Clonal composition of Escherichia coli causing community-acquired urinary tract infections in the State of Rio de Janeiro, Brazil.

Recent studies from North America and Europe have demonstrated community-wide clonal spread of uropathogenic Escherichia coli (UPEC). To investigate if a similar pattern of spread occurs in Brazil, we characterized UPEC from women with community-acquired urinary tract infection (UTI) in Rio de Janeiro. E. coli isolates from women with UTI in one public outpatient clinic were evaluated for antibiotic susceptibility, E. coli phylogenetic grouping, enterobacterial repetitive intergenic consensus (ERIC) 2 PCR and pulsed-field gel electrophoresis fingerprinting, and multilocus sequence typing. From March 2005 to November 2006, 344 patients were studied. Of these, 186 (54%) had confirmed UTI, 118 (63.4%) of which were caused by E. coli. More than 50% of these isolates were resistant to ampicillin and trimethoprim/sulfamethoxazole. Of these, 96 (81%) belonged to 19 ERIC2 clonal groups. The largest group included 15 isolates, all belonging to multilocus sequence typing group ST69 and phylogenetic group D; they had pulsed-field gel electrophoresis patterns sharing at least 89% similarity compared with the CgA reference strain ATCC BAA-457. CgA strains have been found to be widespread in the United States in the early 2000s. Clonal group E. coli strains accounted for a large proportion (52%) of all UTIs and 82% of the trimethoprim/sulfamethoxazole-resistant E. coli UTIs. Thus, as in North America and Europe, UPECs that cause UTI in Rio de Janeiro also show clonal distribution, and a substantial proportion of drug-resistant UTI is caused by a small set of genetically related E. coli strains.

Temporal changes in the prevalence of community-acquired antimicrobial-resistant urinary tract infection affected by Escherichia coli clonal group composition.

BACKGROUND: The changing prevalence of drug-resistant community-acquired urinary tract infection (UTI) is often attributed to local antimicrobial drug use or prescribing practices. However, recent molecular epidemiologic studies of community-acquired UTI suggest that other factors may play a greater role. METHODS: We conducted a multiyear, cross-sectional study to characterize temporal changes in the prevalence of drug-resistant community-acquired UTI at a university community in California. During four 3.5-month sampling periods, urine samples from patients consecutively presenting to the university health service with symptoms of UTI were cultured for Escherichia coli. Antimicrobial susceptibility and genotyping tests of the E. coli isolates were performed. RESULTS: We recovered 780 E. coli isolates from 1667 patients with UTI. The prevalence of trimethoprim-sulfamethoxazole, ciprofloxacin, and nitrofurantoin resistance showed no trend over the 4 periods. The prevalence of ampicillin resistance decreased significantly over the last 2 study periods. A single clonal group accounted for 75% of this decrease. Enterobacterial repetitive intergenic consensus 2 PCR-based genotyping revealed that only 4 large clonal groups accounted for 52% of the UTIs resistant to trimethoprim-sulfamethoxazole, ciprofloxacin, or nitrofurantoin. No initially pansusceptible clonal groups gained resistance over time. CONCLUSIONS: This study revealed no obvious trend in the prevalence of drug-resistant community-acquired UTI in a single community. Prevalence at any time was influenced by a small number of E. coli clonal groups. This observation suggests that the introduction of strains that are drug resistant into a community plays a greater role in changing the prevalence of drug-resistant UTI than does the drug use or prescribing habits in that community.

Retail meat consumption and the acquisition of antimicrobial resistant Escherichia coli causing urinary tract infections: a case-control study.

BACKGROUND: The increasing incidence of community-acquired urinary tract infections (UTIs) caused by antimicrobial resistant Escherichia coli, and observations of potential outbreaks of UTI-causing E. coli, suggest that food may be an important source of E. coli in women who develop UTI. We sought to determine if acquisition of and infection with a UTI-causing, antimicrobial resistant E. coli isolate is associated with a woman's dietary habits, specifically her preparation and consumption of retail meat products. METHODS: Between April 2003 and June 2004, a case-control study was conducted. The dietary habits of women with UTI caused by an antimicrobial resistant E. coli (cases) and women with UTI caused by fully susceptible E. coli (controls) were compared. Broth microdilution was used to perform antimicrobial resistance testing. All E. coli isolates were genotyped by the pulsed-field gel electrophoresis (PFGE) method. RESULTS: Ninety-nine women met study criteria. Women who were infected with multidrug-resistant E. coli reported more frequent chicken consumption (adjusted OR = 3.7, 95% CI 1.1, 12.4). Women with UTI caused by an ampicillin- or cephalosporin-resistant E. coli isolate reported more frequent consumption of pork (adjusted OR = 3.2, 95% CI 1.0, 10.3 and adjusted OR = 4.0, 95% CI 1.0, 15.5, respectively). Frequent alcohol consumption was associated with antimicrobial resistant UTI. CONCLUSIONS: This study provides epidemiologic evidence that antimicrobial resistant, UTI-causing E. coli could have a food reservoir, possibly in poultry or pork.

Patients meet technology: the newest in patient-centered care initiatives.

In recent years, health care consumers have become increasingly sophisticated in their selection and use of health care services. Empowered initially by the Internet, they are seeking medical information to become better informed as they interact with physicians and other health care providers. This article addresses (1) the new patient-provider relationship with more provider accountability, the impact of Baby Boomers on health care, and the evolving consumer-driven marketplace with emerging patient-centered care; (2) emerging technologies being used to transform the patient experience; (3) how the use of cutting-edge technologies affect the health care consumer; and (4) the future impact of the use of patient-centered technology initiatives on the health care industry. The personal health record is predicted by experts to be the primary technology that will promote advancement of the electronic health record; therefore, this article focuses on patients' use of the personal health record.

Possible animal origin of human-associated, multidrug-resistant, uropathogenic Escherichia coli.

BACKGROUND: The multistate occurrence of cases of urinary tract infection (UTI) caused by trimethoprim-sulfamethoxazole (TMP-SMZ)-resistant Escherichia coli strains belonging to a single clonal group (designated as clonal group A [CgA]) in the United States has raised an intriguing hypothesis that these infections may have been spread by contaminated food products. The present study attempted to determine if CgA strains could be traced to food animals. METHODS: A total of 495 animal and environmental E. coli isolates, which belonged to serogroups O11, O17, O73, and O77 and were collected between 1965 and 2002 by the Gastroenteric Disease Center at Pennsylvania State University (University Park, PA), were further subtyped by antimicrobial drug susceptibility, enterobacterial repetitive intergenic consensus (ERIC2) PCR, random amplified polymorphic DNA analysis, pulsed-field gel electrophoresis (PFGE), and virulence profile pattern. RESULTS: Of 495 isolates, 128 (26%) had an ERIC2 PCR electrophoretic pattern indistinguishable from that of the human prototype CgA strain, and 14 CgA isolates were resistant to TMP-SMZ. Cluster analysis of PFGE patterns showed that 1 of these 14 isolates, obtained from a cow in 1988, was 94% similar to a CgA uropathogenic human-associated E. coli strain. The pattern for this isolate was included among a cluster of PFGE patterns for 5 human-associated UTI isolates that were >80% similar to each other. CONCLUSIONS: These observations suggest that drug-resistant, uropathogenic human-associated E. coli strains potentially have an animal origin. The possibility that human drug-resistant UTI could be a foodborne illness has serious public health implications.

HIPAA compliance: deadlines and beyond.

The deadline has passed for the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule and the Transactions and Code Sets Rule. With that in mind, many health care professionals feel that they can sit back and take a deep breath. But do not be fooled, both rules require continuous follow-up and monitoring. Additionally, the Security Rule requires compliance by April 2005. During implementation of future HIPAA regulations, health care professionals can benefit greatly from their experiences in meeting requirements of the Privacy Rule and the Transactions and Code Sets Rule. Many of the same tools and techniques may be used to ensure compliance with future HIPAA regulations. This article will discuss the need for ongoing compliance with the Privacy Rule, the Transactions and Code Sets Rule, and the implementation of the Security Rule.

An analysis of computerization in primary care practices.

To remain profitable, primary care practices, the front-line health care providers, must provide excellent patient care and reduce expenses while providing payers with accurate data. Many primary care practices have turned to computer technology to achieve these goals. This study examined the degree of computerization of primary care providers in the Augusta, Georgia, metropolitan area as well as the level of awareness of the Health Insurance Portability and Accountability Act (HIPAA) by primary care providers and its potential effect on their future computerization plans. The study's findings are presented and discussed as well as a number of recommendations for practice managers.