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Clinical relevance of laboratory-reported antibiotic resistance in acute uncomplicated urinary tract infection in primary care
Objectives: To determine whether patients with an uncomplicated community-acquired urinary tract infection (UTI) and an isolate resistant to trimethoprim had worse clinical outcomes following empirical treatment with trimethoprim 200 mg twice daily for 3 days than did those with a susceptible isolat...
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| Published in: | Journal of antimicrobial chemotherapy 2006-11, Vol.58 (5), p.1000-1008 |
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| container_end_page | 1008 |
| container_issue | 5 |
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| container_title | Journal of antimicrobial chemotherapy |
| container_volume | 58 |
| creator | McNulty, C. A. M. Richards, J. Livermore, D. M. Little, P. Charlett, A. Freeman, E. Harvey, I. Thomas, M. |
| description | Objectives: To determine whether patients with an uncomplicated community-acquired urinary tract infection (UTI) and an isolate resistant to trimethoprim had worse clinical outcomes following empirical treatment with trimethoprim 200 mg twice daily for 3 days than did those with a susceptible isolate. Patients and methods: This was a prospective cohort study of clinical outcome. We enrolled 497 women (≥18–70 years) presenting to general practitioner surgeries in Norwich and Gloucester with at least two symptoms of acute ( |
| doi_str_mv | 10.1093/jac/dkl368 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_68980369</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1154143981</sourcerecordid><originalsourceid>FETCH-LOGICAL-c447t-69c29a5df9dac85657dc77ec95517ba6d9d436005b00d6ecb024974eb8c80c9b3</originalsourceid><addsrcrecordid>eNqF0U1rFTEUBuAgFnutbvwBMgh2IYxNJt_LcmmtUD8WCpduQuZMBnI7d3JNMtJu-tub8Q4W3JjNWZyHNxxehN4Q_JFgTc-2Fs6624EK9QytCBO4brAmz9EKU8xryTg9Ri9T2mKMBRfqBTomQmtV0Ao9rAc_erBDFd3gftsRXBX6arBtiDaHeF9Htw8xu66yY_atD9lDscmn_Af7sbIwZVdNI4TdfihZM56iH228r3K0kAvqHWQfxpnvo9_NK7DRvUJHvR2Se73ME_Tz8uLH-qq-_vbp8_r8ugbGZK6FhkZb3vW6s6C44LIDKR1ozolsreh0x6jAmLcYd8JBixumJXOtAoVBt_QEnR5y9zH8mlzKZucTuGGwowtTMkJphanQ_4VEU8HKK_DdP3AbpjiWI0xD5JzXqII-HBDEkFJ0vVmONwSbuTtTujOH7gp-uyRO7c51T3Qpq4D3C7CpNNbHUoBPT678yDSmxdUHVzpyd3_3Nt4aIank5mpzYzbfv95cfuEbo-gjGii0aA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>217689828</pqid></control><display><type>article</type><title>Clinical relevance of laboratory-reported antibiotic resistance in acute uncomplicated urinary tract infection in primary care</title><source>Oxford Journals Online</source><creator>McNulty, C. A. M. ; Richards, J. ; Livermore, D. M. ; Little, P. ; Charlett, A. ; Freeman, E. ; Harvey, I. ; Thomas, M.</creator><creatorcontrib>McNulty, C. A. M. ; Richards, J. ; Livermore, D. M. ; Little, P. ; Charlett, A. ; Freeman, E. ; Harvey, I. ; Thomas, M.</creatorcontrib><description>Objectives: To determine whether patients with an uncomplicated community-acquired urinary tract infection (UTI) and an isolate resistant to trimethoprim had worse clinical outcomes following empirical treatment with trimethoprim 200 mg twice daily for 3 days than did those with a susceptible isolate. Patients and methods: This was a prospective cohort study of clinical outcome. We enrolled 497 women (≥18–70 years) presenting to general practitioner surgeries in Norwich and Gloucester with at least two symptoms of acute (<7 days) uncomplicated UTI. Significant bacteriuria was defined as ≥104 cfu/mL from a mid-stream urine (MSU). Results: Of enrolled patients 75% (334/448) had significant bacteriuria, and trimethoprim resistance was present in 13.9% (44/317) of isolates. Patients with resistant isolates had a longer median time to symptom resolution (7 versus 4 days, P = 0.0002), greater reconsultation to the practice (39% versus 6% in first week, P < 0.0001), more subsequent antibiotics (36% versus 4% in first week, P < 0.0001) and higher rates of significant bacteriuria at 1 month (42% versus 20% with susceptible isolate, P = 0.04). Half of patients reconsulting in the first week had a resistant organism. Conclusions: Patients with uncomplicated UTI caused by trimethoprim-resistant organisms had significantly worse clinical outcomes than those with trimethoprim-susceptible organisms. Nevertheless, trimethoprim resistance was rarer than predicted from routine laboratory submissions and we calculate that 23 women require microbiological investigation to prevent one reconsultation arising from resistance-based treatment failure. We therefore suggest empirical antibiotic treatment in acute, uncomplicated UTIs. If patients reconsult in the first week, we suggest a change of antibiotic treatment with urine culture and susceptibility testing then done. More generally, laboratory resources should concentrate on resistance surveillance to inform empirical antibiotic choice.</description><identifier>ISSN: 0305-7453</identifier><identifier>EISSN: 1460-2091</identifier><identifier>DOI: 10.1093/jac/dkl368</identifier><identifier>PMID: 16998209</identifier><identifier>CODEN: JACHDX</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Acute Disease ; Adult ; Aged ; Anti-Infective Agents - pharmacology ; Anti-Infective Agents - therapeutic use ; Antibiotics ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Bacterial diseases ; Bacterial diseases of the urinary system ; Biological and medical sciences ; Chemotherapy ; clinical outcome ; Clinical outcomes ; cohort ; Cohort Studies ; Community-Acquired Infections - drug therapy ; Community-Acquired Infections - microbiology ; community/primary care ; Drug resistance ; Epidemiology ; Female ; Human bacterial diseases ; Humans ; Infectious diseases ; Medical sciences ; Microbial Sensitivity Tests ; Middle Aged ; Nephrology. Urinary tract diseases ; Pharmacology. Drug treatments ; Primary care ; Primary Health Care ; Prospective Studies ; Treatment Outcome ; trimethoprim ; Trimethoprim - pharmacology ; Trimethoprim - therapeutic use ; Trimethoprim Resistance ; Urinary system involvement in other diseases. Miscellaneous ; Urinary tract diseases ; Urinary Tract Infections - drug therapy ; Urinary Tract Infections - microbiology ; Urinary tract. Prostate gland ; UTI</subject><ispartof>Journal of antimicrobial chemotherapy, 2006-11, Vol.58 (5), p.1000-1008</ispartof><rights>2006 INIST-CNRS</rights><rights>Copyright Oxford Publishing Limited(England) Nov 2006</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c447t-69c29a5df9dac85657dc77ec95517ba6d9d436005b00d6ecb024974eb8c80c9b3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18284903$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16998209$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McNulty, C. A. M.</creatorcontrib><creatorcontrib>Richards, J.</creatorcontrib><creatorcontrib>Livermore, D. M.</creatorcontrib><creatorcontrib>Little, P.</creatorcontrib><creatorcontrib>Charlett, A.</creatorcontrib><creatorcontrib>Freeman, E.</creatorcontrib><creatorcontrib>Harvey, I.</creatorcontrib><creatorcontrib>Thomas, M.</creatorcontrib><title>Clinical relevance of laboratory-reported antibiotic resistance in acute uncomplicated urinary tract infection in primary care</title><title>Journal of antimicrobial chemotherapy</title><addtitle>J Antimicrob Chemother</addtitle><description>Objectives: To determine whether patients with an uncomplicated community-acquired urinary tract infection (UTI) and an isolate resistant to trimethoprim had worse clinical outcomes following empirical treatment with trimethoprim 200 mg twice daily for 3 days than did those with a susceptible isolate. Patients and methods: This was a prospective cohort study of clinical outcome. We enrolled 497 women (≥18–70 years) presenting to general practitioner surgeries in Norwich and Gloucester with at least two symptoms of acute (<7 days) uncomplicated UTI. Significant bacteriuria was defined as ≥104 cfu/mL from a mid-stream urine (MSU). Results: Of enrolled patients 75% (334/448) had significant bacteriuria, and trimethoprim resistance was present in 13.9% (44/317) of isolates. Patients with resistant isolates had a longer median time to symptom resolution (7 versus 4 days, P = 0.0002), greater reconsultation to the practice (39% versus 6% in first week, P < 0.0001), more subsequent antibiotics (36% versus 4% in first week, P < 0.0001) and higher rates of significant bacteriuria at 1 month (42% versus 20% with susceptible isolate, P = 0.04). Half of patients reconsulting in the first week had a resistant organism. Conclusions: Patients with uncomplicated UTI caused by trimethoprim-resistant organisms had significantly worse clinical outcomes than those with trimethoprim-susceptible organisms. Nevertheless, trimethoprim resistance was rarer than predicted from routine laboratory submissions and we calculate that 23 women require microbiological investigation to prevent one reconsultation arising from resistance-based treatment failure. We therefore suggest empirical antibiotic treatment in acute, uncomplicated UTIs. If patients reconsult in the first week, we suggest a change of antibiotic treatment with urine culture and susceptibility testing then done. More generally, laboratory resources should concentrate on resistance surveillance to inform empirical antibiotic choice.</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Aged</subject><subject>Anti-Infective Agents - pharmacology</subject><subject>Anti-Infective Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Bacterial diseases</subject><subject>Bacterial diseases of the urinary system</subject><subject>Biological and medical sciences</subject><subject>Chemotherapy</subject><subject>clinical outcome</subject><subject>Clinical outcomes</subject><subject>cohort</subject><subject>Cohort Studies</subject><subject>Community-Acquired Infections - drug therapy</subject><subject>Community-Acquired Infections - microbiology</subject><subject>community/primary care</subject><subject>Drug resistance</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Medical sciences</subject><subject>Microbial Sensitivity Tests</subject><subject>Middle Aged</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Pharmacology. Drug treatments</subject><subject>Primary care</subject><subject>Primary Health Care</subject><subject>Prospective Studies</subject><subject>Treatment Outcome</subject><subject>trimethoprim</subject><subject>Trimethoprim - pharmacology</subject><subject>Trimethoprim - therapeutic use</subject><subject>Trimethoprim Resistance</subject><subject>Urinary system involvement in other diseases. Miscellaneous</subject><subject>Urinary tract diseases</subject><subject>Urinary Tract Infections - drug therapy</subject><subject>Urinary Tract Infections - microbiology</subject><subject>Urinary tract. Prostate gland</subject><subject>UTI</subject><issn>0305-7453</issn><issn>1460-2091</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><recordid>eNqF0U1rFTEUBuAgFnutbvwBMgh2IYxNJt_LcmmtUD8WCpduQuZMBnI7d3JNMtJu-tub8Q4W3JjNWZyHNxxehN4Q_JFgTc-2Fs6624EK9QytCBO4brAmz9EKU8xryTg9Ri9T2mKMBRfqBTomQmtV0Ao9rAc_erBDFd3gftsRXBX6arBtiDaHeF9Htw8xu66yY_atD9lDscmn_Af7sbIwZVdNI4TdfihZM56iH228r3K0kAvqHWQfxpnvo9_NK7DRvUJHvR2Se73ME_Tz8uLH-qq-_vbp8_r8ugbGZK6FhkZb3vW6s6C44LIDKR1ozolsreh0x6jAmLcYd8JBixumJXOtAoVBt_QEnR5y9zH8mlzKZucTuGGwowtTMkJphanQ_4VEU8HKK_DdP3AbpjiWI0xD5JzXqII-HBDEkFJ0vVmONwSbuTtTujOH7gp-uyRO7c51T3Qpq4D3C7CpNNbHUoBPT678yDSmxdUHVzpyd3_3Nt4aIank5mpzYzbfv95cfuEbo-gjGii0aA</recordid><startdate>20061101</startdate><enddate>20061101</enddate><creator>McNulty, C. A. M.</creator><creator>Richards, J.</creator><creator>Livermore, D. M.</creator><creator>Little, P.</creator><creator>Charlett, A.</creator><creator>Freeman, E.</creator><creator>Harvey, I.</creator><creator>Thomas, M.</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>BSCLL</scope><scope>IQODW</scope><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>7QL</scope><scope>7QO</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20061101</creationdate><title>Clinical relevance of laboratory-reported antibiotic resistance in acute uncomplicated urinary tract infection in primary care</title><author>McNulty, C. A. M. ; Richards, J. ; Livermore, D. 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Antiparasitic agents</topic><topic>Bacterial diseases</topic><topic>Bacterial diseases of the urinary system</topic><topic>Biological and medical sciences</topic><topic>Chemotherapy</topic><topic>clinical outcome</topic><topic>Clinical outcomes</topic><topic>cohort</topic><topic>Cohort Studies</topic><topic>Community-Acquired Infections - drug therapy</topic><topic>Community-Acquired Infections - microbiology</topic><topic>community/primary care</topic><topic>Drug resistance</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Human bacterial diseases</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Medical sciences</topic><topic>Microbial Sensitivity Tests</topic><topic>Middle Aged</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Pharmacology. 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A. M.</au><au>Richards, J.</au><au>Livermore, D. M.</au><au>Little, P.</au><au>Charlett, A.</au><au>Freeman, E.</au><au>Harvey, I.</au><au>Thomas, M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical relevance of laboratory-reported antibiotic resistance in acute uncomplicated urinary tract infection in primary care</atitle><jtitle>Journal of antimicrobial chemotherapy</jtitle><addtitle>J Antimicrob Chemother</addtitle><date>2006-11-01</date><risdate>2006</risdate><volume>58</volume><issue>5</issue><spage>1000</spage><epage>1008</epage><pages>1000-1008</pages><issn>0305-7453</issn><eissn>1460-2091</eissn><coden>JACHDX</coden><abstract>Objectives: To determine whether patients with an uncomplicated community-acquired urinary tract infection (UTI) and an isolate resistant to trimethoprim had worse clinical outcomes following empirical treatment with trimethoprim 200 mg twice daily for 3 days than did those with a susceptible isolate. Patients and methods: This was a prospective cohort study of clinical outcome. We enrolled 497 women (≥18–70 years) presenting to general practitioner surgeries in Norwich and Gloucester with at least two symptoms of acute (<7 days) uncomplicated UTI. Significant bacteriuria was defined as ≥104 cfu/mL from a mid-stream urine (MSU). Results: Of enrolled patients 75% (334/448) had significant bacteriuria, and trimethoprim resistance was present in 13.9% (44/317) of isolates. Patients with resistant isolates had a longer median time to symptom resolution (7 versus 4 days, P = 0.0002), greater reconsultation to the practice (39% versus 6% in first week, P < 0.0001), more subsequent antibiotics (36% versus 4% in first week, P < 0.0001) and higher rates of significant bacteriuria at 1 month (42% versus 20% with susceptible isolate, P = 0.04). Half of patients reconsulting in the first week had a resistant organism. Conclusions: Patients with uncomplicated UTI caused by trimethoprim-resistant organisms had significantly worse clinical outcomes than those with trimethoprim-susceptible organisms. Nevertheless, trimethoprim resistance was rarer than predicted from routine laboratory submissions and we calculate that 23 women require microbiological investigation to prevent one reconsultation arising from resistance-based treatment failure. We therefore suggest empirical antibiotic treatment in acute, uncomplicated UTIs. If patients reconsult in the first week, we suggest a change of antibiotic treatment with urine culture and susceptibility testing then done. More generally, laboratory resources should concentrate on resistance surveillance to inform empirical antibiotic choice.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>16998209</pmid><doi>10.1093/jac/dkl368</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of antimicrobial chemotherapy, 2006-11, Vol.58 (5), p.1000-1008 |
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| subjects | Acute Disease Adult Aged Anti-Infective Agents - pharmacology Anti-Infective Agents - therapeutic use Antibiotics Antibiotics. Antiinfectious agents. Antiparasitic agents Bacterial diseases Bacterial diseases of the urinary system Biological and medical sciences Chemotherapy clinical outcome Clinical outcomes cohort Cohort Studies Community-Acquired Infections - drug therapy Community-Acquired Infections - microbiology community/primary care Drug resistance Epidemiology Female Human bacterial diseases Humans Infectious diseases Medical sciences Microbial Sensitivity Tests Middle Aged Nephrology. Urinary tract diseases Pharmacology. Drug treatments Primary care Primary Health Care Prospective Studies Treatment Outcome trimethoprim Trimethoprim - pharmacology Trimethoprim - therapeutic use Trimethoprim Resistance Urinary system involvement in other diseases. Miscellaneous Urinary tract diseases Urinary Tract Infections - drug therapy Urinary Tract Infections - microbiology Urinary tract. Prostate gland UTI |
| title | Clinical relevance of laboratory-reported antibiotic resistance in acute uncomplicated urinary tract infection in primary care |
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