Antimicrobial Susceptibilities of Enterobacteriaceae in Community-Acquired Urinary Tract Infections during a 5-year Period: A Single Hospital Study in Korea
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Background Through investigating antimicrobial susceptibility patterns of Enterobacteriaceae in community-acquired urinary tract infection (CA-UTI), we provide basic evidence for the use of empirical antibiotics in CA-UTI. Materials and Methods We retrospectively reviewed the medical records of patients over the age of 19 years who visited a hospital in Seoul between January 2012 and December 2016 for a CA-UTI. Urine cultures were used to identify causative organisms. We investigated extended-spectrum β-lactamase (ESBL) production and the antimicrobial susceptibility of Enterobactereiaceae. We evaluated recommended empirical antibiotics numerically by calculating the syndrome-specific likelihood of inadequate therapy (LIT) for the last 2 years (interpretation of the LIT A value: 1 out of A people is likely to receive inadequate empirical antibiotics). Results Urine cultures were performed in 1,605 out of 2,208 patients who were diagnosed with CA-UTI, and causative pathogens were identified in 1,134 (70.7%) cases. There were 998 (88.0%) cases of Enterobacteriaceae and Escherichia coli was the most common pathogen, accounting for 80.3% of cases (911 cases). The overall resistance rates to trimethoprim-sulfamethoxazole, fluoroquinolones, and cefotaxime were 31.7%, 23.2%, and 13.5%, respectively. There were 128 (10.8%) cases of ESBL-producing Entererobacteriaceae with an increasing but non-significant trend (P = 0.255). The LIT for CA-UTI in the past two years was highest for ertapenem and imipenem. Fluoroquinolones ranked 11th, with a LIT of 8.2, and cefotaxime ranked higher, at 10.5. In ESBL-producing Enterobacteriaceae, except for carbapenems, amikacin and piperacillin-tazobactam showed the highest susceptibility rates at 99.2% and 94.3%, respectively. Conclusion Empiric treatment with fluoroquinolones in CA-UTI should be carefully considered, given the high resistance rate. The proportion of ESBL-producing Entererobacteriaceae in CA-UTI has increased to a high level in Korea. Amikacin and piperacillin-tazobactam could be considered for empiric treatment in patients at risk for ESBL-producing Entererobacteriaceae when considering alternatives to carbapenems.
Abstract
Background Through investigating antimicrobial susceptibility patterns of Enterobacteriaceae in community-acquired urinary tract infection (CA-UTI), we provide basic evidence for the use of empirical antibiotics in CA-UTI. Materials and Methods We retrospectively reviewed the medical records of patients over the age of 19 years who visited a hospital in Seoul between January 2012 and December 2016 for a CA-UTI. Urine cultures were used to identify causative organisms. We investigated extended-spectrum β-lactamase (ESBL) production and the antimicrobial susceptibility of Enterobactereiaceae. We evaluated recommended empirical antibiotics numerically by calculating the syndrome-specific likelihood of inadequate therapy (LIT) for the last 2 years (interpretation of the LIT A value: 1 out of A people is likely to receive inadequate empirical antibiotics). Results Urine cultures were performed in 1,605 out of 2,208 patients who were diagnosed with CA-UTI, and causative pathogens were identified in 1,134 (70.7%) cases. There were 998 (88.0%) cases of Enterobacteriaceae and Escherichia coli was the most common pathogen, accounting for 80.3% of cases (911 cases). The overall resistance rates to trimethoprim-sulfamethoxazole, fluoroquinolones, and cefotaxime were 31.7%, 23.2%, and 13.5%, respectively. There were 128 (10.8%) cases of ESBL-producing Entererobacteriaceae with an increasing but non-significant trend (P = 0.255). The LIT for CA-UTI in the past two years was highest for ertapenem and imipenem. Fluoroquinolones ranked 11th, with a LIT of 8.2, and cefotaxime ranked higher, at 10.5. In ESBL-producing Enterobacteriaceae, except for carbapenems, amikacin and piperacillin-tazobactam showed the highest susceptibility rates at 99.2% and 94.3%, respectively. Conclusion Empiric treatment with fluoroquinolones in CA-UTI should be carefully considered, given the high resistance rate. The proportion of ESBL-producing Entererobacteriaceae in CA-UTI has increased to a high level in Korea. Amikacin and piperacillin-tazobactam could be considered for empiric treatment in patients at risk for ESBL-producing Entererobacteriaceae when considering alternatives to carbapenems.
참고문헌 (32)
- Rodríguez-Baño J, "Epidemiology and clinical features of infections caused by extended-spectrum beta-lactamase-producing Escherichia coli in nonhospitalized patients", J Clin Microbiol, 42, pp.1089~1094 (2004)
- Azap OK, "Risk factors for extended- spectrum beta-lactamase positivity in uropathogenic Escherichia coli isolated from community-acquired urinary tract infections", Clin Microbiol Infect, 16, pp.147~151 (2010)
- Pitout JD, "Emergence of Enterobacteriaceae producing extended-spectrum β-lactamases (ESBLs) in the community", J Antimicrob Chemother, 56, pp.52~59 (2005)
- Rodríguez‐Baño J, "Extended‐spectrum β‐lactamases in ambulatory care: a clinical perspective", Clin Microbiol Infect, 14(Suppl 1), pp.104~110 (2008)
- Kim B, "Clinical characteristics of community-acquired acute pyelonephritis caused by ESBL-producing pathogens in South Korea", Infection, 41, pp.603~612 (2013)
- Gupta K, "International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases", Clin Infect Dis, 52, pp.e103~e120 (2011)
- Lob SH, "Susceptibility patterns and ESBL rates of Escherichia coli from urinary tract infections in Canada and the United States, SMART 2010-2014", Diagn Microbiol Infect Dis, 85, pp.459~465 (2016)
- Friedman ND, "Health care–associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections", Ann Intern Med, 137, pp.791~797 (2002)
- Park SH, "Emergence of extended-spectrum beta-lact-amase-producing escherichia coli as a cause of community- onset bacteremia in South Korea: risk factors and clinical outcomes", Microb Drug Resist, 17, pp.537~544 (2011)
- Burgmann H, "Likelihood of inadequate treatment: a novel approach to evaluating drug-resistance patterns", Infect Control Hosp Epidemiol, 30, pp.672~677 (2009)
- Davis ME, "Constructing unit-specific empiric treatment guidelines for catheter-related and primary bacteremia by determining the likelihood of inadequate therapy", Infect Control Hosp Epidemiol, 33, pp.416~420 (2012)
- Clinical and Laboratory Standards Institute (CLSI), "Performance standards for antimicrobial susceptibility testing, 24th informational supplement", CLSI, M100~S24 (2014)
- Clinical and Laboratory Standards Institute (CLSI), "Performance standards for antimicrobial susceptibility testing, 21st informational supplement", CLSI, M100~ (2011)
- Rodriguez-Baño J, "A change in the epidemiology of infections due to extended-spectrum β-lactamase- producing organisms", Clin Infect Dis, 42, pp.935~937 (2006)
- 대한감염학회, "요로 감염 임상진료지침 권고안: 무증상 세균뇨, 단순 요로감염, 복잡성 요로감염, 세균성 전립선염", Infection and Chemotherapy, 43(1), pp.1~25 (2011), 대한감염학회
- Wright DH, "Application of fluoroquinolone pharmacodynamics", J Antimicrob Chemother, 46, pp.669~683 (2000)
- Yilmaz E, "Risk factors in community-acquired", onset urinary tract infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae, 2008, pp.20, 581~585
- Rodríguez-Baño J, "Community-onset bacteremia due to extended- spectrum beta-lactamase-producing Escherichia coli: risk factors and prognosis", Clin Infect Dis, 50, pp.40~48 (2010)
- Gopal Rao G, "Key demographic characteristics of patients with bacteriuria due to extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae in a multiethnic community, in North West London", Infect Dis (Lond), 47, pp.719~724 (2015)
- Søraas A, "Risk factors for community-acquired urinary tract infections caused by ESBL-producing enterobacteriaceae–a case–control study in a low prevalence country", PLoS One, 8, pp.e69581~ (2013)
- Frakking FN, "Appropriateness of empirical treatment and outcome in bacteremia caused by extended- spectrum β-lactamase producing bacteria", Antimicrob Agents Chemother, 57, pp.3092~3099 (2013)
- Gradel KO, "Impact of appropriate empirical antibiotic treatment on recurrence and mortality in patients with bacteraemia: a population-based cohort study", BMC Infect Dis, 17, pp.122~ (2017)
- Esparcia A, "Influence of inadequate antimicrobial therapy on prognosis in elderly patients with severe urinary tract infections", Eur J Intern Med, 25, pp.523~527 (2014)
- Shorr AF, "Inappropriate antibiotic therapy in Gram-negative sepsis increases hospital length of stay", Crit Care Med, 39, pp.46~51 (2011)
- Harris PN, "β-lactam and β-lactamase inhibitor combinations in the treatment of extended- spectrum β-lactamase producing Enterobacteriaceae: time for a reappraisal in the era of few antibiotic options?", Lancet Infect Dis, 15, pp.475~485 (2015)
- Rodríguez-Baño J, "β-Lactam", β-lactam inhibitor combinations for the treatment of bacteremia due to extended-spectrum β-lactamase–producing Escherichia coli: a post hoc analysis of prospective cohorts, 2012, pp.54, 167~174
- Trivedi M, "The outcome of treating ESBL infections with carbapenems vs. non carbapenem antimicrobials", J Assoc Physicians India, 60, pp.28~30 (2012)
- Vardakas KZ, "Carbapenems versus alternative antibiotics for the treatment of bacteraemia due to Enterobacteriaceae producing extended- spectrum β-lactamases: a systematic review and meta-analysis", J Antimicrob Chemother, 67, pp.2793~2803 (2012)
- Doi A, "The efficacy of cefmetazole against pyelonephritis caused by extended- spectrum beta-lactamase-producing Enterobacteriaceae", Int J Infect Dis, 17, pp.e159~e163 (2013)
- Park SH, "The efficacy of non-carbapenem antibiotics for the treatment of community-onset acute pyelonephritis due to extended-spectrum beta-lactamase-producing Escherichia coli", J Antimicrob Chemother, 69, pp.2848~2856 (2014)
- 서유빈, "Extended-spectrum β-lactamase 를 생산하는 Enterobacteriaceae 요로감염에서 카바페넴 이외의 항생제 사용 가능성에 대한 고찰", 의료관련감염관리, 21(2), pp.50~56 (2016), 대한의료관련감염관리학회
- Cho YH, "Antimicrobial susceptibilities of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in health care-associated urinary tract infection: focus on susceptibility to fosfomycin", Int Urol Nephrol, 47, pp.1059~1066 (2015)