Antimicrobial-resistance trends in bacterial isolates from companion-animal community practice in the UK.

We conducted a longitudinal, retrospective investigation of antimicrobial resistance in bacterial isolates obtained from canine and feline clinical cases in veterinary community practice in UK (1989-1997). Individual-drug resistance was examined using isolates of Escherichia coli and Staphylococcus spp. as Gram-negative and Gram-positive indicator organisms, respectively. The annual prevalence of resistance was calculated for each organism to each of nine (for E. coli) and 11 (for Staphylococcus spp.) selected antimicrobials. The annual prevalence of multiple-drug resistance (MDR) was calculated for E. coli, Proteus spp., Pseudomonas spp., staphylococci and streptococci. Using a chi-square test for trend, significant rising trends were identified in individual resistance of E. coli to clavulanate-amoxycillin and streptomycin, and in MDR of E. coli, Proteus spp. and Pseudomonas spp. Declining trends were identified in individual resistance of Staphylococcus spp. to ampicillin and penicillin. Comparison with previously reported results from a contemporaneous investigation of companion-animal hospital patients indicated that selection pressures acting on the two populations overlapped but were not identical.

Trends of antimicrobial resistance in bacterial isolates from a small animal referral hospital.

A longitudinal, retrospective investigation was made of antimicrobial resistance in bacterial isolates obtained from clinical cases in a small animal hospital between 1989 and 1997. Isolates of Escherichia coli and Staphylococcus species were used as Gram-negative and Gram-positive indicator organisms, respectively, and the annual prevalence of antimicrobial resistance was calculated for each organism to each of nine (for E coli) and 11 (for Staphylococcus species) appropriate antimicrobials, including enrofloxacin. Using a chi-square test for trend, statistically significant, rising trends were identified in the resistance of E coli to amoxycillin (P=0.04), clavulanate-amoxycillin (P<0.01) and streptomycin (P<0.01), and in the resistance of Staphylococcus species to erythromycin (P<0.01). There was an equivocal, rising trend for the resistance of Staphylococcus species to cephalexin. No significant trends were apparent for any of the other 15 organism/drug interactions. The annual prevalence of multiple drug resistance was calculated for E coli, Proteus species, Pseudomonas species, staphylococci and streptococci, but no statistically significant trends were identified.

Value of direct smears of synovial fluid in the diagnosis of canine joint disease.

Assessments of direct smears of synovial fluid by four clinicians were compared with the results obtained with a Coulter counter. Estimates of total white cell counts by the clinicians were inaccurate and generally higher than the Coulter counter results. The method had a low sensitivity and specificity for the identification of degenerative joint disease and normal joints in comparison with the identification of inflammatory joint disease. There were marked variations in the results obtained by the four clinicians for all the analyses in the study.

Use of spermicide-coated condoms and other risk factors for urinary tract infection caused by Staphylococcus saprophyticus.

BACKGROUND: Staphylococcus saprophyticus is the second most common cause of urinary tract infection (UTI) in young women. Relatively little is known about risk factors for this infection including exposure to vaginal spermicides, which increases the risk of UTI caused by Escherichia coli. PATIENTS AND METHODS: We conducted a case-control study in a large health maintenance organization Case patients were sexually active young women with acute UTIs caused by S saprophyticus identified from computerized laboratory files during 1990 to 1993. Population-based control patients were randomly selected from the organization's enrollment files. Exposures such as sexual activity and contraceptive practice were determined by interview. RESULTS: Of 1299 eligible women, 66% (96 case patients and 629 control patients) were interviewed. Case patients were more often unmarried and were more sexually active. Ninety-nine percent of case patients and 57% of control patients reported previous UTIs. Exposure to any type of condom during the previous year was reported by 53% of case patients and 31% of control patients. Exposure to spermicide-coated condoms during the previous month was associated with a higher risk of UTI (odds ratio [OR], 3.8; 95% confidence interval, 1.4-10.3). The OR for exposure during the previous year ranged from 2.2 (95% confidence interval, 1.0-4.8) for less than once weekly to 6.05 (95% confidence interval, 2.2-16.6) for more than twice weekly. In multivariate analyses, younger age (OR, 0.97 per year), intercourse frequency (OR, 1.2 per weekly episode), prior UTI (OR, 3.3), and frequency of exposure to spermicide-coated condoms (OR, 8.4 for more than once weekly and 10.9 for more than twice weekly) were independent predictors of UTI. Among women exposed to spermicide-coated condoms, 74% of UTIs caused by S saprophyticus were attributable to this exposure. CONCLUSIONS: Spermicide-coated condoms were associated with an increase risk of UTI caused by S saprophyticus. Because sexual activity and spermicide exposure are important risk factors for UTI caused by both S saprophyticus and E coli, it is likely that they share a similar pathogenesis.

Association between use of spermicide-coated condoms and Escherichia coli urinary tract infection in young women.

Diaphragm/spermicide use increases the risk of urinary tract infection (UTI). To determine whether spermicide-coated condoms are also associated with an increased risk of UTI, the authors conducted a case-control study at a large health maintenance organization in Seattle, Washington. Cases were sexually active young women with acute UTI caused by Escherichia coli, identified from computerized laboratory files during 1990-1993. Age-matched controls were randomly selected from the enrollment files of the plan. Of 1,904 eligible women, 604 cases and 629 controls (65%) were interviewed. During the previous year, 40% of the cases and 31% of the controls had been exposed to any type of condom. The unadjusted odds ratio for UTI increased with frequency of condom exposure from 0.91 (95% confidence interval (CI) 0.65-1.28) for weekly or less during the previous month to 2.11 (95% CI 1.37-3.26) for more than once weekly. Exposure to spermicide-coated condoms conferred a higher risk of UTI, with odds ratios ranging from 1.09 (95% CI 0.58-2.05) for use weekly or less to 3.05 (95% CI 1.47-6.35) for use more than once weekly. In multivariate analyses, intercourse frequency (odds ratio (OR) = 1.14 per weekly episode), history of UTI (OR = 2.64), and frequency of spermicide-coated condom exposure (OR = 3.34 for more than once weekly and 5.65 for use more than twice weekly) were independent predictors of UTI. Spermicide-coated condoms were responsible for 42% of the UTIs among women who were exposed to these products.

PIP: A large population-based case-control study found that condoms coated with the spermicide nonoxynol-9 were responsible for 42% of urinary tract infections (UTIs) in women exposed to these products. 604 women 18-40 years old who presented to a health maintenance organization in Seattle, Washington, during 1990-93 with acute UTI caused By Escherichia coli served as cases; 629 age-matched controls were randomly selected from the health facility's files. In the preceding month, nonoxynol-coated condoms had been used by 35% of cases and 25% of controls. The unadjusted odds ratios for having an acute UTI among women who had used any type of condom in the previous month and previous year were 1.24 (95% confidence interval, 0.94-1.63) and 1.47 (1.16-1.85), respectively. The UTI risks for women who used the nonoxynol-9 coated condoms in the previous month and more than twice a week during the past year were 1.72 (1.08-2.75) and 2.39 (1.10-5.16), respectively. Independent predictors of UTI, identified through multivariate analyses, included intercourse frequency (odds ratio of 1.14 per weekly episode), past history of UTI (2.64), and frequency of coated condom exposure (3.34 for more than once weekly and 5.65 for use more than twice weekly). Among cases exposed to spermicide-coated condoms during the previous month, 41.9% of UTIs were due to coated condoms. The association confirmed in this study is supported by research indicating that nonoxynol-9 induces changes in the normal vaginal flora that facilitate colonization with coliform bacteria.

Nonsteroidal antiinflammatory drug discontinuation in patients with osteoarthritis.

OBJECTIVE: To determine whether discontinuation patterns differed among nonsteroidal antiinflammatory drugs (NSAID) prescribed to treat osteoarthritis (OA). METHODS: In a retrospective cohort study of Health Maintenance Organization enrollees, 1405 patients with OA aged 45 and older who received a new prescription for one of 4 NSAID were followed for 12 months. Survival analysis was used to evaluate time to discontinuation, used here as a relative measure of both drug efficacy and tolerability. RESULTS: Rates of NSAID discontinuation during the study period were high; only 15 to 20% of those started on a study NSAID were still using the same drug at the end of the 12 month followup period. Using a proportional hazards model to adjust for covariates, the risk of discontinuation did not differ when comparing the agent with the longest duration of use, piroxicam (the referent), to enteric coated aspirin [relative risk (RR) 1.10, 95% confidence interval (CI) 0.93 to 1.30]. Adjusted rates of discontinuation were significantly higher for ibuprofen (RR 1.43, 95% CI 1.22 to 1.69) and for naproxen (RR 1.40, 95% CI 1.19 to 1.65) when compared to piroxicam. CONCLUSION: NSAID discontinuation rates are high among patients with OA and risk of discontinuation differed between NSAID, even after controlling for the effects of such variables as age, disease severity, and concomitant therapy.

Tubal sterilization and the long-term risk of hysterectomy.

To assess the effect of tubal sterilization on the risk of hysterectomy, we studied 7414 women aged 20 to 49 years who had had a tubal sterilization at a health maintenance organization between January 1, 1968, and December 31, 1983. Compared with a population-based cohort of nonsterilized women, women sterilized while 20 to 29 years old were 3.4 times more likely to have had a subsequent hysterectomy (95% confidence interval, 2.4 to 4.7). Adjustment for the effects of potential confounders with a subset of 276 women did not appreciably alter this association. For multivariate comparisons with 5323 wives of vasectomized men, there was no significant elevation in the risk of hysterectomy following sterilization among women sterilized while 20 to 29 years old. Tubal sterilization was not associated with hysterectomy for married women who underwent tubal sterilization at age 30 or older. These results do not support a biological basis for the relationship between tubal sterilization and hysterectomy.