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Basic patient characteristics predict antimicrobial resistance in E. coli from urinary tract specimens: a retrospective cohort analysis of 5246 urine samples
Antimicrobial resistance data from surveillance networks are frequently do not accurately predict resistance patterns of urinary tract infections at the bedside. To determine simple patient- and institution-related risk factors affecting antimicrobial resistance patterns of Escherichia coli urine is...
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| Published in: | Swiss medical weekly 2018-11, Vol.148 (4546), p.w14660-w14660 |
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| container_issue | 4546 |
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| container_title | Swiss medical weekly |
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| creator | Erb, Stefan Frei, Reno Tschudin Sutter, Sarah Egli, Adrian Dangel, Marc Bonkat, Gernot Widmer, Andreas F |
| description | Antimicrobial resistance data from surveillance networks are frequently do not accurately predict resistance patterns of urinary tract infections at the bedside.
To determine simple patient- and institution-related risk factors affecting antimicrobial resistance patterns of Escherichia coli urine isolates.
From January 2012 to May 2015 all consecutive urine samples with significant growth of E. coli (≥103 CFU/ml) obtained from a tertiary care hospital were analysed for antimicrobial susceptibility and related to basic clinical data such a patient age, ward, sample type (catheter vs non-catheter urine).
Antimicrobial susceptibility testing was available for 5246 E. coli urine isolates from 4870 patients. E. coli was most commonly resistant to amoxicillin (43.1%), cotrimoxazole (24.5%) and ciprofloxacin (17.4%). Resistance rates were low for meropenem (0.0%), fosfomycin (0.9%) and nitrofurantoin (1.5%). Significantly higher rates of resistance to ciprofloxacin (32.8 vs 15.8%) and cotrimoxazole (30.6 vs 23.9%) were found in urological patients compared with patients on other wards (p |
| doi_str_mv | 10.4414/smw.2018.14660 |
| format | article |
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To determine simple patient- and institution-related risk factors affecting antimicrobial resistance patterns of Escherichia coli urine isolates.
From January 2012 to May 2015 all consecutive urine samples with significant growth of E. coli (≥103 CFU/ml) obtained from a tertiary care hospital were analysed for antimicrobial susceptibility and related to basic clinical data such a patient age, ward, sample type (catheter vs non-catheter urine).
Antimicrobial susceptibility testing was available for 5246 E. coli urine isolates from 4870 patients. E. coli was most commonly resistant to amoxicillin (43.1%), cotrimoxazole (24.5%) and ciprofloxacin (17.4%). Resistance rates were low for meropenem (0.0%), fosfomycin (0.9%) and nitrofurantoin (1.5%). Significantly higher rates of resistance to ciprofloxacin (32.8 vs 15.8%) and cotrimoxazole (30.6 vs 23.9%) were found in urological patients compared with patients on other wards (p <0.01). In multivariable analysis, predictors for E. coli resistance against ciprofloxacin and cotrimoxazole were: treatment in the urological unit (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.63-2.54; p <0.001 and OR 1.33, 95% CI 1.07-1.64; p = 0.010, respectively), male sex (OR 1.93, 95% CI 1.630-2.29; p <0.001 and OR 1.22, 95% CI 1.22-1.04; p = 0.015), and only to a lesser extent urine samples obtained from indwelling catheters (OR 1.30, 95% CI 1.05-1.61; p = 0.014 and OR 1.26, 95% CI 1.04-1.53; p = 0.020). Age ≥65 years was associated with higher resistance to ciprofloxacin (OR 1.42, 95% CI 1.21-1.67; p <0.001), but lower resistance to cotrimoxazole (OR 0.76, 95% CI 0.67-0.86; p <0.001).
Simple bedside patient data such as age, sex and treating hospital unit help to predict antimicrobial resistance and can improve the empirical treatment of urinary tract infections.</description><identifier>ISSN: 1424-3997</identifier><identifier>EISSN: 1424-3997</identifier><identifier>DOI: 10.4414/smw.2018.14660</identifier><identifier>PMID: 30440065</identifier><language>eng</language><publisher>Switzerland: SMW supporting association (Trägerverein Swiss Medical Weekly SMW)</publisher><subject>Age Factors ; Amoxicillin - pharmacology ; Anti-Bacterial Agents - pharmacology ; antimicrobial resistance ; Catheters, Indwelling - statistics & numerical data ; ciprofloxacin ; Ciprofloxacin - pharmacology ; cotrimoxazole ; Drug Resistance, Bacterial ; Escherichia coli - drug effects ; Escherichia coli - isolation & purification ; Escherichia coli Infections - drug therapy ; Escherichia coli Infections - microbiology ; Female ; Hospitals ; Humans ; Male ; Middle Aged ; Retrospective Studies ; risk factors ; Sex Factors ; Switzerland ; Trimethoprim, Sulfamethoxazole Drug Combination - pharmacology ; Urinary Tract Infections - drug therapy ; Urinary Tract Infections - microbiology ; Urine ; urology ; Urology Department, Hospital - statistics & numerical data</subject><ispartof>Swiss medical weekly, 2018-11, Vol.148 (4546), p.w14660-w14660</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c497t-75f2111fffbfaf5d3bd8f64dcceadf0047a306d63a873a5be828ebbffaf9d4b83</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30440065$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Erb, Stefan</creatorcontrib><creatorcontrib>Frei, Reno</creatorcontrib><creatorcontrib>Tschudin Sutter, Sarah</creatorcontrib><creatorcontrib>Egli, Adrian</creatorcontrib><creatorcontrib>Dangel, Marc</creatorcontrib><creatorcontrib>Bonkat, Gernot</creatorcontrib><creatorcontrib>Widmer, Andreas F</creatorcontrib><title>Basic patient characteristics predict antimicrobial resistance in E. coli from urinary tract specimens: a retrospective cohort analysis of 5246 urine samples</title><title>Swiss medical weekly</title><addtitle>Swiss Med Wkly</addtitle><description>Antimicrobial resistance data from surveillance networks are frequently do not accurately predict resistance patterns of urinary tract infections at the bedside.
To determine simple patient- and institution-related risk factors affecting antimicrobial resistance patterns of Escherichia coli urine isolates.
From January 2012 to May 2015 all consecutive urine samples with significant growth of E. coli (≥103 CFU/ml) obtained from a tertiary care hospital were analysed for antimicrobial susceptibility and related to basic clinical data such a patient age, ward, sample type (catheter vs non-catheter urine).
Antimicrobial susceptibility testing was available for 5246 E. coli urine isolates from 4870 patients. E. coli was most commonly resistant to amoxicillin (43.1%), cotrimoxazole (24.5%) and ciprofloxacin (17.4%). Resistance rates were low for meropenem (0.0%), fosfomycin (0.9%) and nitrofurantoin (1.5%). Significantly higher rates of resistance to ciprofloxacin (32.8 vs 15.8%) and cotrimoxazole (30.6 vs 23.9%) were found in urological patients compared with patients on other wards (p <0.01). In multivariable analysis, predictors for E. coli resistance against ciprofloxacin and cotrimoxazole were: treatment in the urological unit (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.63-2.54; p <0.001 and OR 1.33, 95% CI 1.07-1.64; p = 0.010, respectively), male sex (OR 1.93, 95% CI 1.630-2.29; p <0.001 and OR 1.22, 95% CI 1.22-1.04; p = 0.015), and only to a lesser extent urine samples obtained from indwelling catheters (OR 1.30, 95% CI 1.05-1.61; p = 0.014 and OR 1.26, 95% CI 1.04-1.53; p = 0.020). Age ≥65 years was associated with higher resistance to ciprofloxacin (OR 1.42, 95% CI 1.21-1.67; p <0.001), but lower resistance to cotrimoxazole (OR 0.76, 95% CI 0.67-0.86; p <0.001).
Simple bedside patient data such as age, sex and treating hospital unit help to predict antimicrobial resistance and can improve the empirical treatment of urinary tract infections.</description><subject>Age Factors</subject><subject>Amoxicillin - pharmacology</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>antimicrobial resistance</subject><subject>Catheters, Indwelling - statistics & numerical data</subject><subject>ciprofloxacin</subject><subject>Ciprofloxacin - pharmacology</subject><subject>cotrimoxazole</subject><subject>Drug Resistance, Bacterial</subject><subject>Escherichia coli - drug effects</subject><subject>Escherichia coli - isolation & purification</subject><subject>Escherichia coli Infections - drug therapy</subject><subject>Escherichia coli Infections - microbiology</subject><subject>Female</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>risk factors</subject><subject>Sex Factors</subject><subject>Switzerland</subject><subject>Trimethoprim, Sulfamethoxazole Drug Combination - pharmacology</subject><subject>Urinary Tract Infections - drug therapy</subject><subject>Urinary Tract Infections - microbiology</subject><subject>Urine</subject><subject>urology</subject><subject>Urology Department, Hospital - statistics & numerical data</subject><issn>1424-3997</issn><issn>1424-3997</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNpNkU9vFSEUxYnR2Pbp1qVh6eaNMMD8cadNrU2auNE1ucDF0swMI_A0_TB-V5n3auOKm8s5vwv3EPKGs0ZKLt_n-XfTMj40XHYde0bOuWzlXoxj__y_-oxc5HzPWDt0XL0kZ4JJyVinzsmfT5CDpSuUgEuh9g4S2IIp5BJspmtCF2yhsJQwB5uiCTDRhLnew2KRhoVeNdTGKVCf4kwPKSyQHmjZMDSvaMOMS_5AobpKilunhF9YLXcxbWCYHiqNRk9VK7sjAGmGeZ0wvyIvPEwZXz-eO_L989W3yy_726_XN5cfb_dWjn3Z98q3nHPvvfHglRPGDb6TzloE5xmTPQjWuU7A0AtQBod2QGN8FY9OmkHsyM2J6yLc6zWFuf5BRwj62Ijph4ZUFzKh7pW1A1ipYDDSQyVyI7h0dWjHx1rvyLsTa03x5wFz0XPIFqcJFoyHrFsuFBdc1KfsSHOS1sXmnNA_jeZMb_HqGq_e4tXHeKvh7SP7YGZ0T_J_eYq_Hx-llA</recordid><startdate>20181105</startdate><enddate>20181105</enddate><creator>Erb, Stefan</creator><creator>Frei, Reno</creator><creator>Tschudin Sutter, Sarah</creator><creator>Egli, Adrian</creator><creator>Dangel, Marc</creator><creator>Bonkat, Gernot</creator><creator>Widmer, Andreas F</creator><general>SMW supporting association (Trägerverein Swiss Medical Weekly SMW)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>DOA</scope></search><sort><creationdate>20181105</creationdate><title>Basic patient characteristics predict antimicrobial resistance in E. coli from urinary tract specimens: a retrospective cohort analysis of 5246 urine samples</title><author>Erb, Stefan ; Frei, Reno ; Tschudin Sutter, Sarah ; Egli, Adrian ; Dangel, Marc ; Bonkat, Gernot ; Widmer, Andreas F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c497t-75f2111fffbfaf5d3bd8f64dcceadf0047a306d63a873a5be828ebbffaf9d4b83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Age Factors</topic><topic>Amoxicillin - pharmacology</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>antimicrobial resistance</topic><topic>Catheters, Indwelling - statistics & numerical data</topic><topic>ciprofloxacin</topic><topic>Ciprofloxacin - pharmacology</topic><topic>cotrimoxazole</topic><topic>Drug Resistance, Bacterial</topic><topic>Escherichia coli - drug effects</topic><topic>Escherichia coli - isolation & purification</topic><topic>Escherichia coli Infections - drug therapy</topic><topic>Escherichia coli Infections - microbiology</topic><topic>Female</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>risk factors</topic><topic>Sex Factors</topic><topic>Switzerland</topic><topic>Trimethoprim, Sulfamethoxazole Drug Combination - pharmacology</topic><topic>Urinary Tract Infections - drug therapy</topic><topic>Urinary Tract Infections - microbiology</topic><topic>Urine</topic><topic>urology</topic><topic>Urology Department, Hospital - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Erb, Stefan</creatorcontrib><creatorcontrib>Frei, Reno</creatorcontrib><creatorcontrib>Tschudin Sutter, Sarah</creatorcontrib><creatorcontrib>Egli, Adrian</creatorcontrib><creatorcontrib>Dangel, Marc</creatorcontrib><creatorcontrib>Bonkat, Gernot</creatorcontrib><creatorcontrib>Widmer, Andreas F</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Swiss medical weekly</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Erb, Stefan</au><au>Frei, Reno</au><au>Tschudin Sutter, Sarah</au><au>Egli, Adrian</au><au>Dangel, Marc</au><au>Bonkat, Gernot</au><au>Widmer, Andreas F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Basic patient characteristics predict antimicrobial resistance in E. coli from urinary tract specimens: a retrospective cohort analysis of 5246 urine samples</atitle><jtitle>Swiss medical weekly</jtitle><addtitle>Swiss Med Wkly</addtitle><date>2018-11-05</date><risdate>2018</risdate><volume>148</volume><issue>4546</issue><spage>w14660</spage><epage>w14660</epage><pages>w14660-w14660</pages><issn>1424-3997</issn><eissn>1424-3997</eissn><abstract>Antimicrobial resistance data from surveillance networks are frequently do not accurately predict resistance patterns of urinary tract infections at the bedside.
To determine simple patient- and institution-related risk factors affecting antimicrobial resistance patterns of Escherichia coli urine isolates.
From January 2012 to May 2015 all consecutive urine samples with significant growth of E. coli (≥103 CFU/ml) obtained from a tertiary care hospital were analysed for antimicrobial susceptibility and related to basic clinical data such a patient age, ward, sample type (catheter vs non-catheter urine).
Antimicrobial susceptibility testing was available for 5246 E. coli urine isolates from 4870 patients. E. coli was most commonly resistant to amoxicillin (43.1%), cotrimoxazole (24.5%) and ciprofloxacin (17.4%). Resistance rates were low for meropenem (0.0%), fosfomycin (0.9%) and nitrofurantoin (1.5%). Significantly higher rates of resistance to ciprofloxacin (32.8 vs 15.8%) and cotrimoxazole (30.6 vs 23.9%) were found in urological patients compared with patients on other wards (p <0.01). In multivariable analysis, predictors for E. coli resistance against ciprofloxacin and cotrimoxazole were: treatment in the urological unit (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.63-2.54; p <0.001 and OR 1.33, 95% CI 1.07-1.64; p = 0.010, respectively), male sex (OR 1.93, 95% CI 1.630-2.29; p <0.001 and OR 1.22, 95% CI 1.22-1.04; p = 0.015), and only to a lesser extent urine samples obtained from indwelling catheters (OR 1.30, 95% CI 1.05-1.61; p = 0.014 and OR 1.26, 95% CI 1.04-1.53; p = 0.020). Age ≥65 years was associated with higher resistance to ciprofloxacin (OR 1.42, 95% CI 1.21-1.67; p <0.001), but lower resistance to cotrimoxazole (OR 0.76, 95% CI 0.67-0.86; p <0.001).
Simple bedside patient data such as age, sex and treating hospital unit help to predict antimicrobial resistance and can improve the empirical treatment of urinary tract infections.</abstract><cop>Switzerland</cop><pub>SMW supporting association (Trägerverein Swiss Medical Weekly SMW)</pub><pmid>30440065</pmid><doi>10.4414/smw.2018.14660</doi><oa>free_for_read</oa></addata></record> |
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| source | Alma/SFX Local Collection |
| subjects | Age Factors Amoxicillin - pharmacology Anti-Bacterial Agents - pharmacology antimicrobial resistance Catheters, Indwelling - statistics & numerical data ciprofloxacin Ciprofloxacin - pharmacology cotrimoxazole Drug Resistance, Bacterial Escherichia coli - drug effects Escherichia coli - isolation & purification Escherichia coli Infections - drug therapy Escherichia coli Infections - microbiology Female Hospitals Humans Male Middle Aged Retrospective Studies risk factors Sex Factors Switzerland Trimethoprim, Sulfamethoxazole Drug Combination - pharmacology Urinary Tract Infections - drug therapy Urinary Tract Infections - microbiology Urine urology Urology Department, Hospital - statistics & numerical data |
| title | Basic patient characteristics predict antimicrobial resistance in E. coli from urinary tract specimens: a retrospective cohort analysis of 5246 urine samples |
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