Etiologies of community-onset urinary tract infections requiring hospitalization and antimicrobial susceptibilities of causative microorganisms
Background: Community-onset urinary tract infections (CoUTIs) are the most common bacterial infections, and a decline in antibiotic susceptibility causes many clinical challenges. Adequate empiric antibiotic treatment can decrease unnecessary hospital stays and complications, while reducing the anti...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2017-12-01
|
| Series: | Journal of Microbiology, Immunology and Infection |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1684118216301438 |
| _version_ | 1818389223992983552 |
|---|---|
| author | Chih-Chien Chiu Tzu-Chao Lin Rui-Xin Wu Ya-Sung Yang Po-Jen Hsiao Yi Lee Jung-Chung Lin Feng-Yee Chang |
| author_facet | Chih-Chien Chiu Tzu-Chao Lin Rui-Xin Wu Ya-Sung Yang Po-Jen Hsiao Yi Lee Jung-Chung Lin Feng-Yee Chang |
| author_sort | Chih-Chien Chiu |
| collection | DOAJ |
| description | Background: Community-onset urinary tract infections (CoUTIs) are the most common bacterial infections, and a decline in antibiotic susceptibility causes many clinical challenges. Adequate empiric antibiotic treatment can decrease unnecessary hospital stays and complications, while reducing the antimicrobial resistance progression. Methods: From October 2014 to April 2015, we retrospectively enrolled patients who were at least 18 years old and required hospitalization for CoUTIs. Demographic variables of these patients, and uropathogens and their antimicrobial susceptibilities were evaluated. Results: In total, 457 patients were enrolled in this study. Their mean age was 71.9 years, and 35.2% of the patients were male. Escherichia coli (54.5%) was the most common uropathogen, followed by Klebsiella pneumoniae (13.1%), Enterococcus spp. (7.1%), Pseudomonas aeruginosa (4.6%), and Proteus mirabilis (3.5%). Bacteremia was present in 25.2% of patients. Diabetes mellitus and acute kidney injury at admission were risk factors for CoUTIs with concomitant bacteremia. Among the UTI-associated bloodstream strains, E. coli (53.1%) was also the most predominant pathogen, followed by K. pneumoniae (11.3%), Staphylococcus aureus (6.1%), and P. mirabilis (4.3%). The overall susceptibility of cefazolin was 62.8%, ceftriaxone 71.4%, ceftazidime 82.8%, flomoxef 82%, cefepime 94.5%, ampicillinâsulbactam 41.6%, piperacillinâtazobactam 85%, levofloxacin 65.2%, trimethoprimâsulfamethoxazole 61.5%, imipenem 92.3%, gentamicin 76.1%, and amikacin 97.5%. Cefazolin-susceptible isolates could be found more frequently among patients who are less than 65 years of age and without diabetes mellitus, had no UTI episode in the past year, and have no bacteremia risk. Patients with nasogastric tube retention more commonly experienced antimicrobial resistance to all the third-generation cephalosporins. Conclusion: Third-generation cephalosporins effectively treated CoUTIs. However, patients with nasogastric tube retention more commonly experienced cephalosporin resistance. Cefepime, imipenem, and amikacin may be used in patients with higher antimicrobial resistance. In selected patients, cefazolin may still be an adequate drug of choice for CoUTIs. Keywords: antibiotic susceptibility, cefazolin, community onset, third-generation cephalosporin, urinary tract infection |
| first_indexed | 2024-12-14T04:38:20Z |
| format | Article |
| id | doaj.art-361c5234da1540d4a06383ad893d342f |
| institution | Directory Open Access Journal |
| issn | 1684-1182 |
| language | English |
| last_indexed | 2024-12-14T04:38:20Z |
| publishDate | 2017-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Microbiology, Immunology and Infection |
| spelling | doaj.art-361c5234da1540d4a06383ad893d342f2022-12-21T23:16:52ZengElsevierJournal of Microbiology, Immunology and Infection1684-11822017-12-01506879885Etiologies of community-onset urinary tract infections requiring hospitalization and antimicrobial susceptibilities of causative microorganismsChih-Chien Chiu0Tzu-Chao Lin1Rui-Xin Wu2Ya-Sung Yang3Po-Jen Hsiao4Yi Lee5Jung-Chung Lin6Feng-Yee Chang7Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Division of Infectious Disease and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDivision of Infectious Disease and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Internal Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, TaiwanDivision of Infectious Disease and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDivision of Infectious Disease and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDepartment of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, TaiwanDivision of Infectious Disease and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, TaiwanDivision of Infectious Disease and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDivision of Infectious Disease and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Corresponding author. Division of Infectious Disease and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, Number 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.Background: Community-onset urinary tract infections (CoUTIs) are the most common bacterial infections, and a decline in antibiotic susceptibility causes many clinical challenges. Adequate empiric antibiotic treatment can decrease unnecessary hospital stays and complications, while reducing the antimicrobial resistance progression. Methods: From October 2014 to April 2015, we retrospectively enrolled patients who were at least 18 years old and required hospitalization for CoUTIs. Demographic variables of these patients, and uropathogens and their antimicrobial susceptibilities were evaluated. Results: In total, 457 patients were enrolled in this study. Their mean age was 71.9 years, and 35.2% of the patients were male. Escherichia coli (54.5%) was the most common uropathogen, followed by Klebsiella pneumoniae (13.1%), Enterococcus spp. (7.1%), Pseudomonas aeruginosa (4.6%), and Proteus mirabilis (3.5%). Bacteremia was present in 25.2% of patients. Diabetes mellitus and acute kidney injury at admission were risk factors for CoUTIs with concomitant bacteremia. Among the UTI-associated bloodstream strains, E. coli (53.1%) was also the most predominant pathogen, followed by K. pneumoniae (11.3%), Staphylococcus aureus (6.1%), and P. mirabilis (4.3%). The overall susceptibility of cefazolin was 62.8%, ceftriaxone 71.4%, ceftazidime 82.8%, flomoxef 82%, cefepime 94.5%, ampicillinâsulbactam 41.6%, piperacillinâtazobactam 85%, levofloxacin 65.2%, trimethoprimâsulfamethoxazole 61.5%, imipenem 92.3%, gentamicin 76.1%, and amikacin 97.5%. Cefazolin-susceptible isolates could be found more frequently among patients who are less than 65 years of age and without diabetes mellitus, had no UTI episode in the past year, and have no bacteremia risk. Patients with nasogastric tube retention more commonly experienced antimicrobial resistance to all the third-generation cephalosporins. Conclusion: Third-generation cephalosporins effectively treated CoUTIs. However, patients with nasogastric tube retention more commonly experienced cephalosporin resistance. Cefepime, imipenem, and amikacin may be used in patients with higher antimicrobial resistance. In selected patients, cefazolin may still be an adequate drug of choice for CoUTIs. Keywords: antibiotic susceptibility, cefazolin, community onset, third-generation cephalosporin, urinary tract infectionhttp://www.sciencedirect.com/science/article/pii/S1684118216301438 |
| spellingShingle | Chih-Chien Chiu Tzu-Chao Lin Rui-Xin Wu Ya-Sung Yang Po-Jen Hsiao Yi Lee Jung-Chung Lin Feng-Yee Chang Etiologies of community-onset urinary tract infections requiring hospitalization and antimicrobial susceptibilities of causative microorganisms Journal of Microbiology, Immunology and Infection |
| title | Etiologies of community-onset urinary tract infections requiring hospitalization and antimicrobial susceptibilities of causative microorganisms |
| title_full | Etiologies of community-onset urinary tract infections requiring hospitalization and antimicrobial susceptibilities of causative microorganisms |
| title_fullStr | Etiologies of community-onset urinary tract infections requiring hospitalization and antimicrobial susceptibilities of causative microorganisms |
| title_full_unstemmed | Etiologies of community-onset urinary tract infections requiring hospitalization and antimicrobial susceptibilities of causative microorganisms |
| title_short | Etiologies of community-onset urinary tract infections requiring hospitalization and antimicrobial susceptibilities of causative microorganisms |
| title_sort | etiologies of community onset urinary tracta infections requiring hospitalization anda antimicrobial susceptibilities ofa causative microorganisms |
| url | http://www.sciencedirect.com/science/article/pii/S1684118216301438 |
| work_keys_str_mv | AT chihchienchiu etiologiesofcommunityonseturinarytractainfectionsrequiringhospitalizationandaantimicrobialsusceptibilitiesofacausativemicroorganisms AT tzuchaolin etiologiesofcommunityonseturinarytractainfectionsrequiringhospitalizationandaantimicrobialsusceptibilitiesofacausativemicroorganisms AT ruixinwu etiologiesofcommunityonseturinarytractainfectionsrequiringhospitalizationandaantimicrobialsusceptibilitiesofacausativemicroorganisms AT yasungyang etiologiesofcommunityonseturinarytractainfectionsrequiringhospitalizationandaantimicrobialsusceptibilitiesofacausativemicroorganisms AT pojenhsiao etiologiesofcommunityonseturinarytractainfectionsrequiringhospitalizationandaantimicrobialsusceptibilitiesofacausativemicroorganisms AT yilee etiologiesofcommunityonseturinarytractainfectionsrequiringhospitalizationandaantimicrobialsusceptibilitiesofacausativemicroorganisms AT jungchunglin etiologiesofcommunityonseturinarytractainfectionsrequiringhospitalizationandaantimicrobialsusceptibilitiesofacausativemicroorganisms AT fengyeechang etiologiesofcommunityonseturinarytractainfectionsrequiringhospitalizationandaantimicrobialsusceptibilitiesofacausativemicroorganisms |