[Antibiotic resistance transformation in community-acquired urinary infections]. / Evolución de la resistencia antibiótica en las infecciones urinarias adquiridas en la comunidad.

OBJECTIVE: To detect the prevalence of uropathogens in community-acquired urinary tract infection in our environment, and the degree of sensitivity to antibiotics used as empirical treatment. PATIENTS AND METHOD: Retrospective longitudinal study on 16,392 consecutive urine cultures collected in the emergency department of Hospital del Mar, between January 1997 and December 2001. Resistance rates were compared through variance analysis. RESULTS: 8,743 urine cultures with significant count were obtained. 6,062 Escherichia coli (69.3%), 517 Proteus mirabilis (5.9%) and 390 Klebsiella pneumoniae (4.5%) were identified. Escherichia coli showed progressive growth rate and significant resistances to most of antibiotics evaluated, especially to quinolones which came close to 30%. Fosfomycin showed the least resistance rate (0.9%) and remained stable along the years studied. CONCLUSIONS: These results suggest that higher rate of resistance to quinolones does not advise its use as empirical in community-acquired urinary tract infection treatment in our environment. According to our experience, fosfomycin can be an excellent option for cystitis treatment in patients without risk factors, while for the treatment of parenchymatous urinary tract infection, complicated urinary tract infections, and urinary tract infections associated to risk factors, preference could be second or third generation oral cephalosporins, or amoxicillin-clavulanic acid.

Evolución de la resistencia antibiótica en las infecciones urinarias adquiridas en la comunidad / Antibiotic resistance transformation in community-acquired urinary infections

Objetivo. Conocer la prevalencia de uropatógenos en la infección del tracto urinario comunitaria en nuestro medio y la sensibilidad a los antibióticos utilizados en el tratamiento empírico. Pacientes y método. Estudio longitudinal retrospectivo de 16.392 urinocultivos consecutivos recogidos en el servicio de Urgencias del Hospital del Mar desde enero de 1997 hasta diciembre de 2001. Las tasas de resistencia fueron comparadas mediante el análisis de la varianza. Resultados. Se obtuvieron 8.743 urinocultivos con recuento significativo. Se identificaron 6.062 Escherichia coli (69,3%), 517 Proteus mirabilis (5,9%) y 390 Klebsiella pneumoniae (4,5%). Escherichia coli mostró una tasa de resistencias creciente y significativa en la mayoría de los antibióticos testados, siendo especialmente importante en las quinolonas, en las que se aproximó al 30%. La fosfomicina presentó la menor tasa de resistencia (0,9%) y permaneció estable a lo largo de los años estudiados. Conclusiones. Estos resultados sugieren que la elevada tasa de resistencias para las quinolonas no aconseja su empleo como tratamiento empírico de la infección del tracto urinario comunitaria en nuestro medio. Según nuestra experiencia, la fosfomicina puede ser una excelente opción para el tratamiento de las cistitis de pacientes sin factores de riesgo, mientras que en el tratamiento de las infecciones del tracto urinario parenquimatosas, de las complicadas o de las que asocian factores de riesgo, la elección podría ser las cefalosporinas orales de segunda o tercera generación o la amoxicilina-ácido clavulánico

Objective. To detect the prevalence of uropathogens in community-adquired urinary tract infection in our environment, and the degree of sensitivity to antibiotics used as empirical treatment. Patients and method. Retrospective longitudinal study on 16,392 consecutive urine cultures collected in the emergency department of Hospital del Mar, between January 1997 and December 2001. Resistance rates were compared through variance analysis. Results. 8,743 urine cultures with significant count were obtained. 6,062 Escherichia coli (69.3%), 517 Proteus mirabilis (5.9%) and 390 Klebsiella pneumoniae (4.5%) were identified. Escherechia coli showed progressive growth rate and significant resistances to most of antibiotics evaluated, especially to quinolones which came close to 30%. Fosfomycin showed the least resistance rate (0.9%) and remained stable along the years studied. Conclusions. These results suggest that higher rate of resistance to quinolones does not advise its use as empirical in community-acquired urinary tract infection treatment in our environment. According to our experience, fosfomycin can be an excellent option for cystitis treatment in patients without risk factors, while for the treatment of parenchymatous urinary tract infection, complicated urinary tract infections, and urinary tract infections associated to risk factors, preference could be second or third generation oral cephalosporins, or amoxicillin-clavulanic acid