TY - JOUR
T1 - Antimicrobial Resistance among Community-Acquired Uropathogens in Mashhad, Iran
AU - Vakilzadeh, Mohammad Moein
AU - Heidari, Amirhossein
AU - Mehri, Ali
AU - Shirazinia, Matin
AU - Sheybani, Fereshte
AU - Aryan, Ehsan
AU - Naderi, Hamidreza
AU - Najaf Najafi, Mona
AU - Varzandeh, Marjan
N1 - Funding Information: The authors would like to thank the supports of the Vice Chancellery for Research of Mashhad University of Medical Sciences, Mashhad, Iran, and the Centre for Disease Control and Prevention (CDC) of Imam Reza Teaching Hospital and Imam Reza Clinical Research Unit (CRU) affiliated Mashhad University of Medical Sciences, Mashhad, Iran. *e helpful cooperation of Dr. Seyyed Ali Akbar Shamsian was appreciated. The authors also acknowledge Imam Reza Medical Diagnostic Laboratory, Ghaem Medical Diagnostic Laboratory, and Jihad Daneshgahi Medical Diagnostic Laboratory for their cooperation. This research was conducted with funding support from the Vice Chancellery for Research of Mashhad University of Medical Sciences (Research Project no. 951020 and ethic code IR.MUMS.fm.REC.1395.542). Publisher Copyright: © 2020 Mohammad Moein Vakilzadeh et al.
PY - 2020
Y1 - 2020
N2 - Background. Antimicrobial resistance among community-acquired uropathogens is an emerging concern over the past decades that warrants a continuing reevaluation of the appropriateness of recommended empiric antimicrobial regimens for treatment of urinary tract infections (UTIs). Aims. To describe the microbial spectrum and resistance profile of community-acquired uropathogens and predictors of isolation of resistant strains. Methods. Between October 2017 and June 2019, individuals who visited the outpatient clinics for diagnosis of UTIs or screening of asymptomatic bacteriuria were included in the study if they were tested for urine culture in one of the three main medical diagnostic laboratories of Mashhad, Iran. The standard disk diffusion antimicrobial susceptibility testing was used, with the Clinical and Laboratory Standards Institute (CLSI) threshold cutoffs for susceptibility of isolated uropathogens. Results. Three hundred thirty cases were included with a median age of 47 years. Two hundred seventy-six (83.6%) were female. The most common isolated uropathogens were Escherichia coli in 201 (60.9%) cases and Klebsiella species in 46 (13.9%) cases. E. coli isolates showed the highest rates of susceptibility to nitrofurantoin (89.3%), cefixime (75%), and gentamicin (72.4%). Exposure to antibiotics in the past 3 months was a predictor of resistance to ciprofloxacin (OR: 2.8, 95% CI: 1.33-6.28), and older age was a predictor of resistance to TMP-SMX (OR: 2.1, 95% CI: 1.07-3.97) among E. coli isolates. Conclusion. E. coli and Klebsiella species accounted for about two-thirds of community-acquired uropathogens. In regard to the high susceptibility rates, nitrofurantoin was identified as the first-choice agent for empiric treatment of community-acquired cystitis, while cefixime and gentamicin might be the second-choice alternatives. Ciprofloxacin and TMP-SMX, on the other hand, cannot be considered appropriate agents for empiric therapy of community-acquired UTIs, particularly in those who had exposure to antibiotics in the past 3 months and the elderly.
AB - Background. Antimicrobial resistance among community-acquired uropathogens is an emerging concern over the past decades that warrants a continuing reevaluation of the appropriateness of recommended empiric antimicrobial regimens for treatment of urinary tract infections (UTIs). Aims. To describe the microbial spectrum and resistance profile of community-acquired uropathogens and predictors of isolation of resistant strains. Methods. Between October 2017 and June 2019, individuals who visited the outpatient clinics for diagnosis of UTIs or screening of asymptomatic bacteriuria were included in the study if they were tested for urine culture in one of the three main medical diagnostic laboratories of Mashhad, Iran. The standard disk diffusion antimicrobial susceptibility testing was used, with the Clinical and Laboratory Standards Institute (CLSI) threshold cutoffs for susceptibility of isolated uropathogens. Results. Three hundred thirty cases were included with a median age of 47 years. Two hundred seventy-six (83.6%) were female. The most common isolated uropathogens were Escherichia coli in 201 (60.9%) cases and Klebsiella species in 46 (13.9%) cases. E. coli isolates showed the highest rates of susceptibility to nitrofurantoin (89.3%), cefixime (75%), and gentamicin (72.4%). Exposure to antibiotics in the past 3 months was a predictor of resistance to ciprofloxacin (OR: 2.8, 95% CI: 1.33-6.28), and older age was a predictor of resistance to TMP-SMX (OR: 2.1, 95% CI: 1.07-3.97) among E. coli isolates. Conclusion. E. coli and Klebsiella species accounted for about two-thirds of community-acquired uropathogens. In regard to the high susceptibility rates, nitrofurantoin was identified as the first-choice agent for empiric treatment of community-acquired cystitis, while cefixime and gentamicin might be the second-choice alternatives. Ciprofloxacin and TMP-SMX, on the other hand, cannot be considered appropriate agents for empiric therapy of community-acquired UTIs, particularly in those who had exposure to antibiotics in the past 3 months and the elderly.
UR - http://www.scopus.com/inward/record.url?scp=85094222233&partnerID=8YFLogxK
U2 - https://doi.org/10.1155/2020/3439497
DO - https://doi.org/10.1155/2020/3439497
M3 - Article
C2 - 33082791
SN - 1687-9805
VL - 2020
JO - Journal of Environmental and Public Health
JF - Journal of Environmental and Public Health
M1 - 3439497
ER -