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Multicenter Study
. 2020 Jan;38(1):27-34.
doi: 10.1007/s00345-019-02963-9. Epub 2019 Sep 25.

Condition-specific surveillance in health care-associated urinary tract infections as a strategy to improve empirical antibiotic treatment: an epidemiological modelling study

Zafer Tandogdu  1   2   3 , Bela Koves  4 , Tommaso Cai  5 , Mete Cek  6 , Peter Tenke  4 , Kurt Naber  7 , Florian Wagenlehner  8 , Truls Erik Bjerklund Johansen  9   10   11
Affiliations
Multicenter Study

Condition-specific surveillance in health care-associated urinary tract infections as a strategy to improve empirical antibiotic treatment: an epidemiological modelling study

Zafer Tandogdu et al. World J Urol. 2020 Jan.

Abstract

Background: Health care-associated urinary tract infection (HAUTI) consists of unique conditions (cystitis, pyelonephritis and urosepsis). These conditions could have different pathogen diversity and antibiotic resistance impacting on the empirical antibiotic choices. The aim of this study is to compare the estimated chances of coverage of empirical antibiotics between conditions (cystitis, pyelonephritis and urosepsis) in urology departments from Europe.

Methods: A mathematical modelling based on antibiotic susceptibility data from a point prevalence study was carried. Data were obtained for HAUTI patients from multiple urology departments in Europe from 2006 to 2017. The primary outcome of the study is the Bayesian weighted incidence syndromic antibiogram (WISCA) and Bayesian factor. Bayesian WISCA is the estimated chance of an antibiotic to cover the causative pathogens when used for first-line empirical treatment. Bayesian factor is used to compare if HAUTI conditions did or did not impact on empirical antibiotic choices.

Results: Bayesian WISCA of antibiotics in European urology departments from 2006 to 2017 ranged between 0.07 (cystitis, 2006, Amoxicillin) to 0.89 (pyelonephritis, 2009, Imipenem). Bayesian WISCA estimates were lowest in urosepsis. Clinical infective conditions had an impact on the Bayesian WISCA estimates (Bayesian factor > 3 in 81% of studied antibiotics). The main limitation of the study is the lack of local data.

Conclusions: Our estimates illustrate that antibiotic choices can be different between HAUTI conditions. Findings can improve empirical antibiotic selection towards a personalized approach but should be validated in local surveillance studies.

Keywords: Antibiotic stewardship; Condition-specific surveillance; Health care-associated UTI.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Pathogen frequency (a) and diversity (b) within conditions and dissimilarity between conditions (c) stratified according to high- and low-resistant countries. Ranking of pathogens are similar amongst conditions. The dissimilarity between conditions is apparent when studied with Bray–Curtis index. The Bray–Curtis index was analysed for each year but to illustrate that its range was not reported in chronological order
Fig. 2
Fig. 2
Median Bayesian WISCA estimates of antibiotic choices for each year and HAUTI subgroup (cystitis, pyelonephritis and urosepsis) stratified according to lower vs higher frequency-resistant countries (stratification was carried out based on the ECDC reported pooled E. coli resistance frequencies. The 5% threshold was used)
See this image and copyright information in PMC

References

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