The influence of smoking on bacterial resistance after vaccine or antibiotic prophylaxis against recurrent urinary tract infections

• Published in: Actas urológicas españolas (English ed.) 2020-09, Vol.44 (7), p.497-504
• Main Authors: Lorenzo-Gómez, M.F., Santos-Antunes, M.T., Nieto-Huertos, A., Lorenzo-Gómez, A., Marquez-Sanchez, M.T., Flores-Fraile, M.C., Valverde-Martinez, L.S., González-Casado, I., García-Cenador, M.B., Mirón-Canelo, J.A., Padilla-Fernández, B.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Antibiotic; Antibiotic Prophylaxis; Antibiótico; Bacterial Infections - drug therapy; Bacterial Infections - prevention & control; Bacterial resistance; Bacterial Vaccines; Drug Resistance, Bacterial; Female; Humans; Infecciones urinarias de repetición; Middle Aged; Recurrence; recUrrent urinary tract infections; Resistencia bacteriana; Retrospective Studies; Smoking; Smoking - adverse effects; Tabaquismo; Urinary Tract Infections - drug therapy; Urinary Tract Infections - microbiology; Vaccine; Vacuna; Young Adult
• ISSN: 2173-5786; 2173-5786
• DOI: 10.1016/j.acuroe.2020.08.004

The influence of tobacco on the microbiological spectrum, resistance-sensitivity pattern and evolution in patients with recurrent urinary tract infections (RUTI) is analyzed. Evaluation of the effect of polyvalent bacterial vaccine on the prevention of RUTI and smoking status. Retrospective multicenter study of 855 women with RUTI receiving suppressive antibiotic treatment or bacterial vaccine between 2009 and 2013. Group A (GA): Antibiotic (n = 495). Subgroups: GA1 non-smoker (n = 417), GA2 smoker (n = 78). Group B (GB): Vaccine (n = 360). Subgroups: GB1 non-smoker (n = 263), GB2 smoker (n = 97). Variables: Age, pre-treatment UTI, disease-free time (DFT), microbial species, sensitivity and resistance. Follow-up at 3, 6 and 12 months with culture and SF-36 questionnaire. Mean age 56.51 years (18–75), similar between groups (p =  0.2257). No difference in the number of pretreatment UTIs (p =  0.1329) or in the distribution of the bacterial spectrum (p =  0.7471). DFT was higher in subgroups B compared with A. Urine cultures in GA1: E. coli 62.71% with 8.10% resistance (33% quinolones; 33% cotrimoxazole; 33% quinolones + cotrimoxazole); in GA2 E. coli 61.53% with 75% resistance (16.66% quinolones; 33.33% quinolones + cotrimoxazole; 16.66% amoxicillin-clavulanate; 16.66% erythromycin + phosphomycin + clindamycin) (p =  0, 0133). There were no differences between patients of GA treated with cotrimoxazole and nitrofurantoin (p =  0.8724). Urine cultures in GB1: E. coli 47.36% with 22.22% resistance (5.55% ciprofloxacin; 5.55% cotrimoxazole; 5.55% ciprofloxacin + cotrimoxazole; 5.55% amoxicillin / clavulanic acid). In GB2 E.coli 70.02% with 61.90% resistances (30.76% quinolones; 30.76% cotrimoxazole; 30.76% quinolones + cotrimoxazole; 17.69% amoxicillin-clavulanic acid) (p = 0,0144). The development of bacterial resistance is more frequent among women with smoking habits and recurrent urinary infections. This could influence a worse response to preventive treatments, either with antibiotics or vaccines. Se analiza la influencia del tabaco en el espectro microbiológico, patrón de resistencia-sensibilidad y evolución en pacientes con infección de orina de repetición (ITUR). Evaluación del efecto de vacuna bacteriana polivalente en la prevención de las ITUR y el estado como fumador. Estudio retrospectivo multicéntrico de 855 mujeres con ITUR tratadas con pauta antibiótica supresiva o vacuna bacteriana entre 2009 y 2013. Grupo A (GA): Antibiótico (n = 495). Subgrupo