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The panhellenic study on the antimicrobial susceptibility of community-acquired uropathogens: preliminary data report

Abstract number: 1733_627

Katsarolis I., Poulakou G., Athanasia S., Kontopidou F.V., Panagopoulos P., Karaiskos E., Voutsinas D., Zarkotou L., Gavra P., Koratzanis G., Kanellopoulou M., Adamis G., Vagiakou E., Matthaiopoulou I., Vogiatzi E., Perdikaki P., Panou G., Kremastinou E., Giamarellou H.

Purpose: To present preliminary microbiological data from the first panhellenic survey investigating the prevalence and susceptibility of pathogens causing community-acquired acute uncomplicated urinary tract infections in 2005, with a view to guide empirical treatment.

Methods: Midstream urine samples were cultured from women <65 years, without known complicating factors, presenting with symptoms of acute cystitis at public and private community healthcare centres across Greece in 2005. Pathogens were identified and tested for their susceptibility to 13 antimicrobials by disk diffusion assay, using CLSI 2005 methodology and breakpoints. Patients with known complicating factors (urinary tract abnormalities, comorbidities, pregnancy, recent hospitalisation, antibiotic usage or UTI history in the past 2 weeks) were excluded.

Results: Preliminary microbiological data (March–July 2005) were derived from 418 consecutive positive cultures from women with acute uncomplicated cystitis, out of 1,532 patients tested in the same period. Escherichia coli accounted for 78.7% of isolates, Proteus mirabilis 8.9% and Klebsiella pneumoniae 2.4%. Staphylococcus saprophyticus was isolated in only two cases. Full susceptibility to all investigated antimicrobials was recorded among 39.2% of E. coli isolates, whereas resistance was most common to ampicillin (27.1%) and cephalothin (24.8%), followed by cotrimoxazole (21.1%), nitrofurantoin (19%) and amoxicillin/clavulanate (7.7%). Resistance to nalidixic acid and ciprofloxacin, fosfomycin and cefuroxime was 7.8%, 4%, 3.1% and 2.1%, respectively. Proteus mirabilis resistance rates per antimicrobial were: ampicillin (25%), cotrimoxazole (27.8%), nalidixic acid/ciprofloxacin (10.8/0.0%), amoxicillin/clavulanate (5.4%) and cefuroxime (2.7%). Gentamycin resistance rates for E. coli and P. mirabilis were similar (2.2/2.8% respectively). No ESBL-producing strains were detected.

Conclusions: From the up till now analysed preliminary data, it is evident that: (1) Empirical use of first-line antimicrobials in uncomplicated community-acquired UTIs, such as ampicillin, cotrimoxazole and nitrofurantoin, should be reevaluated, due to high rates of resistance. (2) Quinolones are still highly efficacious in this setting, but increasing resistance rates may advocate caution in their use in uncomplicated infections. (3) Low-level resistance to amoxicillin/clavulanate, cefuroxime and fosfomycin must be taken into account in the empirical treatment strategy.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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