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Observational Study
. 2024 Mar 22;121(6):175-181.
doi: 10.3238/arztebl.m2023.0267.

The Percentage of Antibiotic Resistance in Uncomplicated Community-Acquired Urinary Tract Infections

Anja Klingeberg  1 , Niklas Willrich, Marc Schneider, Guido Schmiemann, Ildikó Gágyor, Doreen Richter, Ines Noll, Tim Eckmanns
Affiliations
Observational Study

The Percentage of Antibiotic Resistance in Uncomplicated Community-Acquired Urinary Tract Infections

Anja Klingeberg et al. Dtsch Arztebl Int. .

Abstract

Background: Uncomplicated bacterial urinary tract infections(uUTIs) are commonly seen in outpatient practice. They are usuallytreated empirically with antibiotics. The pertinent German ClinicalPractice Guideline contains recommendations on antibiotic selection,with the additional advice that the local resistance situationshould be considered as well. However, up-to-date information onlocal resistance is often unavailable, because microbiological testingis mainly recommended for complicated UTIs. Resistance ratesare often higher in recurrent uUTIs than in single episodes. In thisstudy, we aimed to determine the resistance rates of Escherichiacoli (E. coli) in patients with community-acquired uUTIs and tomake these data available to the treating physicians.

Methods: In a nationwide cross-sectional study in Germany (DRKS00019059), we determined the percentages of resistance to antibioticsrecommended for uUTIs (first choice: fosfomycin, nitro -xoline, mecillinam, nitrofurantoin, trimethoprim; second choice:cefpodoxime, ciprofloxacin, cotrimoxazole, levofloxacin, norfloxacin,ofloxacin) over the period 2019-2021. The data were stratified bysingle episodes vs. recurrent UTIs (rUTIs).

Results: Data from 2390 subjects were analyzed. E. coli was foundin 75.4% of the samples with positive urine cultures (1082 out of1435). The resistance rate of E. coli in single episodes (n = 725)was less than 15% for all antibiotics tested. In rUTIs(n = 357), resistance rates were also less than 15%for the most part; the only exceptions were trimethoprim(21.4%) and cotrimoxazole (19.3%).

Conclusion: For single episodes of uUTI, all of theantibiotics studied can be recommended, at least asfar as their resistance profiles are concerned. Forrecurrent UTI, all but trimethoprim and cotrimoxazolecan be recommended. The second-choice antibioticsexamined do not have a more favorable resistanceprofile than the first-choice antibiotics.

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Figures

Figure
Figure
Flow chart E. coli, Escherichia coli; SP, study participants; UTI, urinary tract infection
See this image and copyright information in PMC

References

    1. Wagenlehner FM, Pilatz A, Naber K, Weidner W. [Urinary tract infections] Aktuelle Urol. 2014;45:135–145. quiz 46. - PubMed
    1. Schmiemann G, Hoffmann F, Hamprecht A, Jobski K. Patterns and trends of antibacterial treatment in patients with urinary tract infections, 2015-2019: an analysis of health insurance data. BMC Prim Care. 2022;23 - PMC - PubMed
    1. Malmros K, Huttner BD, McNulty C, Rodríguez-Baño J, Pulcini C, Tängdén T. Comparison of antibiotic treatment guidelines for urinary tract infections in 15 European countries: results of an online survey. Int J Antimicrob Agents. 2019;54:478–486. - PubMed
    1. Dicheva S. Glaeske G, Schicktanz C, editors. Harnwegsinfekte bei Frauen. BARMER GEK Arzneimittelreport. 2015:107–137.
    1. Leitlinienprogramm DGU. Interdisziplinäre S3 Leitlinie: Epidemiologie, Diagnostik, Therapie, Prävention und Management unkomplizierter, bakterieller, ambulant erworbener Harnwegsinfektionen bei erwachsenen Patienten. www.awmf.org/leitlinien/detail/ll/043-044.html (last accessed on 15 November 2023) Langversion 1.1-2, 2017 AWMF Registernummer: 043/044.

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