Symptoms Of Uncomplicated Uncomplicated Urinary Tract Infection Research Articles

Antibiotic resistance in patients with urinary tract infections in Pakistan.

The level of antibiotic resistance of pathogens causing uncomplicated urinary tract infections (UTIs) is increasing. The 2017-2018 GLASS (Global Antimicrobial Resistance and Use Surveillance System) report indicated >70% resistance to ceftriaxone and ciprofloxacin in Escherichia coli in Pakistan. A prospective study was conducted in the Médecins Sans Frontières (MSF) supported Timurgara District Hospital, Timurgara, Pakistan, from September 2017 to December 2018. Women aged 18-65 years presenting to the Emergency Department with symptoms of uncomplicated UTI (cystitis/pyelonephritis) were invited to participate. We conducted microbiological culture and sensitivity testing for samples with positive dipstick or nitrite test. Of the 200 patients who participated, 109 (54.5%) were diagnosed with pyelonephritis and 91 (45.5%) with cystitis. Forty-three samples (21.5%) were culture-positive: E. coli was isolated in 27 samples, Enterococcus spp. in 7 and Klebsiella pneumoniae in 6. Overall resistance to ciprofloxacin was observed in 51.8% of E. coli isolates, and ceftriaxone resistance in 66.7% of E. coli isolates and in 33.3% of K. pneumoniae. Resistance to fosfomycin was low (one E. coli isolate). This study found resistance to first- and second-line antibiotics for treating UTIs as per the MSF protocol. Heightened awareness and potential changes to local prescription practices are necessary to curb the spread of antimicrobial resistance pathogens causing UTIs.

A hospital-based descriptive cross-sectional study in Eastern India to estimate the effect of nitrofurantoin, an age-old therapeutic option, in uncomplicated urinary tract infection

Background: Urinary pathogens develop lesser resistance against Nitrofurantoin than other antimicrobials such as Fluoroquinolones, Cotrimoxazole, and Carbapenems. Aim and Objective: The objective of this study was to estimate the sensitivity pattern of the urinary isolates against Nitrofurantoin in uncomplicated Urinary tract infection (UTI). Materials and Methods: The descriptive cross-sectional study was performed from January 1, 2020, to June 30, 2020, with 759 cases with signs and symptoms of uncomplicated UTI. Aseptically collected midstream urine was inoculated on Nutrient Agar Media, MacConkey’s Agar media, and Blood Agar media for bacterial isolation. Antimicrobial susceptibility testing was done by disk diffusion technique on Mueller Hinton Agar (Kirby Bauer technique) as per Clinical Laboratory Standards Institute guidelines. Results: Out of total of 759 urine samples, in 165 cases bacterial pathogens were isolated (21.73%). Only 17 were resistant to Nitrofurantoin (10.30%) whereas resistance to Fluoroquinolone (Ciprofloxacin) was in 58 isolates (35.15%) and Cotrimoxazole, in 37 isolates (22.42%). Resistance against Carbapenem antibiotics (Imipenem and Meropenem) was found in 29 isolates (17.57%). All the Nitrofurantoin resistant isolates were Gram-negative. Majority of the Nitrofurantoin resistant isolates were Klebsiella pneumonia (8 out of 17, i.e, 47.05%). All Nitrofurantoin resistant isolates were sensitive to Colistin and Tigecycline. Five out of 17 Nitrofurantoin resistant isolates were sensitive to Meropenem and Imipenem (29.41%). The Fischer exact test reveals that Nitrofurantoin is effective against the isolates resistant to Fluoroquinolones, Cotrimoxazole, and Carbapenems. Conclusion: Nitrofurantoin, even today, remains a good choice for empirical therapy for uncomplicated UTI.

Predicting the use of antibiotics after initial symptomatic treatment of an uncomplicated urinary tract infection: analyses performed after a randomised controlled trial

ObjectiveTo predict antibiotic use after initial treatment with ibuprofen using data from a randomised controlled trial comparing ibuprofen to pivmecillinam in the treatment of women with symptoms of an uncomplicated...

Algorithms Using Previous Resistance, Prior Antimicrobial Prescriptions, and Patient Place of Residence Enhance Empirical Therapy for Women With Uncomplicated Urinary Tract Infections

To evaluate how previous antimicrobial resistance, prior prescription data, and patient place of residence (ZIP code) can guide empirical therapy for uncomplicated urinary tract infections (UTI). Guidelines recommend empirical antimicrobial selection for women with symptoms of uncomplicated UTIs, most commonly trimethoprim-sulfamethoxazole (SXT), nitrofurantoin (NIT), or ciprofloxacin (CIP). Previous antimicrobial resistance and prior prescription data are potential predictors of resistance in subsequent urine cultures for UTIs. Also, there is evidence of geographic clustering of antimicrobial resistance for UTIs. Retrospective data from women (age ≥18) with an assigned diagnosis of UTI, submitting urine cultures as outpatients (2011-2018), were gathered. Univariate analyses and multivariable regression models were used to determine odds ratios for predicting resistance to SXT, NIT, and CIP on the 2011-2017 data. Antimicrobial choice algorithms were created using 2011-2017 results and tested on 2018 data. In the training cohort, 9455 women had diagnoses of uncomplicated UTIs and positive urine cultures. Prevalence of resistance for SXT, NIT, and CIP was 19.4%, 12.1%, and 10.3%, respectively. A urine culture with previous resistance, prior antimicrobial prescription within 2 years and ZIP code were the strongest predictors of a subsequent resistant culture. An algorithm based on these data had a success rate of 92.2%, compared to provider's choice (87.5%, P <.001) or best theoretical outcomes with guidelines (90.0%, P=.048). Previous resistance, prior prescriptions, and patient ZIP code are predictors of subsequent resistance in patients with uncomplicated UTIs. Algorithms using these data can outperform real-world outcomes and guidelines.

Predictors of Symptom Duration and Bacteriuria in Uncomplicated Urinary Tract Infection

Objective: To identify baseline predictors of symptom duration after empirical treatment for uncomplicated urinary tract infection (UTI) and significant bacteriuria in a cohort of women treated for UTI.Design: Prospective single-centre cohort study.Setting: Outpatient clinic in Norway.Patients: From September 2010 to November 2011, 441 women aged 16–55 years with symptoms of uncomplicated UTI were included.Results: Dipstick findings of leukocyte esterase 1 + (incidence rate ratio (IRR) 1.93, 95% confidence interval (CI) 1.23–3.01, p < 0.01) and microbe resistant to mecillinam treatment (IRR 1.41, 95% CI 1.07–1.89, p = 0.02) predicted longer symptom duration. More pronounced symptoms did not predict longer symptom duration (IRR 1.18, 95% CI 0.94–1.46, p = 0.15) or significant bacteriuria (odds ratio [OR] 1.16, 95% CI 0.72–1.88, p = 0.54). Leukocyte esterase 2 + (OR 2.51, 95% CI 0.92–6.83, p = 0.07) or 3 + (OR 2.40, 95% CI 0.88–6.05, p = 0.09) and nitrite positive urine dipstick test (OR 3.22, 95% CI 1.58–7.01, p = <0.01) were associated with bacteriuria.Conclusion: More pronounced symptoms did not correlate with significant bacteriuria or symptom duration after empirical treatment for acute cystitis. One might reconsider the current practice of treating uncomplicated UTI based on symptoms alone.Key PointsTreatment strategies for milder infectious diseases must consider ways of reducing antibiotic consumption to decelerate the increase in antibiotic resistance. Our findings suggest that more emphasis should be put on urine dipstick results and bacteriological findings in the clinical setting. One might reconsider the current practice of treating uncomplicated UTIs based on symptoms alone.

Correction: Antibiotic resistance rates and physician antibiotic prescription patterns of uncomplicated urinary tract infections in southern Chinese primary care.

[This corrects the article DOI: 10.1371/journal.pone.0177266.].

Antibiotic resistance rates and physician antibiotic prescription patterns of uncomplicated urinary tract infections in southern Chinese primary care.

Uncomplicated urinary tract infections (UTI) are common in primary care. Whilst primary care physicians are called to be antimicrobial stewards, there is limited primary care antibiotic resistance surveillance and physician antibiotic prescription data available in southern Chinese primary care. The study aimed to investigate the antibiotic resistance rate and antibiotic prescription patterns in female patients with uncomplicated UTI. Factors associated with antibiotic resistance and prescription was explored. A prospective cohort study was conducted in 12 primary care group clinics in Hong Kong of patients presenting with symptoms of uncomplicated UTI from January 2012 to December 2013. Patients’ characteristics such as age, comorbidity, presenting symptoms and prior antibiotic use were recorded by physicians, as well as any empirical antibiotic prescription given at presentation. Urine samples were collected to test for antibiotic resistance of uropathogens. Univariate analysis was conducted to identify factors associated with antibiotic resistance and prescription. A total of 298 patients were included in the study. E. coli was detected in 107 (76%) out of the 141 positive urine samples. Antibiotic resistance rates of E. coli isolates for ampicillin, co-trimoxazole, ciprofloxacin, amoxicillin and nitrofurantoin were 59.8%, 31.8%, 23.4%, 1.9% and 0.9% respectively. E. coli isolates were sensitive to nitrofurantoin (98.1%) followed by amoxicillin (78.5%). The overall physician antibiotic prescription rate was 82.2%. Amoxicillin (39.6%) and nitrofurantoin (28.6%) were the most common prescribed antibiotics. Meanwhile, whilst physicians in public primary care prescribed more amoxicillin (OR: 2.84, 95% CI: 1.67 to 4.85, P<0.001) and nitrofurantoin (OR: 2.01, 95% CI: 1.14 to 3.55, P = 0.015), physicians in private clinics prescribed more cefuroxime and ciprofloxacin (P<0.05). Matching of antibiotic prescription and antibiotic sensitivity of E. coli isolates occurred in public than private primary care prescriptions (OR: 6.72, 95% CI: 2.07 to 21.80 P = 0.001) and for other uropathogens (OR: 6.19, 95% CI: 1.04 to 36.78 P = 0.034). Mismatching differences of antibiotic prescription and resistance were not evident. In conclusion, nitrofurantoin and amoxicillin should be used as first line antibiotic treatment for uncomplicated UTI. There were significant differences in antibiotic prescription patterns between public and private primary care. Public primary care practitioners were more likely to prescribe first line antibiotic treatment which match antibiotic sensitivity of E. coli isolates and other uropathogens. Further exploration of physician prescribing behaviour and educational interventions, particularly in private primary care may helpful. Meanwhile, development and dissemination of guidelines for primary care management of uncomplicated UTI as well as continued surveillance of antibiotic resistance and physician antibiotic prescription is recommended.

MP032: Do urine cultures in the emergency department change management of young women with symptoms of uncomplicated urinary tract infection?

Introduction: Current guidelines do not recommend the routine use of urinary cultures in the management of uncomplicated urinary tract infection (UTI) in premenopausal, non-pregnant women. Complicating factors include atypical presentation, structural abnormalities or recent recurrent infection/antibiotic use. The objective of this study was to determine the number of urine cultures ordered for women who presented to the emergency department (ED) with symptoms of uncomplicated UTI, and whether a culture result impacted subsequent management. Methods: This was a retrospective chart review of women aged 18-39 presenting to one of two academic EDs with a discharge diagnosis of uncomplicated UTI from Jan-Dec 2014. Patients were excluded if any of the following were documented: pregnancy, fever, immunocompromised state, diabetes mellitus, absence of lower urinary tract symptoms, ED administration of intravenous antibiotics, a previous UTI treated with antibiotics in the last 90 days, two weeks post-partum or post-instrumentation. Results: Of the 512 charts included in the analysis, 494 (96.5%) patients had a urinalysis, of which 463 (93.7%) had positive leukocyte esterase and 90 (18.2%) had positive nitrites. 370 patients (72.3%) had urine cultures performed, of which 236 (63.8%) were positive. 505 (98.6%) patients received antibiotics (53.9% Macrobid; 22.6% Ciprofloxacin; 15.0% Septra; 6.7% other; 1.8% not documented). 7 (1.9%) cultures grew organisms resistant to the prescribed antibiotic; 2 (0.5%) patients received new prescriptions. Conclusion: For the majority of young female patients with uncomplicated UTI, urine cultures did not change management. Almost all of these patients had a positive leukocyte esterase and were treated with antibiotics, yet approximately 40% of the patients tested did not return positive urine cultures, suggesting that better algorithms for the diagnosis of UTI in the ED are required. Unnecessary treatment with antibiotics is expensive, contributes to the development of multidrug resistant organisms, and exposes the patient to the unnecessary risks of possible allergic reactions, drug interactions and side effects.

The ECOSENS Project: a prospective, multinational, multicentre epidemiological survey of the prevalence and antimicrobial susceptibility of urinary tract pathogens--interim report

The ECO.SENS Project is the first international survey to investigate the prevalence and susceptibility of pathogens causing community-acquired, uncomplicated urinary tract infections (UTIs) in women. At 240 centres in 17 countries, female patients presenting with symptoms of uncomplicated UTIs were asked to provide a urine sample for testing for the presence of leucocytes and bacteria. The bacteria were identified and their susceptibility to 12 antibiotics commonly used in the treatment of UTIs was determined. The objective of the survey was to collect 5000 urine samples to obtain approximately 3500 isolates of defined uropathogens. This interim report includes the results from 1960 urine samples, 75% of which contained a uropathogen. Escherichia coli accounted for the majority (80%) of uropathogens isolated in all 17 countries. The rates of resistance among E. coli strains were: ampicillin and sulphamethoxazole, 30%; trimethoprim alone or with sulphamethoxazole, 15%; nalidixic acid, 6%; ciprofloxacin, 3%; amoxycillin-clavulanic acid, mecillinam, cefadroxil, nitrofurantoin and fosfomycin, < or =2%. The use of ampicillin, sulphonamides and trimethoprim alone or with sulphamethoxazole needs to be reconsidered. The seemingly rapid increase in quinolone resistance among community-acquired E. coli in some of the countries gives cause for concern.