RESUMEN
BACKGROUND: In sight of increasing bacterial resistances, appropriate and cautious antibiotic therapy (antibiotic stewardship) is becoming more and more important, in private practices as well. A current S3 guideline is available for the treatment of uncomplicated urinary tract infections, which recommends that regular epidemiological examinations of pathogen sensitivity are to be carried out promptly and locally. With this said, the antibiotic prescriptions of the resident doctors in Hesse were examined and compared with the sensitivity of the most important pathogens causing urinary tract infections. MATERIAL AND METHOD: The prescription data for antibiotics (ATC J01) for the area of ââthe Association of Statutory Health Insurance Physicians in Hessen for the years 2013 to 2020 were received from Insight Health GmbH & Co. KG, Waldems-Esch, which manages the data. A large laboratory that supplies numerous resident doctors in the Rhine-Main region provided sensitivity data tested according to CLSI until the year 2016 and from 2017 to EUCAST from microbiological examinations of urine samples for the clarification of community-acquired urinary tract infections from the years 2011-2020. RESULTS: From 2013 to 2020 the antibiotic prescriptions decreased from 2â692â370 to 1â708â134 (minus 37â%). The prescriptions for cephalosporins were reduced by more than 40â%, those of quinolones by 76â%. Among the antibiotics recommended for urinary tract infections, the most common antibiotics used were fosfomycin (2020: 130â476), followed by co-trimoxazole (2020: 96â559), nitrofurantoin (2020: 37â415), trimethoprim (2020: 27â388), pivmecillinam (20â984) and nitroxoline (6818). Urologists, on the other hand, most frequently prescribed nitrofurantoin (2020: 9951) and co-trimoxazole (9772), followed by fosfomycin (7193), trimethoprim (5050), nitroxoline (3289) and pivmecillinam (2722). Despite the high use of fosfomycin in outpatient medicine, E. coli and Citrobacter spp.âexhibited no loss of sensitivity, Proteus mirabilis and S.âaureus showed a slight loss of activity, while in Enterobacter cloacae a clear loss of activity was seen. The E. coli strains detected from urine samples to clarify complicated urinary tract infections show continuously excellent sensitivity for fosfomycin, nitrofurantoin, nitroxoline and mecillinam (>â>â90â%), whereas the sensitivity against trimethoprim was just under 80â%. DISCUSSION AND CONCLUSION: The decrease in antibiotic prescription data from statutory health insurance physicians in Hesse shows that the importance of cautious antibiotic therapy is also gaining ground in outpatient practice. Co-trimoxazole, which continues to be used very frequently, should be avoided in favor of monotherapy with trimethoprim because of the increased side effects of the sulfonamide component with the same effectiveness of trimethoprim. The E. coli strains detected from urine samples to clarify complicated urinary tract infections showed a sensitivity, of just under 80â% to trimethoprim. Since an approximately 10â% better sensitivity rate was found for uncomplicated community-acquired urinary tract infections that usually do not require microbiological diagnostics, in our opinion, in transferring this observation in the Rhine-Main area and in Hesse, trimethoprim can also continue to be used empirically for uncomplicated urinary tract infections.
Asunto(s)
Antibacterianos , Infecciones Urinarias , Antibacterianos/uso terapéutico , Farmacorresistencia Microbiana , Escherichia coli , Humanos , Staphylococcus aureus , Infecciones Urinarias/tratamiento farmacológicoRESUMEN
BACKGROUND: Every year, about 2.2 million deaths occur worldwide due to diarrhea. Reliable diagnosis of patients with acute infectious diarrhea remains a formidable challenge to the clinicians. This is the first study reporting use of fecal calprotectin in diagnosing acute diarrhea. The aim was to compare the diagnostic accuracy of fecal calprotectin, fecal lactoferrin, and guaiac-based fecal occult blood test in a diverse group of consecutive patients with acute diarrhea in which routine bacterial stool cultures and cytotoxins for Clostridium difficile were performed. METHODS: This was a prospective case-control multicenter study from January 2004 until October 2007 in 2383 consecutive patients with acute diarrhea. They provided stool samples for performing cultures. Patients with positive cultures and an equal number of matched controls with negative cultures underwent fecal occult blood test and calprotectin and lactoferrin assays. RESULTS: Calprotectin, lactoferrin, and fecal occult blood tests demonstrated sensitivity and specificity of 83% and 87%, 78% and 54%, and 38% and 85%, respectively, for diagnosing acute bacterial diarrhea. CONCLUSIONS: Calprotectin showed high correlation with bacteriologically positive infectious diarrhea compared with lactoferrin and fecal occult blood test. It may potentially revolutionize management algorithm for patients with acute diarrhea. As a screening test, calprotectin can generate results within hours to support presumptive diagnosis of infectious diarrhea, which can decide suitability of stool samples for culture.