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. 2019 Oct;51(8):494-498.
doi: 10.1016/j.aprim.2018.06.004. Epub 2018 Aug 10.

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

Martín C Grados  1 , Israel J Thuissard  2 , Juan-Ignacio Alós  3
Affiliations

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

Martín C Grados et al. Aten Primaria. 2019 Oct.

Abstract
in English, Spanish

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.

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.

Keywords: Antimicrobial resistance; Escherichia coli; Infecciones del tracto urinario; Resistencia a antibióticos; Urinary tract infections.

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