguchi Nephrourology and Internal Medicine Clinic Shinkoiwa, Tokyo, Japan
| | - Junko Sato
- The Surveillance Committee of JSC, JAID and JSCM, Tokyo, Japan
| | | | - Naoki Hasegawa
- The Surveillance Committee of JSC, JAID and JSCM, Tokyo, Japan
| | - Intetsu Kobayashi
- Department of Infection Control and Prevention, Toho University Faculty of Nursing, Tokyo, Japan
| | - Naoya Masumori
- Department of Urology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroki Yamada
- Department of Urology, School of Medicine, The Jikei University Katsushika Medical Center, Tokyo, Japan
| | - Kazumasa Matsumoto
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kiyohito Ishikawa
- Department of Urology, School of Medicine, Fujita Health University, Aichi, Japan
| | | | | | - Takuya Sadahira
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kenji Ito
- Ito Urology Clinic, Kitakyushu, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shohei Nishi
- Nishi Urology and Dermatology Clinic, Kitakyushu, Japan
| | | | | | - Hiroshi Okusa
- Ookusa Urology & Internal Medicine Clinic, Kanagawa, Japan
| | | | | | | | | | - Eiichiro Takaoka
- Department of Urology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Takanori Tojo
- Department of Urology, Tomei Atsugi Hospital, Kanagawa, Japan
| | - Soichi Arakawa
- Department of Urology, Sanda City Hospital, Hyogo, Japan
| | | | - Atsushi Tomioka
- Department of Urology, Saiseikai Chuwa Hospital, Nara, Japan
| | - Kiyotaka Iihara
- Department of Urology, Fukuoka Shin Mizumaki Hospital, Fukuoka, Japan
| | - Satoshi Ishitoya
- Department of Urology, Japanese Red Cross Otsu Hospital, Shiga, Japan
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Chalasani N, Li YJ, Dellinger A, Navarro V, Bonkovsky H, Fontana RJ, Gu J, Barnhart H, Phillips E, Lammert C, Schwantes-An TH, Nicoletti P, Kleiner DE, Hoofnagle JH. Clinical features, outcomes, and HLA risk factors associated with nitrofurantoin-induced liver injury. J Hepatol 2023; 78:293-300. [PMID: 36152763 PMCID: PMC9852026 DOI: 10.1016/j.jhep.2022.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND & AIMS Nitrofurantoin (NTF) is widely used for the treatment (short-term) and prevention (long-term) of urinary tract infections. We aimed to describe the clinical characteristics, outcomes, and HLA risk factors for NTF-induced liver injury (NTF-DILI) among individuals enrolled in the Drug Induced Liver Injury Network (DILIN). METHODS Seventy-eight individuals with definite, highly likely, or probable NTF-DILI were enrolled into DILIN studies between 2004-2020. HLA alleles were compared between NTF-DILI and three control groups: population (n = 14,001), idiopathic autoimmune hepatitis (n = 231), and non-NTF DILI (n = 661). RESULTS Liver injury was hepatocellular in 69% and icteric in 55%. AST > ALT was more common in the 44 long-exposure (≥1 year) NTF-DILI cases than in the 18 short (≤7 days) and 16 intermediate (>7 to <365 days) exposure cases (73% vs. 33% vs. 50%, respectively, p = 0.018), as was ANA or SMA positivity (91% vs. 44% vs. 50%, respectively, p <0.001), and corticosteroid use (61% vs. 27% vs. 44%, respectively, p = 0.06). In long-term NTF-DILI, bridging fibrosis, nodularity or cirrhosis, or clinical and imaging evidence for cirrhosis were present in 38%, with massive or sub-massive necrosis in 20%. No one in the short-term exposure group died or underwent transplantation, whereas 7 (12%) patients from the other groups died or underwent transplantation. After covariate adjustments, HLA-DRB1∗11:04 was significantly more frequent in NTF-DILI compared to population controls (odds ratio [OR] 4.29, p = 1.15 × 10-4), idiopathic autoimmune hepatitis (OR 11.77, p = 7.76 × 10-5), and non-NTF DILI (OR 3.34, p = 0.003). CONCLUSION NTF-DILI can result in parenchymal necrosis, bridging fibrosis, cirrhosis, and death or liver transplantation, especially with long-term exposure, and is associated with HLA-DRB1∗11:04. To mitigate against serious liver injury associated with NTF, regulators should revise the prescribing information and consider other mitigation strategies. IMPACT AND IMPLICATIONS Nitrofurantoin is a recognized cause of drug-induced liver injury (DILI). In this study consisting of a large cohort of well-phenotyped individuals with nitrofurantoin-induced liver injury, two distinct patterns of liver injury were identified: liver injury associated with short-term exposure, which is generally self-limiting, and liver injury associated with long-term exposure, which can lead to advanced fibrosis, cirrhosis and liver failure. HLA DRB1∗11:04 is a risk factor for liver injury due to long-term nitrofurantoin exposure. Our findings are important for regulators as well as physicians prescribing and pharmacists dispensing nitrofurantoin.
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Affiliation(s)
- Naga Chalasani
- Indiana University School of Medicine & Indiana University Health, Indianapolis, Indiana, USA.
| | - Yi-Ju Li
- Duke University Medical Center, Durham, NC, USA
| | | | | | | | | | - Jiezhun Gu
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Huiman Barnhart
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | | | - Craig Lammert
- Indiana University School of Medicine & Indiana University Health, Indianapolis, Indiana, USA
| | - Tae-Hwi Schwantes-An
- Indiana University School of Medicine & Indiana University Health, Indianapolis, Indiana, USA
| | | | - David E Kleiner
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jay H Hoofnagle
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Antibiotic-Specific Risk for Community-Acquired Clostridioides difficile Infection in the United States from 2008 to 2020. Antimicrob Agents Chemother 2022; 66:e0112922. [PMID: 36377887 PMCID: PMC9764966 DOI: 10.1128/aac.01129-22] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Antibiotic exposure is a crucial risk factor for community-acquired Clostridioides difficile infection (CA-CDI). However, the relative risks associated with specific antibiotics may vary over time, and the absolute risks have not been clearly established. This is a retrospective cohort study. Adults were included if they received an outpatient antibiotic prescription within the IBM MarketScan databases between 2008 and 2020. The primary exposure was an outpatient antibiotic prescription, and the receipt of doxycycline was used as the reference comparison. The primary outcome was CA-CDI, defined as the presence of an International Classification of Diseases (ICD) diagnosis code for CDI within 90 days of receiving an outpatient antibiotic prescription, and subsequent treatment for CDI. There were 36,626,794 unique patients who received outpatient antibiotics, including 11,607 (0.03%) who developed CA-CDI. Relative to doxycycline, the antibiotics conferring the highest risks for CA-CDI were clindamycin (adjusted odds ratio [aOR], 8.81; 95% confidence interval [CI], 7.76 to 10.00), cefdinir (aOR, 5.86; 95% CI, 5.03 to 6.83), cefuroxime (aOR, 4.57; 95% CI, 3.87 to 5.39), and fluoroquinolones (aOR, 4.05; 95% CI, 3.58 to 4.59). Among older patients with CA-CDI risk factors, nitrofurantoin was also associated with CA-CDI (aOR, 3.05; 95% CI, 1.92 to 4.84), with a smaller number needed to harm, compared to the fluoroquinolones. While clindamycin, cefuroxime, and fluoroquinolone use declined from 2008 to 2020, nitrofurantoin use increased by 40%. Clindamycin was associated with the greatest CA-CDI risk, overall. Among older patients with an elevated baseline risk for CA-CDI, multiple antibiotics, including nitrofurantoin, had strong associations with CA-CDI. These results may guide antibiotic selection and future stewardship efforts.
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Kon S, Meslovich D, Valdez C, Jenkins TC, Shihadeh K, Franco-Paredes C, Price CS. Long-term impact of fluoroquinolone-sparing strategies for empirical treatment of acute uncomplicated cystitis among ambulatory patients. Ther Adv Infect Dis 2022; 9:20499361221129415. [PMID: 36225854 PMCID: PMC9549079 DOI: 10.1177/20499361221129415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Acute uncomplicated cystitis is common among outpatients and frequently leads
to antibiotic prescriptions, making urinary tract infections (UTIs) an
important area for antimicrobial stewardship initiatives. Infectious Disease
Society of America (IDSA) guidelines promote alternative agents in place of
fluoroquinolones for acute uncomplicated cystitis. Despite IDSA guidance,
adherence to the guideline remains low in the United States (US). Several
studies have described interventions to improve guideline-concordant
prescribing for UTIs. However, the long-term sustainability and impact of
fluoroquinolone (FLQ)-sparing strategies on community antimicrobial
resistance and treatment outcomes are unknown. The objectives of this study
were to characterize current antibiotic prescribing patterns, treatment
failures and Escherichia coli resistance rates in a setting
which instituted FLQ sparing strategies for UTIs in 2007. Methods: Retrospective cohort study of women aged ⩾ 18 diagnosed with acute
uncomplicated cystitis based on International Classification of Diseases,
10th Revision (ICD-10) codes were included. Data were abstracted for
ambulatory visits over a 6-month period, January 2018 to June 2018, at a
large urban health care system. Treatment decisions were made by individual
providers, and data were analyzed retrospectively. Nitrofurantoin (NFT)
resistance was obtained from the institutional antibiogram and patient-level
data. Treatment failure was defined as the need for a different antibiotic
for UTI within 28 days of the original prescription. Results: NFT was the most frequently prescribed antibiotic (n = 386,
71.6%) of empiric antibiotic prescriptions for UTIs. FLQs comprised 4.6% of
all antibiotic prescriptions (n = 25). Treatment failure
rate was 2.3% in patients treated with NFT. Urine culture was ordered for
only 26.8% of patients. Among the small group of patients with cultures
ordered, E. coli remained 98.5% susceptible to NFT. Conclusions: This study is the first to report significantly low rates (4.6%) of FLQ
prescribing for acute uncomplicated cystitis. Treatment failure rate was low
with empiric NFT. Increased NFT resistance among E. coli
was not observed at the institution or among the subset of patients with
E. coli positive urine cultures. These findings support
current IDSA treatment guidance for uncomplicated cystitis.
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Affiliation(s)
| | | | | | - Timothy C. Jenkins
- Denver Health, Denver, Colorado, USA,University of Colorado School of Medicine,
Aurora, CO, USA
| | | | - Carlos Franco-Paredes
- University of Colorado School of Medicine,
Aurora, CO, USA,University of Colorado Hospital, Aurora, CO,
USA
| | - Connie S. Price
- Chief Medical Officer, Denver Health and
Hospital Authority, 601 Broadway St., Denver, CO 80204, USA,Professor of Medicine (Infectious Diseases),
University of Colorado School of Medicine, Aurora, CO, USA
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Amayun I. Adherence to recent antibiotic guidelines for acute uncomplicated cystitis. J Am Assoc Nurse Pract 2021; 33:879-885. [PMID: 33731550 DOI: 10.1097/jxx.0000000000000526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/02/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2017, the Centers for Disease Control and Prevention (CDC) published guidelines for treating acute uncomplicated cystitis (AUC) with nitrofurantoin (NTF), sulfamethoxazole-trimethoprim (SMX-TMP), or fosfomycin (FM) as appropriate first-line agents. OBJECTIVE To evaluate whether provider adherence to prescribing NTF, SMX-TMP, or FM has improved since the 2017 CDC guidelines were released, and to examine outcomes relative to the use of prescribing guidelines. DATA SOURCE A literature review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, and a systematic search for articles was conducted in the PubMed and Cochrane search engines using Boolean operators (AND, OR). The searches resulted in 56 published studies. After application of exclusion criteria, 11 peer-reviewed articles were ultimately included in this review. CONCLUSION The review showed prescribers' increasing efforts to adhering to antibiotic prescription guidelines for treating AUC, such as the 2017 CDC guidelines. The studies presented strong evidence that NTF, SMX-TMP, and FM are equally efficacious and cost-effective for treating AUC without concern for antibiotic resistance. Studies that referenced prescription guidelines and local antibiotic resistance yielded desired patient outcomes in bacterial and symptom resolution and cost-effectiveness. IMPLICATIONS FOR PRACTICE This article provides evidence and a platform for nurse practitioners to initiate collaborative efforts for structured AUC treatment guidelines in primary health care. To increase prescription adherence, electronic health records could be designed that would prompt prescribers to use updated local antibiotic resistance information and to use NTF, SMT-TMX, and FM as first-line agents.
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Affiliation(s)
- Ira Amayun
- University of San Francisco School of Nursing and Health Professions, San Franciso, California
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Frost HM, Knepper BC, Shihadeh KC, Jenkins TC. A Novel Approach to Evaluate Antibiotic Utilization Across the Spectrum of Inpatient and Ambulatory Care and Implications for Prioritization of Antibiotic Stewardship Efforts. Clin Infect Dis 2021; 70:1675-1682. [PMID: 31162539 DOI: 10.1093/cid/ciz466] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/03/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Antibiotic overuse remains a significant problem. The objective of this study was to develop a methodology to evaluate antibiotic use across inpatient and ambulatory care sites in an integrated healthcare system to prioritize antibiotic stewardship efforts. METHODS We conducted an epidemiologic study of antibiotic use across an integrated healthcare system on 12 randomly selected days from 2017 to 2018. For inpatients and perioperative patients, administrations of antibiotics were recorded, whereas prescriptions were recorded for outpatients. RESULTS On the study days, 10.9% (95% confidence interval [CI], 10.6%-11.3%) of patients received antibiotics. Of all antibiotics, 54.1% were from ambulatory care (95% CI, 52.6%-55.7%), 38.0% were from the hospital (95% CI, 36.6%-39.5%), and 7.8% (95% CI, 7.1%-8.7%) were perioperative. The emergency department/urgent care centers, adult outpatient clinics, and adult non-critical care inpatient wards accounted for 26.4% (95% CI, 25.0%-27.7%), 23.8% (95% CI, 22.6%-25.2%), and 23.9% (95% CI, 22.7%-25.3%) of antibiotic use, respectively. Only 9.2% (95% CI, 8.3%-10.1%) of all antibiotics were administered in critical care units. Antibiotics with a broad spectrum of gram-negative activity accounted for 30.4% (95% CI, 29.0%-31.9%) of antibiotics. Infections of the respiratory tract were the leading indication for antibiotics. CONCLUSIONS In an integrated healthcare system, more than half of antibiotic use occurred in the emergency department/urgent care centers and outpatient clinics. Antibiotics with a broad spectrum of gram-negative activity accounted for a large portion of antibiotic use. Analysis of antibiotic utilization across the spectrum of inpatient and ambulatory care is useful to prioritize antibiotic stewardship efforts.
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Affiliation(s)
- Holly M Frost
- Department of Pediatrics, Denver Health Medical Center.,University of Colorado School of Medicine
| | - Bryan C Knepper
- Department of Patient Safety and Quality, Denver Health Medical Center, Colorado
| | | | - Timothy C Jenkins
- University of Colorado School of Medicine.,Division of Infectious Diseases and Department of Medicine, Denver Health Medical Center, Colorado
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7
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Leuin AS, Hartmann F, Viviano K. Administration of nitrofurantoin in dogs with lower urinary tract infections: 14 cases (2013-2019). J Small Anim Pract 2020; 62:42-48. [PMID: 33107048 DOI: 10.1111/jsap.13252] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/20/2020] [Accepted: 09/28/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The purpose of this study was to describe the clinical use of nitrofurantoin in client-owned dogs with lower urinary tract infections. The primary aim was to describe the patient population, dosage, treatment duration, outcome and side effects. MATERIALS AND METHODS Medical records in an institution were retrospectively reviewed from July 2013 to January 2019. RESULTS Nitrofurantoin was prescribed in this clinical population of 14 client-owned dogs for lower urinary tract infections. Recurrent urinary tract infection was the clinical diagnosis in all dogs. Each dog's urinary tract infection was associated with a nitrofurantoin-susceptible, multidrug-resistant uropathogen. The median dosage and duration of nitrofurantoin treatment was 4.3 mg/kg by mouth every 8 hours for 14 days. Twelve of the 14 dogs had successful outcomes including bacteriologic cure (n = 9), clinical cure (2) and resolution of target bacteria (1). Treatment failures (n = 2) were associated with uropathogens developing progressive nitrofurantoin resistance. CLINICAL SIGNIFICANCE In some dogs with recurrent lower urinary tract infections, nitrofurantoin may be an effective antibiotic for treatment of nitrofurantoin-susceptible uropathogens. Treatment failures were associated with progressive uropathogen resistance. Urine bacterial culture and quantitative susceptibility testing are essential to initiating and monitoring treatment due to the multidrug-resistant isolates and, in some cases, persistent bacteriuria in the face of treatment.
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Affiliation(s)
- A S Leuin
- Veterinary Specialty Hospital - North County, 2055 Montiel Road, Unit 104, San Marcos, California, 92069, USA
| | - F Hartmann
- University Wisconsin Veterinary Care, University of Wisconsin-Madison, 2015 Linen Drive, Madison, Wisconsin, 53706, USA
| | - K Viviano
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, Wisconsin, 53706, USA
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Robinson TF, Barsoumian AE, Aden JK, Giancola SE. Evaluation of the trends and appropriateness of fluoroquinolone use in the outpatient treatment of acute uncomplicated cystitis at five family practice clinics. J Clin Pharm Ther 2019; 45:513-519. [PMID: 31821580 DOI: 10.1111/jcpt.13099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/08/2019] [Accepted: 11/19/2019] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Despite recommendations to avoid fluoroquinolones (FQs) as a first-line treatment for uncomplicated cystitis, recent data suggest that FQs remain widely prescribed. Therefore, the objectives of this study were to evaluate the appropriateness of empiric FQ use compared to nitrofurantoin for uncomplicated cystitis and to determine whether there are any trends or predictors of empiric FQ versus nitrofurantoin use for uncomplicated cystitis. METHODS This retrospective study included women ages 19-64 years who were seen at five family medicine clinics and were prescribed targeted antibiotics (nitrofurantoin, ciprofloxacin or levofloxacin) for uncomplicated cystitis. Charts were reviewed to collect data, including symptoms, comorbidities, allergies, creatinine clearance, recent antibiotic use and urine culture data. Appropriateness of empiric selection was determined based on national guidelines and local susceptibility data. RESULTS AND DISCUSSION A total of 677 patient encounters were screened for inclusion. Of those, 567 met the inclusion criteria: 395 nitrofurantoin and 172 FQs. Treatment was considered appropriate in 86.8% and 10.5% of cases that were prescribed nitrofurantoin and FQs, respectively (P < .01). There were four independent predictors of FQ use identified by multivariate logistical regression: clinic at which the patient was treated, age, nitrofurantoin use within 90 days prior to encounter and previous urine culture within one year with an organism non-susceptible to nitrofurantoin. WHAT IS NEW AND CONCLUSION Despite recommendations against FQs for uncomplicated cystitis, they continue to be widely prescribed, and their use for this indication is often inappropriate. This highlights the need for additional interventions and education to improve use and preserve the utility of FQs.
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Affiliation(s)
- Thomas F Robinson
- Department of Pharmacy, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Alice E Barsoumian
- Infectious Disease Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - James K Aden
- Department of Graduate Medical Education, Brooke Army Medical Center, Fort Sam Houston, TX, USA
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Hanlon JT, Perera S, Drinka PJ, Crnich CJ, Schweon SJ, Klein-Fedyshin M, Wessel CB, Saracco S, Anderson G, Mulligan M, Nace DA. The IOU Consensus Recommendations for Empirical Therapy of Cystitis in Nursing Home Residents. J Am Geriatr Soc 2019; 67:539-545. [PMID: 30584657 PMCID: PMC7980083 DOI: 10.1111/jgs.15726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To establish consensus recommendations for empirical treatment of uncomplicated cystitis with anti-infectives in noncatheterized older nursing home residents to be implemented in the Improving Outcomes of UTI Management in Long-Term Care Project (IOU) funded by the Agency for Healthcare Research and Quality. DESIGN Two-round modified Delphi survey. PARTICIPANTS Expert panel of 19 clinical pharmacists. MEASUREMENTS Comprehensive literature search and development/review/edit of draft survey by the investigative group (one geriatric clinical pharmacist, two geriatric medicine physicians, and one infectious disease physician). The expert panel members rated their agreement with each of 31 recommendations for drugs of choice, dosing medications at various levels of renal function, drug-drug interactions to avoid, and duration of therapy by sex on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Consensus agreement was defined as a lower 95% confidence limit of 4.0 or higher for the recommendation-specific mean score. RESULTS The response rate was 95% for the first round, and three recommendations achieved consensus (dosing for nitrofurantoin and trimethoprim/sulfamethoxazole in those without chronic kidney disease, and drug-drug interaction between trimethoprim/sulfamethoxazole and warfarin). In the second round, 90% responded and reached consensus on an additional eight recommendations (two for nitrofurantoin or trimethoprim/sulfamethoxazole as initial drugs of choice, three for dosing ciprofloxacin, nitrofurantoin, and trimethoprim/sulfamethoxazole at various levels of chronic kidney disease, and three drug-drug interactions to avoid: trimethoprim/sulfamethoxazole with phenytoin and ciprofloxacin with theophylline or with tizanidine). CONCLUSION An expert panel of clinical pharmacists was able to reach consensus on a set of recommendations for the empirical treatment of cystitis with oral anti-infective medications in older nursing home residents. The recommendations were incorporated into a treatment algorithm for uncomplicated cystitis in noncatheterized nursing home residents and used in educational materials for health professionals in an ongoing controlled intervention study. J Am Geriatr Soc 67:539-545, 2019.
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Affiliation(s)
- Joseph T Hanlon
- Division of Geriatric Medicine, Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System (VAPHS), Pittsburgh, Pennsylvania
- Center for Health Equity Research and Promotion (CHERP), VAPHS, Pittsburgh, Pennsylvania
| | - Subashan Perera
- Division of Geriatric Medicine, Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Paul J Drinka
- Divisions of Internal Medicine and Geriatric Medicine, University of Wisconsin, Madison, Wisconsin
| | - Christopher J Crnich
- Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
- William S. Middleton Veterans Administration Medical Center, Madison, Wisconsin
| | | | | | - Charles B Wessel
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stacey Saracco
- Division of Geriatric Medicine, Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gulsum Anderson
- Division of Geriatric Medicine, Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary Mulligan
- AMDA, The Society of Post-Acute and Long-Term Care Medicine, Columbia, Maryland
| | - David A Nace
- Division of Geriatric Medicine, Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, Pennsylvania
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Kulchavenya E. Acute uncomplicated cystitis: is antibiotic unavoidable? Ther Adv Urol 2018; 10:257-262. [PMID: 30116301 DOI: 10.1177/1756287218783644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/27/2018] [Indexed: 01/17/2023] Open
Abstract
Background Acute uncomplicated cystitis in women is one of the most frequently diagnosed bacterial infections. Methods In a pilot, open, noncomparative prospective study, 29 nonpregnant, sexually active women with acute uncomplicated cystitis were enrolled. The mean age was 28.9 ± 4.3, range 22-36 years. All patients received unique therapy: the nonsteroidal anti-inflammatory drug (NSAID) ketoprofen, 100 mg once a day for 5 days, and Canephron, 2 dragees three times a day for 1 month. Results In 2 days, four patients (13.8%) had no tendency to improvement; they were considered as nonresponders and antibiotics were prescribed for them. The remaining 25 patients (86.2%) showed significant improvement and were considered as responders; they continued the therapy with ketoprofen and Canephron. In 7 days, 21 patients (72.4%) had no dysuria and leucocyturia; they were considered as fast responders to phytotherapy. In four patients (13.8%), after 7 days of therapy insignificant dysuria and leucocyturia were found; they were considered as slow responders to phytotherapy. All 25 patients continued the intake of Canephron for 1 month to prevent a relapse. When treatment finished, all patients were well. In 6 months, no relapses were diagnosed. Conclusion The majority (86.2%) of young, nonpregnant women with acute uncomplicated cystitis were cured by 30 days of phytotherapy combined initially (5 days) with the NSAID ketoprofen; an antibiotic was indicated in only 13.8% of patients. Patients with acute uncomplicated cystitis may be divided into three subgroup: nonresponders to phytotherapy; slow responders to phytotherapy; fast responders to phytotherapy. Antibiotic therapy is indicated in nonresponders, but slow and fast responders may be treated without an antibiotic, by phytotherapy with an initial short course of an NSAID only.
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Affiliation(s)
- Ekaterina Kulchavenya
- Novosibirsk Research TB Institute, Novosibirsk Medical University, Okhotskaya 81-a, Novosibirsk, Russian Federation
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