Uncomplicated urinary tract infections in Swedish primary care; etiology, resistance and treatment.
Adolescent
Adult
Aged
Anti-Bacterial Agents
/ therapeutic use
Ciprofloxacin
/ pharmacology
Drug Prescriptions
/ statistics & numerical data
Drug Resistance, Bacterial
/ drug effects
Escherichia coli
/ drug effects
Escherichia coli Infections
/ drug therapy
Female
Humans
Middle Aged
Nitrofurantoin
/ therapeutic use
Prevalence
Primary Health Care
/ statistics & numerical data
Prospective Studies
Sweden
/ epidemiology
Urinary Tract Infections
/ drug therapy
Antibiotic
Antibiotic resistance
E.Coli
General practice
Primary health care
Urinary tract infection
Urine culture
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
13 Feb 2019
13 Feb 2019
Historique:
received:
15
06
2018
accepted:
06
02
2019
entrez:
15
2
2019
pubmed:
15
2
2019
medline:
28
5
2019
Statut:
epublish
Résumé
Uncomplicated urinary tract infection (uUTI) is common and a majority of patients are prescribed antibiotics. There is little knowledge about antibiotic resistance in urine samples from patients with uUTI in primary health care (PHC). The aim was to describe antibiotic treatment, bacterial findings, the prevalence of resistant E.coli and factors associated with antibiotic resistance. The aim was also to compare the prevalence of resistant E.coli in clinical practice with the prevalence of resistant E.coli in routine microbiological laboratory data. This observational study in PHC setting started in November 2014 and ended in March 2016. Women aged 17 years and older with symptoms indicating uUTI from eight PHCs were included. Questionnaires were used to retrieve anamnestic data. All urine samples were sent to the local laboratory of microbiology for diagnostic analysis and susceptibility testing. Proportions of resistant E.coli were compared with corresponding data from the regional laboratory. Urine cultures were analysed in 304 women with a median age of 46 (IQR 32-66) years. Bacterial growth was found in 243 (80%) of urine samples, and E.coli in 72% of the positive samples. A total of 80% of detected E.coli isolates were susceptible to all tested antimicrobials and resistance rates to ciprofloxacin were lower than reported from the local clinical laboratory. Antibiotic treatment within the last year was independently associated with antibiotic resistant E.coli in the urine sample adjusted OR 4.97 (95% CI 2.04-12.06). A total of 74% of the women were treated with antibiotics. The most prescribed was pivmecillinam followed by nitrofurantoin. Antibiotic resistance in E.coli was low. Antibiotic treatment within the last year was associated with antibiotic resistant E.coli. Data from the clinical microbiology laboratory indicates that laboratory data may overestimate antibiotic resistance and lead to an unnecessary change in empiric antibiotic treatment of uUTI in primary care. The empirically prescribed antibiotics, were inline with Swedish treatment recommendations for uUTI.
Sections du résumé
BACKGROUND
BACKGROUND
Uncomplicated urinary tract infection (uUTI) is common and a majority of patients are prescribed antibiotics. There is little knowledge about antibiotic resistance in urine samples from patients with uUTI in primary health care (PHC). The aim was to describe antibiotic treatment, bacterial findings, the prevalence of resistant E.coli and factors associated with antibiotic resistance. The aim was also to compare the prevalence of resistant E.coli in clinical practice with the prevalence of resistant E.coli in routine microbiological laboratory data.
METHODS
METHODS
This observational study in PHC setting started in November 2014 and ended in March 2016. Women aged 17 years and older with symptoms indicating uUTI from eight PHCs were included. Questionnaires were used to retrieve anamnestic data. All urine samples were sent to the local laboratory of microbiology for diagnostic analysis and susceptibility testing. Proportions of resistant E.coli were compared with corresponding data from the regional laboratory.
RESULTS
RESULTS
Urine cultures were analysed in 304 women with a median age of 46 (IQR 32-66) years. Bacterial growth was found in 243 (80%) of urine samples, and E.coli in 72% of the positive samples. A total of 80% of detected E.coli isolates were susceptible to all tested antimicrobials and resistance rates to ciprofloxacin were lower than reported from the local clinical laboratory. Antibiotic treatment within the last year was independently associated with antibiotic resistant E.coli in the urine sample adjusted OR 4.97 (95% CI 2.04-12.06). A total of 74% of the women were treated with antibiotics. The most prescribed was pivmecillinam followed by nitrofurantoin.
CONCLUSIONS
CONCLUSIONS
Antibiotic resistance in E.coli was low. Antibiotic treatment within the last year was associated with antibiotic resistant E.coli. Data from the clinical microbiology laboratory indicates that laboratory data may overestimate antibiotic resistance and lead to an unnecessary change in empiric antibiotic treatment of uUTI in primary care. The empirically prescribed antibiotics, were inline with Swedish treatment recommendations for uUTI.
Identifiants
pubmed: 30760219
doi: 10.1186/s12879-019-3785-x
pii: 10.1186/s12879-019-3785-x
pmc: PMC6375206
doi:
Substances chimiques
Anti-Bacterial Agents
0
Ciprofloxacin
5E8K9I0O4U
Nitrofurantoin
927AH8112L
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
155Subventions
Organisme : Southern Regional Health Care Committee Sweden
ID : 1
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