Sex, drugs, bugs, and age: Rational selection of empirical therapy for outpatient urinary tract infection in an era of extensive antimicrobial resistance

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dc.contributor.authorRocha J.L.
dc.contributor.authorTuon F.F.
dc.contributor.authorJohnson J.R.
dc.date.accessioned2024-03-13T01:08:35Z
dc.date.available2024-03-13T01:08:35Z
dc.date.issued2012
dc.description.abstractBackground: Optimal empirical therapy of urinary tract infection requires accurate knowledge of local susceptibility patterns, which may vary with organism and patient characteristics. Methods: Among 9,798 consecutive, non-duplicate, community-source urine isolates from ambulatory patients ≥ 13 years old, from clinical laboratory and an academic medical center in Curitiba, Brazil (May 1st to December 1st, 2009), susceptibility data for ampicillin, nitrofurantoin, trimethoprim-sulfamethoxazole, gentamicin, fluoroquinolones, and ceftriaxone/cefotaxime were compared with organism and patient gender and age. Results: The female-to-male ratio decreased with age, from 28.1 (among 20-29 year-olds) to 3.3 (among > 80 year-olds). Overall, susceptibility prevalence varied widely by drug class, from unacceptably low levels (53.5% and 61.1%: ampicillin and trimethoprimsulfamethoxazole) to acceptable but suboptimal levels (81.2% to 91.7%: fluoroquinolones, ceftriaxone, nitrofurantoin, and gentamicin). E. coli isolates exhibited higher susceptibility rates than other isolates, from 3-4% higher (fluoroquinolones, gentamicin) to ≥ 30% (nitrofurantoin, ceftriaxone). Males exhibited lower susceptibility rates than females. Within each gender, susceptibility declined with increasing age. For females, only nitrofurantoin and gentamicin were suitable for empirical therapy (≥ 80% susceptibility) across all age cohorts; fluoroquinolones were suitable only through age 60, and ceftriaxone only through age 80. For males, only gentamicin yielded ≥ 80% susceptibility in any age cohort. Conclusion: Few suitable empirical treatment options for community-source urinary tract infection were identified for women aged over 60 years or males of any age. Empirical therapy recommendations must consider the patient's demographic characteristics. Site-specific, age and gender-stratified susceptibility surveillance involving all uropathogens is needed. © 2012 Elsevier Editora Ltda.
dc.description.firstpage115
dc.description.issuenumber2
dc.description.lastpage121
dc.description.volume16
dc.identifier.doi10.1016/S1413-8670(12)70291-X
dc.identifier.issn1678-4391
dc.identifier.urihttps://dspace.mackenzie.br/handle/10899/36837
dc.relation.ispartofBrazilian Journal of Infectious Diseases
dc.rightsAcesso Aberto
dc.subject.otherlanguageAnti-bacterial agents
dc.subject.otherlanguageDrug resistance, bacterial
dc.subject.otherlanguageEscherichia coli
dc.subject.otherlanguageFluoroquinolones
dc.subject.otherlanguageUrinary tract infections
dc.titleSex, drugs, bugs, and age: Rational selection of empirical therapy for outpatient urinary tract infection in an era of extensive antimicrobial resistance
dc.typeArtigo
local.scopus.citations22
local.scopus.eid2-s2.0-85027942080
local.scopus.updated2024-05-01
local.scopus.urlhttps://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85027942080&origin=inward
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