Sex, drugs, bugs, and age: rational selection of empirical therapy for outpatient urinary tract infection in an era of extensive antimicrobial resistance
Braz. j. infect. dis
;
16(2): 115-121, May-Apr. 2012. tab
Artículo
en Inglés
| LILACS
| ID: lil-622730
ABSTRACT
BACKGROUND:
Optimal empirical therapy of urinary tract infection requires accurate knowledge of local susceptibility patterns, which may vary with organism and patient characteristics.METHODS:
Among 9,798 consecutive, non-duplicate, community-source urine isolates from ambulatory patients > 13 years old, from clinical laboratory and an academic medical center in Curitiba, Brazil (May 1st to December 1st, 2009), susceptibility data for ampicillin, nitrofurantoin, trimethoprim-sulfamethoxazole, gentamicin, fluoroquinolones, and ceftriaxone/cefotaxime were compared with organism and patient gender and age.RESULTS:
The female-to-male ratio decreased with age, from 28.1 (among 20-29 year-olds) to 3.3 (among > 80 year-olds). Overall, susceptibility prevalence varied widely by drug class, from unacceptably low levels (53.5% and 61.1% ampicillin and trimethoprimsulfamethoxazole) to acceptable but suboptimal levels (81.2% to 91.7% fluoroquinolones, ceftriaxone, nitrofurantoin, and gentamicin). E. coli isolates exhibited higher susceptibility rates than other isolates, from 3-4% higher (fluoroquinolones, gentamicin) to > 30% (nitrofurantoin, ceftriaxone). Males exhibited lower susceptibility rates than females. Within each gender, susceptibility declined with increasing age. For females, only nitrofurantoin and gentamicin were suitable for empirical therapy (> 80% susceptibility) across all age cohorts; fluoroquinolones were suitable only through age 60, and ceftriaxone only through age 80. For males, only gentamicin yielded > 80% susceptibility in any age cohort.CONCLUSION:
Few suitable empirical treatment options for community-source urinary tract infection were identified for women aged over 60 years or males of any age. Empirical therapy recommendations must consider the patient's demographic characteristics. Site-specific, age and gender-stratified susceptibility surveillance involving all uropathogens is needed.
Texto completo:
Disponible
Índice:
LILACS (Américas)
Asunto principal:
Infecciones Urinarias
/
Farmacorresistencia Bacteriana
/
Bacterias Gramnegativas
/
Bacterias Grampositivas
/
Antibacterianos
Tipo de estudio:
Guía de Práctica Clínica
/
Estudio pronóstico
/
Factores de riesgo
Límite:
Adolescente
/
Adulto
/
Anciano
/
Aged80
/
Femenino
/
Humanos
/
Masculino
País/Región como asunto:
America del Sur
/
Brasil
Idioma:
Inglés
Revista:
Braz. j. infect. dis
Asunto de la revista:
Enfermedades Transmisibles
Año:
2012
Tipo del documento:
Artículo
País de afiliación:
Brasil
/
Estados Unidos
Institución/País de afiliación:
Hospital Universitário Evangélico de Curitiba/BR
/
University of Minnesota/US
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