Interaction between Antibiotic Resistance, Resistance Genes, and Treatment Response for Urinary Tract Infections in Primary Care
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 pros...
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| Veröffentlicht in: | Journal of clinical microbiology 2019-09, Vol.57 (9) |
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| creator | Ho, Hanley J Tan, Mei Xuan Chen, Mark I Tan, Thean Yen Koo, Seok Hwee Koong, Agnes Y L Ng, Lok Pui Hu, Pei Lin Tan, Kee Tung Moey, Peter K S Koh, Eileen Y L Wong, Chia Siong Lye, David C Tan, Ngiap Chuan |
| description | 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
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.
was the most common uropathogen (76%).
isolates (
= 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
(14/26, 54%), plasmid-mediated
(12/24, 50%),
(7/69, 10%), and
(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 (
= 0.001) and 27% not treated (
= 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
susceptibility was imperfect. Factors associated with resistance may guide the decision to obtain initial urine culture. |
| doi_str_mv | 10.1128/JCM.00143-19 |
| format | Article |
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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.
was the most common uropathogen (76%).
isolates (
= 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
(14/26, 54%), plasmid-mediated
(12/24, 50%),
(7/69, 10%), and
(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 (
= 0.001) and 27% not treated (
= 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
susceptibility was imperfect. Factors associated with resistance may guide the decision to obtain initial urine culture.</description><identifier>ISSN: 0095-1137</identifier><identifier>EISSN: 1098-660X</identifier><identifier>DOI: 10.1128/JCM.00143-19</identifier><identifier>PMID: 31243084</identifier><language>eng</language><publisher>United States: American Society for Microbiology</publisher><subject>Bacteriology</subject><ispartof>Journal of clinical microbiology, 2019-09, Vol.57 (9)</ispartof><rights>Copyright © 2019 Ho et al.</rights><rights>Copyright © 2019 Ho et al. 2019 Ho et al.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-50c5774130b2ec82c0f6c2f090665627f03de8e88e3937a85969cf7fa72222003</citedby><cites>FETCH-LOGICAL-c384t-50c5774130b2ec82c0f6c2f090665627f03de8e88e3937a85969cf7fa72222003</cites><orcidid>0000-0001-9369-5830</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6711900/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6711900/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,3175,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31243084$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ho, Hanley J</creatorcontrib><creatorcontrib>Tan, Mei Xuan</creatorcontrib><creatorcontrib>Chen, Mark I</creatorcontrib><creatorcontrib>Tan, Thean Yen</creatorcontrib><creatorcontrib>Koo, Seok Hwee</creatorcontrib><creatorcontrib>Koong, Agnes Y L</creatorcontrib><creatorcontrib>Ng, Lok Pui</creatorcontrib><creatorcontrib>Hu, Pei Lin</creatorcontrib><creatorcontrib>Tan, Kee Tung</creatorcontrib><creatorcontrib>Moey, Peter K S</creatorcontrib><creatorcontrib>Koh, Eileen Y L</creatorcontrib><creatorcontrib>Wong, Chia Siong</creatorcontrib><creatorcontrib>Lye, David C</creatorcontrib><creatorcontrib>Tan, Ngiap Chuan</creatorcontrib><title>Interaction between Antibiotic Resistance, Resistance Genes, and Treatment Response for Urinary Tract Infections in Primary Care</title><title>Journal of clinical microbiology</title><addtitle>J Clin Microbiol</addtitle><description>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
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.
was the most common uropathogen (76%).
isolates (
= 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
(14/26, 54%), plasmid-mediated
(12/24, 50%),
(7/69, 10%), and
(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 (
= 0.001) and 27% not treated (
= 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
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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.
was the most common uropathogen (76%).
isolates (
= 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
(14/26, 54%), plasmid-mediated
(12/24, 50%),
(7/69, 10%), and
(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 (
= 0.001) and 27% not treated (
= 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
susceptibility was imperfect. Factors associated with resistance may guide the decision to obtain initial urine culture.</abstract><cop>United States</cop><pub>American Society for Microbiology</pub><pmid>31243084</pmid><doi>10.1128/JCM.00143-19</doi><orcidid>https://orcid.org/0000-0001-9369-5830</orcidid><oa>free_for_read</oa></addata></record> |
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| source | American Society for Microbiology; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Bacteriology |
| title | Interaction between Antibiotic Resistance, Resistance Genes, and Treatment Response for Urinary Tract Infections in Primary Care |
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