Impact of Allergy and Resistance on Antibiotic Selection for Recurrent Urinary Tract Infections in Older Women
To review the impact of antibiotic allergy and resistance in older women with recurrent urinary tract infections (RUTIs) as determinants for a suitable oral antibiotic treatment choice. A prospectively maintained database of women 65 years old and older with documented RUTIs (≥3 UTI/y) and trigoniti...
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| Veröffentlicht in: | Urology (Ridgewood, N.J.) N.J.), 2018-03, Vol.113, p.26-33 |
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| creator | Malik, Rena D. Wu, Yuefeng (Rose) Christie, Alana L. Alhalabi, Feras Zimmern, Philippe E. |
| description | To review the impact of antibiotic allergy and resistance in older women with recurrent urinary tract infections (RUTIs) as determinants for a suitable oral antibiotic treatment choice.
A prospectively maintained database of women 65 years old and older with documented RUTIs (≥3 UTI/y) and trigonitis on cystoscopy was reviewed. Demographic data, known drug allergies, renal function, antibiotic susceptibility of most recent urine culture, allergy, or resistance to trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones, and nitrofurantoin were obtained.
From 2006 to 2014, 86 women with RUTIs met study criteria. Mean age was 77.9 ± 7.8, with 94% being Caucasian. An estimated glomerular filtration rate >30 mL/min was noted in 94%. The percentage of women allergic, resistant, or both allergic and resistant to TMP-SMX was 33%, 29%, and 15%, to fluoroquinolones was 14%, 34%, and 8.1%, or nitrofurantoin was 16%, 14%, and 5%, respectively. Twenty-eight percent (24 of 86) of women who were allergic and/or resistant to TMP-SMX and fluoroquinolones were sensitive to nitrofurantoin. Twenty percent (17 of 86) were allergic and/or resistant to all 3 antibiotics. Women who were allergic or resistant to TMP-SMX had a significantly higher number of other antibiotic resistances compared with women sensitive to TMP-SMX (4.9 ± 3.6 vs 2.1 ± 2.3; P |
| doi_str_mv | 10.1016/j.urology.2017.08.070 |
| format | Article |
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A prospectively maintained database of women 65 years old and older with documented RUTIs (≥3 UTI/y) and trigonitis on cystoscopy was reviewed. Demographic data, known drug allergies, renal function, antibiotic susceptibility of most recent urine culture, allergy, or resistance to trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones, and nitrofurantoin were obtained.
From 2006 to 2014, 86 women with RUTIs met study criteria. Mean age was 77.9 ± 7.8, with 94% being Caucasian. An estimated glomerular filtration rate >30 mL/min was noted in 94%. The percentage of women allergic, resistant, or both allergic and resistant to TMP-SMX was 33%, 29%, and 15%, to fluoroquinolones was 14%, 34%, and 8.1%, or nitrofurantoin was 16%, 14%, and 5%, respectively. Twenty-eight percent (24 of 86) of women who were allergic and/or resistant to TMP-SMX and fluoroquinolones were sensitive to nitrofurantoin. Twenty percent (17 of 86) were allergic and/or resistant to all 3 antibiotics. Women who were allergic or resistant to TMP-SMX had a significantly higher number of other antibiotic resistances compared with women sensitive to TMP-SMX (4.9 ± 3.6 vs 2.1 ± 2.3; P < .0001). Similarly, women with fluoroquinolone allergy or resistance had significantly more antibiotic resistances than those who were fluoroquinolone sensitive (5.8 ± 3.5 vs 2.3 ± 2.5; P < .0001).
Because of allergy and/or antibiotic resistance, several first-line antibiotics are not available for many older women with RUTIs. In nearly a third of women, nitrofurantoin was the only viable alternative.</description><identifier>ISSN: 0090-4295</identifier><identifier>EISSN: 1527-9995</identifier><identifier>DOI: 10.1016/j.urology.2017.08.070</identifier><identifier>PMID: 29196069</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Age Factors ; Aged ; Aged, 80 and over ; Anti-Infective Agents - adverse effects ; Anti-Infective Agents - immunology ; Anti-Infective Agents - therapeutic use ; Anti-Infective Agents, Urinary - adverse effects ; Anti-Infective Agents, Urinary - therapeutic use ; Chronic Disease ; Cohort Studies ; Cystoscopy - methods ; Databases, Factual ; Drug Resistance, Microbial ; Female ; Fluoroquinolones - adverse effects ; Fluoroquinolones - therapeutic use ; Geriatric Assessment ; Humans ; Hypersensitivity - epidemiology ; Hypersensitivity - immunology ; Microbial Sensitivity Tests ; Nitrofurantoin - adverse effects ; Nitrofurantoin - therapeutic use ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Assessment ; Sulfonamides - adverse effects ; Sulfonamides - therapeutic use ; Treatment Outcome ; Urinalysis - methods ; Urinary Tract Infections - diagnosis ; Urinary Tract Infections - drug therapy ; Urinary Tract Infections - epidemiology ; Urinary Tract Infections - microbiology</subject><ispartof>Urology (Ridgewood, N.J.), 2018-03, Vol.113, p.26-33</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c391t-6e43411f3e7f2af49a1e2a24118890f3b355a9e3e2c3d88d2543b8b9040404ea3</citedby><cites>FETCH-LOGICAL-c391t-6e43411f3e7f2af49a1e2a24118890f3b355a9e3e2c3d88d2543b8b9040404ea3</cites><orcidid>0000-0002-3843-7289 ; 0000-0002-7612-2042</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.urology.2017.08.070$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,778,782,3539,27911,27912,45982</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29196069$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Malik, Rena D.</creatorcontrib><creatorcontrib>Wu, Yuefeng (Rose)</creatorcontrib><creatorcontrib>Christie, Alana L.</creatorcontrib><creatorcontrib>Alhalabi, Feras</creatorcontrib><creatorcontrib>Zimmern, Philippe E.</creatorcontrib><title>Impact of Allergy and Resistance on Antibiotic Selection for Recurrent Urinary Tract Infections in Older Women</title><title>Urology (Ridgewood, N.J.)</title><addtitle>Urology</addtitle><description>To review the impact of antibiotic allergy and resistance in older women with recurrent urinary tract infections (RUTIs) as determinants for a suitable oral antibiotic treatment choice.
A prospectively maintained database of women 65 years old and older with documented RUTIs (≥3 UTI/y) and trigonitis on cystoscopy was reviewed. Demographic data, known drug allergies, renal function, antibiotic susceptibility of most recent urine culture, allergy, or resistance to trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones, and nitrofurantoin were obtained.
From 2006 to 2014, 86 women with RUTIs met study criteria. Mean age was 77.9 ± 7.8, with 94% being Caucasian. An estimated glomerular filtration rate >30 mL/min was noted in 94%. The percentage of women allergic, resistant, or both allergic and resistant to TMP-SMX was 33%, 29%, and 15%, to fluoroquinolones was 14%, 34%, and 8.1%, or nitrofurantoin was 16%, 14%, and 5%, respectively. Twenty-eight percent (24 of 86) of women who were allergic and/or resistant to TMP-SMX and fluoroquinolones were sensitive to nitrofurantoin. Twenty percent (17 of 86) were allergic and/or resistant to all 3 antibiotics. Women who were allergic or resistant to TMP-SMX had a significantly higher number of other antibiotic resistances compared with women sensitive to TMP-SMX (4.9 ± 3.6 vs 2.1 ± 2.3; P < .0001). Similarly, women with fluoroquinolone allergy or resistance had significantly more antibiotic resistances than those who were fluoroquinolone sensitive (5.8 ± 3.5 vs 2.3 ± 2.5; P < .0001).
Because of allergy and/or antibiotic resistance, several first-line antibiotics are not available for many older women with RUTIs. In nearly a third of women, nitrofurantoin was the only viable alternative.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Infective Agents - adverse effects</subject><subject>Anti-Infective Agents - immunology</subject><subject>Anti-Infective Agents - therapeutic use</subject><subject>Anti-Infective Agents, Urinary - adverse effects</subject><subject>Anti-Infective Agents, Urinary - therapeutic use</subject><subject>Chronic Disease</subject><subject>Cohort Studies</subject><subject>Cystoscopy - methods</subject><subject>Databases, Factual</subject><subject>Drug Resistance, Microbial</subject><subject>Female</subject><subject>Fluoroquinolones - adverse effects</subject><subject>Fluoroquinolones - therapeutic use</subject><subject>Geriatric Assessment</subject><subject>Humans</subject><subject>Hypersensitivity - epidemiology</subject><subject>Hypersensitivity - immunology</subject><subject>Microbial Sensitivity Tests</subject><subject>Nitrofurantoin - adverse effects</subject><subject>Nitrofurantoin - therapeutic use</subject><subject>Prognosis</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Sulfonamides - adverse effects</subject><subject>Sulfonamides - therapeutic use</subject><subject>Treatment Outcome</subject><subject>Urinalysis - methods</subject><subject>Urinary Tract Infections - diagnosis</subject><subject>Urinary Tract Infections - drug therapy</subject><subject>Urinary Tract Infections - epidemiology</subject><subject>Urinary Tract Infections - microbiology</subject><issn>0090-4295</issn><issn>1527-9995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkMFq3DAQhkVpabZpH6FFx17sjiRbtk5lCWmzEAi0CT0KWR4FLba0lezAvn217LbXMoeB4ZsZ_o-QjwxqBkx-2ddrilN8PtYcWFdDX0MHr8iGtbyrlFLta7IBUFA1XLVX5F3OewCQUnZvyRVXTEmQakPCbj4Yu9Do6HaaMD0fqQkj_YHZ58UEizQGug2LH3xcvKU_cUK7-DJ0MRXMrilhWOhT8sGkI31Mp2u74M5Upj7Qh2nERH_FGcN78saZKeOHS78mT99uH2_uqvuH77ub7X1lhWJLJbERDWNOYOe4cY0yDLnhZdT3CpwYRNsahQK5FWPfj7xtxNAPCppToRHX5PP57iHF3yvmRc8-W5wmEzCuWTPVMdkz1sqCtmfUpphzQqcPyc8li2agT6r1Xl9U65NqDb0uqsvep8uLdZhx_Lf1120Bvp4BLEFfPCadrceidPSp2NFj9P958QekI5Mo</recordid><startdate>20180301</startdate><enddate>20180301</enddate><creator>Malik, Rena D.</creator><creator>Wu, Yuefeng (Rose)</creator><creator>Christie, Alana L.</creator><creator>Alhalabi, Feras</creator><creator>Zimmern, Philippe E.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3843-7289</orcidid><orcidid>https://orcid.org/0000-0002-7612-2042</orcidid></search><sort><creationdate>20180301</creationdate><title>Impact of Allergy and Resistance on Antibiotic Selection for Recurrent Urinary Tract Infections in Older Women</title><author>Malik, Rena D. ; Wu, Yuefeng (Rose) ; Christie, Alana L. ; Alhalabi, Feras ; Zimmern, Philippe E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c391t-6e43411f3e7f2af49a1e2a24118890f3b355a9e3e2c3d88d2543b8b9040404ea3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Infective Agents - adverse effects</topic><topic>Anti-Infective Agents - immunology</topic><topic>Anti-Infective Agents - therapeutic use</topic><topic>Anti-Infective Agents, Urinary - adverse effects</topic><topic>Anti-Infective Agents, Urinary - therapeutic use</topic><topic>Chronic Disease</topic><topic>Cohort Studies</topic><topic>Cystoscopy - methods</topic><topic>Databases, Factual</topic><topic>Drug Resistance, Microbial</topic><topic>Female</topic><topic>Fluoroquinolones - adverse effects</topic><topic>Fluoroquinolones - therapeutic use</topic><topic>Geriatric Assessment</topic><topic>Humans</topic><topic>Hypersensitivity - epidemiology</topic><topic>Hypersensitivity - immunology</topic><topic>Microbial Sensitivity Tests</topic><topic>Nitrofurantoin - adverse effects</topic><topic>Nitrofurantoin - therapeutic use</topic><topic>Prognosis</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Sulfonamides - adverse effects</topic><topic>Sulfonamides - therapeutic use</topic><topic>Treatment Outcome</topic><topic>Urinalysis - methods</topic><topic>Urinary Tract Infections - diagnosis</topic><topic>Urinary Tract Infections - drug therapy</topic><topic>Urinary Tract Infections - epidemiology</topic><topic>Urinary Tract Infections - microbiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Malik, Rena D.</creatorcontrib><creatorcontrib>Wu, Yuefeng (Rose)</creatorcontrib><creatorcontrib>Christie, Alana L.</creatorcontrib><creatorcontrib>Alhalabi, Feras</creatorcontrib><creatorcontrib>Zimmern, Philippe E.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Urology (Ridgewood, N.J.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Malik, Rena D.</au><au>Wu, Yuefeng (Rose)</au><au>Christie, Alana L.</au><au>Alhalabi, Feras</au><au>Zimmern, Philippe E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Allergy and Resistance on Antibiotic Selection for Recurrent Urinary Tract Infections in Older Women</atitle><jtitle>Urology (Ridgewood, N.J.)</jtitle><addtitle>Urology</addtitle><date>2018-03-01</date><risdate>2018</risdate><volume>113</volume><spage>26</spage><epage>33</epage><pages>26-33</pages><issn>0090-4295</issn><eissn>1527-9995</eissn><abstract>To review the impact of antibiotic allergy and resistance in older women with recurrent urinary tract infections (RUTIs) as determinants for a suitable oral antibiotic treatment choice.
A prospectively maintained database of women 65 years old and older with documented RUTIs (≥3 UTI/y) and trigonitis on cystoscopy was reviewed. Demographic data, known drug allergies, renal function, antibiotic susceptibility of most recent urine culture, allergy, or resistance to trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones, and nitrofurantoin were obtained.
From 2006 to 2014, 86 women with RUTIs met study criteria. Mean age was 77.9 ± 7.8, with 94% being Caucasian. An estimated glomerular filtration rate >30 mL/min was noted in 94%. The percentage of women allergic, resistant, or both allergic and resistant to TMP-SMX was 33%, 29%, and 15%, to fluoroquinolones was 14%, 34%, and 8.1%, or nitrofurantoin was 16%, 14%, and 5%, respectively. Twenty-eight percent (24 of 86) of women who were allergic and/or resistant to TMP-SMX and fluoroquinolones were sensitive to nitrofurantoin. Twenty percent (17 of 86) were allergic and/or resistant to all 3 antibiotics. Women who were allergic or resistant to TMP-SMX had a significantly higher number of other antibiotic resistances compared with women sensitive to TMP-SMX (4.9 ± 3.6 vs 2.1 ± 2.3; P < .0001). Similarly, women with fluoroquinolone allergy or resistance had significantly more antibiotic resistances than those who were fluoroquinolone sensitive (5.8 ± 3.5 vs 2.3 ± 2.5; P < .0001).
Because of allergy and/or antibiotic resistance, several first-line antibiotics are not available for many older women with RUTIs. In nearly a third of women, nitrofurantoin was the only viable alternative.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29196069</pmid><doi>10.1016/j.urology.2017.08.070</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-3843-7289</orcidid><orcidid>https://orcid.org/0000-0002-7612-2042</orcidid></addata></record> |
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| subjects | Age Factors Aged Aged, 80 and over Anti-Infective Agents - adverse effects Anti-Infective Agents - immunology Anti-Infective Agents - therapeutic use Anti-Infective Agents, Urinary - adverse effects Anti-Infective Agents, Urinary - therapeutic use Chronic Disease Cohort Studies Cystoscopy - methods Databases, Factual Drug Resistance, Microbial Female Fluoroquinolones - adverse effects Fluoroquinolones - therapeutic use Geriatric Assessment Humans Hypersensitivity - epidemiology Hypersensitivity - immunology Microbial Sensitivity Tests Nitrofurantoin - adverse effects Nitrofurantoin - therapeutic use Prognosis Recurrence Retrospective Studies Risk Assessment Sulfonamides - adverse effects Sulfonamides - therapeutic use Treatment Outcome Urinalysis - methods Urinary Tract Infections - diagnosis Urinary Tract Infections - drug therapy Urinary Tract Infections - epidemiology Urinary Tract Infections - microbiology |
| title | Impact of Allergy and Resistance on Antibiotic Selection for Recurrent Urinary Tract Infections in Older Women |
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