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Abstract

Background

Evidence on the distribution of bacteria and therapy recommendations in male outpatients with urinary tract infections (UTI) remains insufficient.

Aim

We aimed to report frequency distributions and antimicrobial resistance (AMR) of bacteria causing UTI in men and to identify risk factors for resistance of against trimethoprim (TMP) and ciprofloxacin (CIP).

Methods

We conducted a retrospective observational study using routinely collected midstream urine specimens from 102,736 adult male outpatients sent from 6,749 outpatient practices to nine collaborating laboratories from all major regions in Germany between 2015 and 2020. Resistance in was predicted using logistic regression.

Results

The three most frequent bacteria were (38.4%), (16.5%) and (9.3%). Resistance of against amoxicillin (45.7%), TMP (26.6%) and CIP (19.8%) was common. Multiple drug resistance was high (22.9%). Resistance against fosfomycin (0.9%) and nitrofurantoin (1.9%) was low. Resistance of against CIP was high (29.3%). Isolates of revealed high resistance against TMP (41.3%) and CIP (16.6%). The CIP and TMP resistance was significantly higher among bacteria derived from recurrent UTI (p < 0.05). Age ≥ 90 years, recurrent UTI and regions East and South were independently associated with AMR of against TMP and CIP (p < 0.05).

Conclusion

The most frequent UTI-causing pathogens showed highresistance against TMP and CIP, empirical therapy is therefore likely to fail. Apart from intrinsically resistant pathogens, susceptibility to fosfomycin and nitrofurantoin remains sufficient. Therefore, they remain an additional option for empirical treatment of uncomplicated UTI in men.

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/content/10.2807/1560-7917.ES.2022.27.30.2101012
2022-07-28
2024-03-29
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2022.27.30.2101012
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References

  1. Foxman B. The epidemiology of urinary tract infection. Nat Rev Urol. 2010;7(12):653-60.  https://doi.org/10.1038/nrurol.2010.190  PMID: 21139641 
  2. Schulz M, Kern WV, Hering R, Schulz M, Bätzing-Feigenbaum J. Antibiotic regulations in outpatient care in Germany for certain infectious diseases. Part 1 - background, method and main results of an analysis of quality indicators. [Antibiotikaverordnungen in der ambulanten Versorgung in Deutschland bei bestimmten Infektionserkrankungen Teil 1 – Hintergrund, Methode und Hauptergebnisse einer Analyse von Qualitätsindikatoren]. www.versorgungsatlas.de. 2014;1-23. German.  https://doi.org/10.20364/VA-14.04 
  3. Colgan R, Williams M. Diagnosis and treatment of acute uncomplicated cystitis. Am Fam Physician. 2011;84(7):771-6. PMID: 22010614 
  4. Deutsche Gesellschaft für Urologie e. V. (DGU). Interdisciplinary S3 guideline: Epidemiology, diagnostics, therapy, prevention and management of uncomplicated, bacterial, community-acquired urinary tract infections in adult patients. Long version 1.1-2. [Interdisziplinäre S3 Leitlinie: Epidemiologie, Diagnostik, Therapie, Prävention und Management unkomplizierter, bakterieller, ambulant erworbener Harnwegsinfektionen bei erwachsenen Patienten. Langversion 1.1-2]. Berlin: Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. (AWMF); 2017. AWMF register no. 043/044. German. Available from: https://www.awmf.org/leitlinien/detail/ll/043-044.html
  5. Car J. Urinary tract infections in women: diagnosis and management in primary care. BMJ. 2006;332(7533):94-7.  https://doi.org/10.1136/bmj.332.7533.94  PMID: 16410583 
  6. Farrell K, Tandan M, Hernandez Santiago V, Gagyor I, Braend AM, Skow M, et al. Treatment of uncomplicated UTI in males: a systematic review of the literature. BJGP Open. 2021;5(2):bjgpopen20X101140.  https://doi.org/10.3399/bjgpopen20X101140  PMID: 33234514 
  7. Gupta K, Grigoryan L, Trautner B. Urinary tract infection. Ann Intern Med. 2017;167(7):ITC49-64.  https://doi.org/10.7326/AITC201710030  PMID: 28973215 
  8. Brumfitt W, Hamilton-Miller JM, Gillespie WA. The mysterious ‘urethral syndrome’. BMJ. 1991;303(6804):719-20.  https://doi.org/10.1136/bmj.303.6804.719-c  PMID: 1912932 
  9. Foxman B, Barlow R, D’Arcy H, Gillespie B, Sobel JD. Urinary tract infection: self-reported incidence and associated costs. Ann Epidemiol. 2000;10(8):509-15.  https://doi.org/10.1016/S1047-2797(00)00072-7  PMID: 11118930 
  10. Naber KG, Bergman B, Bishop MC, Bjerklund-Johansen TE, Botto H, Lobel B, et al. EAU guidelines for the management of urinary and male genital tract infections. Eur Urol. 2001;40(5):576-88.  https://doi.org/10.1159/000049840  PMID: 11752870 
  11. Ingalsbe ML, Wojciechowski AL, Smith KA, Mergenhagen KA. Effectiveness and safety of nitrofurantoin in outpatient male veterans. Ther Adv Urol. 2015;7(4):186-93.  https://doi.org/10.1177/1756287215581556  PMID: 26445598 
  12. Boel JB, Jansåker F, Hertz FB, Hansen KH, Thønnings S, Frimodt-Møller N, et al. Treatment duration of pivmecillinam in men, non-pregnant and pregnant women for community-acquired urinary tract infections caused by Escherichia coli: a retrospective Danish cohort study. J Antimicrob Chemother. 2019;74(9):2767-73.  https://doi.org/10.1093/jac/dkz211  PMID: 31098630 
  13. Karaiskos I, Galani L, Sakka V, Gkoufa A, Sopilidis O, Chalikopoulos D, et al. Oral fosfomycin for the treatment of chronic bacterial prostatitis. J Antimicrob Chemother. 2019;74(5):1430-7.  https://doi.org/10.1093/jac/dkz015  PMID: 30796442 
  14. Grayson ML, Macesic N, Trevillyan J, Ellis AG, Zeglinski PT, Hewitt NH, et al. Fosfomycin for treatment of prostatitis: new tricks for old dogs. Clin Infect Dis. 2015;61(7):1141-3.  https://doi.org/10.1093/cid/civ436  PMID: 26063723 
  15. Griebling TL. Urologic diseases in america project: trends in resource use for urinary tract infections in men. J Urol. 2005;173(4):1288-94.  https://doi.org/10.1097/01.ju.0000155595.98120.8e  PMID: 15758784 
  16. Caljouw MAA, den Elzen WPJ, Cools HJM, Gussekloo J. Predictive factors of urinary tract infections among the oldest old in the general population. A population-based prospective follow-up study. BMC Med. 2011;9(1):57.  https://doi.org/10.1186/1741-7015-9-57  PMID: 21575195 
  17. Schubert S, Podschun R, Gatermann S, Fünfstück R, Naver KG, Schimanski S, et al. MIQ 02: urinary tract infections. [MIQ 02: Harnwegsinfektionen]. Hannover: Deutsche Gesellschaft für Hygiene und Mikrobiologie (DGHM); 2020. German. Available from: https://shop.elsevier.de/miq-02-harnwegsinfektionen-9783437226854.html#ebook.info.tab
  18. European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Version 12.0, 1 Jan 2022. Växjö: EUCAST; 2022. Available from: http://www.eucast.org/clinical_breakpoints
  19. Breakpoints for nitroxoline on Escherichia coli, Köln: National Committee for Antimicrobial Susceptibility Testing (Nationales Antibiotika-Sensitivitätstest-Komitee; NAK); 14/03/2014. German. Available from: https://www.nak-deutschland.org/nak-deutschland/index.html
  20. Austin PC, Hux JE. A brief note on overlapping confidence intervals. J Vasc Surg. 2002;36(1):194-5.  https://doi.org/10.1067/mva.2002.125015  PMID: 12096281 
  21. Schito GC, Naber KG, Botto H, Palou J, Mazzei T, Gualco L, et al. The ARESC study: an international survey on the antimicrobial resistance of pathogens involved in uncomplicated urinary tract infections. Int J Antimicrob Agents. 2009;34(5):407-13.  https://doi.org/10.1016/j.ijantimicag.2009.04.012  PMID: 19505803 
  22. Schmiemann G, Gágyor I, Hummers-Pradier E, Bleidorn J. Resistance profiles of urinary tract infections in general practice--an observational study. BMC Urol. 2012;12(1):33.  https://doi.org/10.1186/1471-2490-12-33  PMID: 23171154 
  23. Klingeberg A, Noll I, Willrich N, Feig M, Emrich D, Zill E, et al. Antibiotic-resistant E. coli in uncomplicated community-acquired urinary tract infection. Dtsch Arztebl Int. 2018;115(29-30):494-500. German.  https://doi.org/10.3238/arztebl.2018.0494  PMID: 30135009 
  24. Fagan M, Lindbæk M, Grude N, Reiso H, Romøren M, Skaare D, et al. Antibiotic resistance patterns of bacteria causing urinary tract infections in the elderly living in nursing homes versus the elderly living at home: an observational study. BMC Geriatr. 2015;15(1):98.  https://doi.org/10.1186/s12877-015-0097-x  PMID: 26238248 
  25. den Heijer CDJ, Penders J, Donker GA, Bruggeman CA, Stobberingh EE. The importance of gender-stratified antibiotic resistance surveillance of unselected uropathogens: a Dutch Nationwide Extramural Surveillance study. PLoS One. 2013;8(3):e60497.  https://doi.org/10.1371/journal.pone.0060497  PMID: 23555983 
  26. ARS – Antibiotic resistance surveillance. [ARS - Antibiotika-Resistenz-Surveillance]. Berlin: Robert Koch-Institut. [Accessed: 2 Aug 2021]. German. Available from: https://ars.rki.de
  27. Montelin H, Forsman K-J, Tängdén T. Retrospective evaluation of nitrofurantoin and pivmecillinam for the treatment of lower urinary tract infections in men. PLoS One. 2019;14(1):e0211098.  https://doi.org/10.1371/journal.pone.0211098  PMID: 30682092 
  28. Novelli A, Rosi E. Pharmacological properties of oral antibiotics for the treatment of uncomplicated urinary tract infections. J Chemother. 2017;29(sup1):10-8.  https://doi.org/10.1080/1120009X.2017.1380357  PMID: 29271734 
  29. Kline KA, Lewis AL. Gram-positive uropathogens, polymicrobial urinary tract infection, and the emerging microbiota of the urinary tract. Microbiol Spectr. 2016;4(2):10.1128/microbiolspec.UTI-0012-2012.  https://doi.org/10.1128/microbiolspec.UTI-0012-2012  PMID: 27227294 
  30. Gaston JR, Johnson AO, Bair KL, White AN, Armbruster CE. Polymicrobial interactions in the urinary tract: is the enemy of my enemy my friend? Infect Immun. 2021;89(4):IAI.00652-20.  https://doi.org/10.1128/IAI.00652-20  PMID: 33431702 
  31. Zhu H, Chen Y, Hang Y, Luo H, Fang X, Xiao Y, et al. Impact of inappropriate empirical antibiotic treatment on clinical outcomes of urinary tract infections caused by Escherichia coli: a retrospective cohort study. J Glob Antimicrob Resist. 2021;26:148-53.  https://doi.org/10.1016/j.jgar.2021.05.016  PMID: 34118479 
  32. DeMarsh M, Bookstaver PB, Gordon C, Lim J, Griffith N, Bookstaver NK, et al. Prediction of trimethoprim/sulfamethoxazole resistance in community-onset urinary tract infections. J Glob Antimicrob Resist. 2020;21:218-22.  https://doi.org/10.1016/j.jgar.2019.10.023  PMID: 31683038 
  33. Imöhl M, Reinert RR, van der Linden M. Regional differences in serotype distribution, pneumococcal vaccine coverage, and antimicrobial resistance of invasive pneumococcal disease among German federal states. Int J Med Microbiol. 2010;300(4):237-47.  https://doi.org/10.1016/j.ijmm.2009.05.005  PMID: 19604721 
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