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Activity of common UTI agents against enteric urinary isolates from Europe and impact of patient population on activity profile

Abstract number: R2155

Objective: A concern of empiric treatment of urinary tract infections (UTI) is resistance (R) among Enterobaceriaceae spp. (EN). R can vary by patient population. Furthermore, organisms harboring extended-spectrum b-lactamases [ESBL] or exhibiting multi-drug resistance [MDR] pose an additional threat. The GLOBAL Surveillance initiative monitors susceptibility of EN to agents commonly utilized to treat UTI. This study evaluates the current susceptibility of enteric UTI in EU to select agents and the impact of patient age and location on activity profile.

Methods: 2056 EN urinary isolates (906 E. coli [EC], 388 Klebsiella pneumoniae [KP], 448 Proteus spp., 314 other EN) were collected from 2005–2009 across six EU countries. Susceptibility of isolates was determined by broth microdilution (CLSI M7-A8; M100-S19) for a variety of agents (levofloxacin [LVX], ciprofloxacin [CIP], amoxicillin/clavulanate [AMC] and trimethoprim/sulfamethoxazole [SXT]). Multi-drug resistance (MDR) was defined as R to geqslant R: gt-or-equal, slanted3 separate classes of agents. Isolates were analyzed by patient location (outpatient [OP], inpatient [IP], and ICU), and age [pediatric (PED) patients leqslant R: less-than-or-eq, slant17; adult (ADT) 18–64; and elderly (ELD) geqslant R: gt-or-equal, slanted65)].

Results: Overall, % R among urinary EN were: LVX 13.9; CIP 17.2; AMC 13.5; SXT 34.6. Among EC/KP, %R was: LVX 22.5/9.8; CIP 24.8/14.4; AMC 5.4/7.5; SXT 38.1/19.8. ESBL rates among EC and KP were 4.5% and 11.9%, respectively, and 3.6% of EN were MDR. LVX, CIP, amoxicillin–clavulanate (AMC), and SXT MIC90s were all geqslant R: gt-or-equal, slanted16 mg/L for EC. There was a trend towards increased R with increasing age among EN (PED/ADT/ELD %R: LVX 9.4/11.5/16.6; CIP 9.4/14.2/20.8; AMC 6.3/12.9/14.1; SXT 18.8/33.8/35.2). R was generally highest among ICU patients relative to IP and OP (OP/IP/ICU %R: LVX 13.0/13.3/14.7; CIP 17.5/16.4/17.2; AMC 11.4/13.6/16.4; SXT 32.8/34.3/34.5). For EC/KP, ESBL were most common among ELD and IP (6.7%/12.3% and 4.8%/12.8%, respectively). MDR ranged between 2–4% across the subpopulations.

Conclusions: R to UTI agents among EN varied, with lower R to LVX/CIP/AMC relative to SXT. R among EN increased with patient age. ESBL rates were higher among KP compared with EC, and were more common among ELD and IP populations. MDR rates were relatively low (<4%) across the evaluated populations. As the activity profile of UTI agents is impacted by both patient age and patient location, it is important to consider these factors when treating UTI empirically.

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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