Stratification by demographic and clinical data of the antibiotic susceptibility of Escherichia coli from urinary tract infections of the community / Estratificación por datos clínicos y demográficos de la sensibilidad antibiótica de Escherichia coli de infecciones del tracto urinario de origen comunitario

Aim: To determine the patterns of antibiotic susceptibility of Escherichia coli strains isolated from adult patients with urinary tract infection (UTI), and to stratify the results by age and type of UTI to verify if there are statistically significant differences that can help physicians to prescribe better empirical antibiotherapy. Design: Cross-sectional prospective study. Location: Community of Getafe (Madrid). Primary care level. Participants: 100 E. coli strains, randomly chosen, isolated from the urine (104-105 cfu/ml) of different patients from primary care centers in the Getafe area. Main measurements The antibiotic susceptibility of the strains was evaluated and the results were stratified by age and type of UTI. The clinical and demographic data of the patients were analyzed, classifying each episode as complicated UTI or uncomplicated UTI. Results. Strains isolated from patients with uncomplicated UTI showed significantly greater susceptibility than those of complicated UTI to amoxicillin (65.9% vs. 30.6%, p = 0.001), amoxicillin/clavulanic acid (95.5% vs. 77.6%, p = 0.013) and ciprofloxacin (81.8% vs. 63.3%, p = 0.047). In complicated UTI, susceptibility to ciprofloxacin was significantly greater in the ≤ 65 years age group compared to the older age group (78.3% vs. 50%, respectively, p = 0.041). In the rest of antibiotics, no statistically significant differences were obtained when comparing by age (≤ 65 years versus > 65 years), both in uncomplicated and complicated UTI. Conclusions: Clinical and demographic data of patients with UTI are of great importance in the results of the antibiotic susceptibility in E. coli. Antibiograms stratified by patient characteristics may better facilitate empirical antibiotic selection for UTI in primary care

Objetivo: Determinar los patrones de sensibilidad antibiótica de cepas de Escherichia coli aisladas de pacientes adultos con infección del tracto urinario (ITU), y estratificar los resultados por edad y tipo de ITU para verificar si existen diferencias estadísticamente significativas que puedan ayudar a los médicos a la prescripción de una mejor antibioterapia empírica. Diseño: Estudio transversal prospectivo. Emplazamiento Comunidad de Getafe (Madrid). Nivel de atención primaria. Participantes:100 cepas de E. coli, escogidas al azar, aisladas de orina (104 ->105 ufc/ml) de diferentes pacientes de centros de atención primaria del área de Getafe. Mediciones principales: Se evaluó la sensibilidad antibiótica de las cepas y los resultados se estratificaron por edad y tipo de ITU. Se analizaron los datos clínicos y demográficos de los pacientes de los que provenían, clasificándose cada episodio como ITU complicada o ITU no complicada. Resultados: Las cepas aisladas de pacientes con ITU no complicada mostraron una sensibilidad antibiótica significativamente mayor que las de ITU complicada a amoxicilina (65,9% vs. 30,6%, p = 0.001), amoxicilina/clavulánico (95,5% vs. 77,6%, p = 0.013) y ciprofloxacino (81,8% vs. 63,3%, p = 0.047). En la ITU complicada, la sensibilidad al ciprofloxacino fue significativamente mayor en el grupo de edad ≤ 65 años en comparación con el grupo de mayor edad (78,3% vs. 50%, p = 0.041). Para el resto de antibióticos no se observaron diferencias significativas cuando se compararon por edad (≤ 65 versus > 65), tanto en ITU no complicada como complicada. Conclusiones: Los datos clínicos y demográficos de los pacientes con ITU son de gran importancia en los resultados de la sensibilidad antibiótica en E. coli. Los antibiogramas estratificados por características de los pacientes podrían facilitar una mejor selección de antibioterapia empírica para las ITU en atención primaria

Is it possible to extrapolate the rates of resistance of Escherichia coli from asymptomatic bacteriuria in pregnant women to those of E. coli in uncomplicated community-acquired UTI? / ¿Es posible extrapolar las tasas de resistencia de Escherichia coli de bacteriurias asintomáticas en gestantes a las de E. coli en ITU no complicada adquirida en la comunidad?

OBJECTIVE: Treatment of uncomplicated urinary tract infections in primary care is generally empirical without requesting urine culture and based on biased resistance data collected from selected patients, most of them having risk factors for the isolation of resistant microorganisms. In order to overcome the lack of information on the real resistance rates in uncomplicated UTI, we compared antimicrobial phenotype and genotype of Escherichia coli isolated from pregnant women with asymptomatic bacteriuria (culture always performed) with those from women with uncomplicated acute cystitis (culture rarely performed) of different age groups. MATERIAL AND METHODS: Between September 2017 and March 2018, 103 urines were randomly collected from pregnant women aged between 16 and 47 with asymptomatic bacteriuria (AB) (n=42), not hospitalized women in the same age range with uncomplicated acute cystitis (UAC) (n=31) and women older than 47 not hospitalized with UAC (n=30). Bacteria identification was performed using mass spectrometry and the antibiogram by broth microdilution. Genetic typification was carried out by pulsed-field gel electrophoresis. RESULTS: There are no significant differences between the groups of patients in the antibiotic susceptibility. Likewise, as expected, a wide genetic diversity is observed among the strains of E. coli studied without significant differences between the three groups. CONCLUSIONS: We propose a simple model that could provide better guidance for selection of empirical antimicrobial therapy for non-pregnant women with UAC than do generic hospital antibiogram data based on reliably extrapolating the susceptibility data of strains isolated from pregnant women with AB as representation of women with community-acquired UAC

OBJETIVOS: El tratamiento en atención primaria de las infecciones del tracto urinario no complicadas es generalmente empírico sin solicitar urocultivo y basado en datos de resistencia sesgados procedentes de pacientes seleccionados, muchos de ellos con factores de riesgo de aislamiento de microorganismos resistentes. Con el fin de solventar el déficit de información sobre las tasas de resistencia reales en ITU no complicada, comparamos el fenotipo antimicrobiano y genotipo de aislados de Escherichia coli procedentes de mujeres embarazadas con bacteriuria asintomática (cultivo siempre realizado) con aquellos procedentes de mujeres con cistitis aguda no complicada (cultivo raramente realizado) de diferentes grupos de edad. MATERIAL Y MÉTODOS: Entre septiembre de 2017 y marzo de 2018 se recogieron aleatoriamente 103 orinas de mujeres embarazadas con edades entre 16 y 47 años con bacteriuria asintomática (BA) (n=42), mujeres no hospitalizadas en el mismo rango de edad con cistitis aguda no complicada (CANC) (n=31) y mujeres mayores de 47 años no hospitalizadas con CANC (n=30). La identificación bacteriana se realizó por espectrometría de masas y el antibiograma por microdilución en caldo. La tipificación genética se llevo a cabo por electroforesis en gel por campo pulsado. RESULTADOS: No hay diferencias significativas en la sensibilidad antibiótica entre los grupos de pacientes. De igual forma, y según lo esperado, se observó una amplia diversidad genética entre las cepas de E. coli estudiadas sin diferencias significativas entre los diferentes grupos. CONCLUSIONES: Proponemos un modelo sencillo que podría orientar mejor que los datos generales del hospital en la selección del tratamiento antimicrobiano empírico de mujeres no embarazadas con CANC, basado en extrapolar los datos de sensibilidad de cepas aisladas de mujeres embarazadas con BA como representación de mujeres con CANC adquirida en la comunidad

Stratification by demographic and clinical data of the antibiotic susceptibility of Escherichia coli from urinary tract infections of the community.

AIM: To determine the patterns of antibiotic susceptibility of Escherichia coli strains isolated from adult patients with urinary tract infection (UTI), and to stratify the results by age and type of UTI to verify if there are statistically significant differences that can help physicians to prescribe better empirical antibiotherapy. DESIGN: Cross-sectional prospective study. LOCATION: Community of Getafe (Madrid). Primary care level. PARTICIPANTS: 100 E. coli strains, randomly chosen, isolated from the urine (104-105cfu/ml) of different patients from primary care centers in the Getafe area. MAIN MEASUREMENTS: The antibiotic susceptibility of the strains was evaluated and the results were stratified by age and type of UTI. The clinical and demographic data of the patients were analyzed, classifying each episode as complicated UTI or uncomplicated UTI. RESULTS: Strains isolated from patients with uncomplicated UTI showed significantly greater susceptibility than those of complicated UTI to amoxicillin (65.9% vs. 30.6%, p=0.001), amoxicillin/clavulanic acid (95.5% vs. 77.6%, p=0.013) and ciprofloxacin (81.8% vs. 63.3%, p=0.047). In complicated UTI, susceptibility to ciprofloxacin was significantly greater in the ≤65 years age group compared to the older age group (78.3% vs. 50%, respectively, p=0.041). In the rest of antibiotics, no statistically significant differences were obtained when comparing by age (≤65 years versus >65 years), both in uncomplicated and complicated UTI. CONCLUSIONS: Clinical and demographic data of patients with UTI are of great importance in the results of the antibiotic susceptibility in E. coli. Antibiograms stratified by patient characteristics may better facilitate empirical antibiotic selection for UTI in primary care.

Hiperpigmentación inducida por minociclina / Minocycline induced hyperpigmentation

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Utilidad de la resistencia a piperacilina/tazobactam como factor predictor de carbapenemasa OXA-48 en enterobacterias / Usefulness of piperacillin/tazobactam resistance as a predictor of OXA-48 carbapenemase in Enterobacteriaceae

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