Bacterial Growth and Antimicrobial Resistance in Urinary Isolates Among Men with Lower UTI in Swedish Primary Healthcare: Retrospective Data over a 4 year Period

Overview

Journal JAC Antimicrob Resist

Publisher Oxford University Press

Specialty Infectious Diseases

Date 2024 Dec 30

PMID 39734489

Authors

Helena Kornfalt Isberg

Martin Sundqvist

Eva Melander

Anders Beckman

Katarina Hedin

Affiliations

Soon will be listed here.

Abstract

Background: , the most common bacterium causing urinary tract infections (UTIs), is increasingly reported as resistant to multiple antibiotics. Swedish surveillance data from hospital and primary health care (PHC) report a 17%-19% prevalence of resistance to ciprofloxacin in from urine cultures in men over 20 years of age. Surveillance data may include nosocomial infections. However, few studies have described resistance in in men with community-acquired UTI in PHC. We aimed to describe the microbiological results, including antibiotic resistance in , in men with lower UTI (LUTI) attending PHC.

Methods: In this retrospective study based on information from electronic medical records, we included patients from 289 PHC centres. For all men aged 18-79 years diagnosed with LUTI in PHC from January 2012 to December 2015, we extracted data on age, UTI diagnosis and results from urine cultures.

Results: A total of 17 987 episodes of lower UTI were identified. was detected in 62% of positive cultures and 63% of detected isolates were susceptible to all tested antimicrobials. Resistance in to the first-choice antibiotics pivmecillinam and nitrofurantoin were 2% and 1%, respectively. Resistance to ciprofloxacin was 9%, and to trimethoprim it was 17%.

Conclusions: Resistance levels for ciprofloxacin in among men with LUTI in PHC were lower than in surveillance data. The results of this study point to the importance of surveillance of resistance in urine samples from patients with LUTI in PHC in order to choose the right empirical antibiotic treatment.

References

Farrell K, Tandan M, Hernandez Santiago V, Gagyor I, Braend A, Skow M . Treatment of uncomplicated UTI in males: a systematic review of the literature. BJGP Open. 2020; 5(2). PMC: 8170603. DOI: 10.3399/bjgpopen20X101140. View

Germanos G, Trautner B, Zoorob R, Salemi J, Drekonja D, Gupta K . No Clinical Benefit to Treating Male Urinary Tract Infection Longer Than Seven Days: An Outpatient Database Study. Open Forum Infect Dis. 2019; 6(6):ofz216. PMC: 6580996. DOI: 10.1093/ofid/ofz216. View

Kornfalt Isberg H, Hedin K, Melander E, Molstad S, Beckman A . Increased adherence to treatment guidelines in patients with urinary tract infection in primary care: A retrospective study. PLoS One. 2019; 14(3):e0214572. PMC: 6438509. DOI: 10.1371/journal.pone.0214572. View

Sundqvist M, Kahlmeter G . 'Pre-emptive culturing' will improve the chance of 'getting it right' when empirical therapy of urinary tract infections fails. J Antimicrob Chemother. 2009; 64(2):227-8. DOI: 10.1093/jac/dkp181. View

Kornfalt Isberg H, Hedin K, Melander E, Molstad S, Cronberg O, Engstrom S . Different antibiotic regimes in men diagnosed with lower urinary tract infection - a retrospective register-based study. Scand J Prim Health Care. 2020; 38(3):291-299. PMC: 7470089. DOI: 10.1080/02813432.2020.1794409. View

Griebling T . Urologic diseases in america project: trends in resource use for urinary tract infections in men. J Urol. 2005; 173(4):1288-94. DOI: 10.1097/01.ju.0000155595.98120.8e. View

Soudais B, Lacroix-Hugues V, Meunier F, Gillibert A, Darmon D, Schuers M . Diagnosis and management of male urinary tract infections: a need for new guidelines. Study from a French general practice electronic database. Fam Pract. 2020; 38(4):432-440. DOI: 10.1093/fampra/cmaa136. View

Montelin H, Forsman K, Tangden T . Retrospective evaluation of nitrofurantoin and pivmecillinam for the treatment of lower urinary tract infections in men. PLoS One. 2019; 14(1):e0211098. PMC: 6347205. DOI: 10.1371/journal.pone.0211098. View

Kornfalt Isberg H, Grondal H, Tyrstrup M . GPs' experience with diagnosis and treatment guidelines for lower UTI in men: a qualitative interview. BJGP Open. 2024; 8(3). PMC: 11523524. DOI: 10.3399/BJGPO.2023.0254. View

10.

Mulder M, Baan E, Verbon A, Stricker B, Verhamme K . Trends of prescribing antimicrobial drugs for urinary tract infections in primary care in the Netherlands: a population-based cohort study. BMJ Open. 2019; 9(5):e027221. PMC: 6530323. DOI: 10.1136/bmjopen-2018-027221. View

11.

den Heijer C, Penders J, Donker G, Bruggeman C, Stobberingh E . The importance of gender-stratified antibiotic resistance surveillance of unselected uropathogens: a Dutch Nationwide Extramural Surveillance study. PLoS One. 2013; 8(3):e60497. PMC: 3612053. DOI: 10.1371/journal.pone.0060497. View

12.

Kurotschka P, Fulgenzio C, Da Cas R, Traversa G, Ferrante G, Massidda O . Effect of Fluoroquinolone Use in Primary Care on the Development and Gradual Decay of Resistance to Fluoroquinolones: A Matched Case-Control Study. Antibiotics (Basel). 2022; 11(6). PMC: 9219874. DOI: 10.3390/antibiotics11060822. View

13.

Osthoff M, McGuinness S, Wagen A, Eisen D . Urinary tract infections due to extended-spectrum beta-lactamase-producing Gram-negative bacteria: identification of risk factors and outcome predictors in an Australian tertiary referral hospital. Int J Infect Dis. 2015; 34:79-83. DOI: 10.1016/j.ijid.2015.03.006. View

14.

Fallon R, Farrell K, Leon G, Rajan A, Duane S, FitzGerald C . GPs' attitudes towards the diagnosis and treatment of male urinary tract infections: a qualitative interview study in Ireland. BJGP Open. 2019; . PMC: 6995865. DOI: 10.3399/bjgpopen19X101667. View

15.

Koeijers J, Verbon A, Kessels A, Bartelds A, Donkers G, Nys S . Urinary tract infection in male general practice patients: uropathogens and antibiotic susceptibility. Urology. 2010; 76(2):336-40. DOI: 10.1016/j.urology.2010.02.052. View

16.

Goossens H, Ferech M, Vander Stichele R, Elseviers M . Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005; 365(9459):579-87. DOI: 10.1016/S0140-6736(05)17907-0. View

17.

Kornfalt Isberg H, Melander E, Hedin K, Molstad S, Beckman A . Uncomplicated urinary tract infections in Swedish primary care; etiology, resistance and treatment. BMC Infect Dis. 2019; 19(1):155. PMC: 6375206. DOI: 10.1186/s12879-019-3785-x. View

18.

Moragas Moreno A, Fernandez-Garcia S, Llor C, Ouchi D, Garcia-Sangenis A, Monteagudo M . Diagnostic and Therapeutic Management of Urinary Tract Infections in Catalonia, Spain: Protocol for an Observational Cohort Study. JMIR Res Protoc. 2023; 12:e44244. PMC: 9996422. DOI: 10.2196/44244. View