Dataset Information

Bacterial species and antimicrobial resistance differ between catheter and non-catheter-associated urinary tract infections: Data from a national surveillance network.

ABSTRACT:

Objective

To investigate clinically relevant microbiological characteristics of uropathogens and to compare patients with catheter-associated urinary tract infections (CAUTIs) to those with non-CAUTIs.

Methods

All urine cultures from the calendar year 2019 of the Swiss Centre for Antibiotic Resistance database were analyzed. Group differences in the proportions of bacterial species and antibiotic-resistant isolates from CAUTI and non-CAUTI samples were investigated.

Results

Data from 27,158 urine cultures met the inclusion criteria. Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis together represented 70% and 85% of pathogens identified in CAUTI and non-CAUTI samples, respectively. Pseudomonas aeruginosa was significantly more often detected in CAUTI samples. The overall resistance rate for the empirically often-prescribed antibiotics ciprofloxacin (CIP), norfloxacin (NOR), and trimethoprim-sulfamethoxazole (TMP-SMX) was between 13% and 31%. Except for nitrofurantoin, E. coli from CAUTI samples were more often resistant (P ≤ .048) to all classes of antibiotics analyzed, including third-generation cephalosporines used as surrogate for extended-spectrum β-lactamase (ESBL). Significanty higher resistance proportions in CAUTI samples versus non-CAUTI samples were observed for CIP (P = .001) and NOR (P = .033) in K. pneumoniae, for NOR (P = .011) in P. mirabilis, and for cefepime (P = .015), and piperacillin-tazobactam (P = .043) in P. aeruginosa.

Conclusion

CAUTI pathogens were more often resistant to recommended empirical antibiotics than non-CAUTI pathogens. This finding emphasizes the need for urine sampling for culturing before initiating therapy for CAUTI and the importance of considering therapeutic alternatives.

SUBMITTER: D'Incau S

PROVIDER: S-EPMC10031580 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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Publications

Bacterial species and antimicrobial resistance differ between catheter and non-catheter-associated urinary tract infections: Data from a national surveillance network.

D'Incau Stéphanie S Atkinson Andrew A Leitner Lorenz L Kronenberg Andreas A Kessler Thomas M TM Marschall Jonas J

Antimicrobial stewardship & healthcare epidemiology : ASHE 20230320 1

<h4>Objective</h4>To investigate clinically relevant microbiological characteristics of uropathogens and to compare patients with catheter-associated urinary tract infections (CAUTIs) to those with non-CAUTIs.<h4>Methods</h4>All urine cultures from the calendar year 2019 of the Swiss Centre for Antibiotic Resistance database were analyzed. Group differences in the proportions of bacterial species and antibiotic-resistant isolates from CAUTI and non-CAUTI samples were investigated.<h4>Results</h4 ...[more]

PMID: 36970431

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Project description:Background and objectiveCatheter-associated urinary tract infections (CAUTIs) represent a significant burden in health care and its management is challenging. This study aims to assess and compare central European CAUTIs regarding diagnostics, treatment, and prophylaxis.MethodsAn anonymized online questionnaire was distributed among urologists in Austria, France, Germany, and Switzerland between January and October 2023, consisting of demographic questions on catheter management and diagnostics, treatment, and prophylaxis of CAUTIs. An analysis was performed per country. Comparisons were done with the Fisher's exact test (statistical significance with p < 0.05).Key findings and limitationsOut of 423 participating urologists, most regularly performed catheter changes and managed catheter-related issues, except for French urologists. Swiss urologists tended to change the catheter after a longer interval. In France, a higher estimated number of CAUTIs were observed. Diagnostic symptoms and measures varied significantly between countries. French urologists prescribed more antimicrobials per patient and administered longer treatment regimens. The choice of antimicrobial agents differed notably for nonfebrile and febrile CAUTIs, with cotrimoxazole/nitrofurantoin being common for nonfebrile cases and cephalosporin/amoxicillin for febrile ones. Follow-up protocols were similar among urologists, while prophylactic measures showed variations.Conclusions and clinical implicationsCAUTI management varied notably across countries in terms of diagnostics, treatment, and prophylaxis. Discrepancies in antimicrobial therapy could be influenced by local resistance rates; yet, nonrecommended drugs and prolonged regimens, as compared with guideline recommendations, were common. This trend, along with inappropriate diagnostics and prophylaxis, may increase antimicrobial resistance and CAUTI morbidity. This study emphasizes the necessity for diagnostic and antimicrobial stewardship interventions, and proper training in CAUTI management.Patient summaryIn this questionnaire-based study examining the clinical practices for managing urinary tract infections in patients with bladder catheters (CAUTIs), significant disparities were observed among European urologists regarding diagnosis, treatment, and prophylaxis. These findings underscore the critical need for clear guidelines and comprehensive training in CAUTI management.

Project description:BackgroundThere are still no detailed data about the burden of bacterial antimicrobial resistance (AMR) in urinary tract infections (UTI). Concrete knowledge of global and regional bacterial AMR data is crucial for developing informed programs and policies to control bacterial AMR and for prudent use of antibiotics to optimize antibiotic therapy in patients with UTI. This study aimed to provide comprehensive global and regional estimates for the AMR burden of UTI in 2019.MethodsData were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), including death, disability-adjusted life-years (DALYs), year lived with disability (YLD), and years of life lost (YLL) for bacterial AMR in UTI for 7 GBD super-regions, 21 regions, 14 pathogens, 13 antibiotic classes, and 66 pathogen-antibiotic combinations in 2019. The estimates were based on two counterfactual scenarios: drug-susceptible infection and no infection.ResultsGlobally, there were 64.89 thousand deaths (95% uncertainty interval [UI]: 45.86-93.35) attributed to and 0.26 million deaths (95% UI: 0.18-0.36) associated with bacterial AMR in UTI in 2019. Among regions, the all-age death rates were higher in southern Latin America, tropical Latin America, and Europe and lower in sub-Saharan Africa. Escherichia coli and Klebsiella pneumoniae accounted for more than 50% of deaths attributable to and associated with AMR, and resistance was high among multiple types of antibiotic class, including fluoroquinolones, carbapenems, and third-generation cephalosporins. There were 2 pathogen-drug combinations that caused more than 6000 resistance-attributable deaths: third-generation cephalosporin-resistant Escherichia coli and fluoroquinolone-resistant Escherichia coli.ConclusionsAMR in UTI is an unignorable health problem, both for the management of urology disease and for global antibiotic resistance. Special tailored strategies, including enhanced surveillance and rational use of antibiotics, should be developed for different regions according to the region-specific pathogen-antibiotic situations and resources.

Project description:Gram-positive bacteria in the genus Enterococcus are a frequent cause of catheter-associated urinary tract infection (CAUTI), a disease whose treatment is increasingly challenged by multiantibiotic-resistant strains. We have recently shown that E. faecalis uses the Ebp pilus, a heteropolymeric surface fiber, to bind the host protein fibrinogen as a critical step in CAUTI pathogenesis. Fibrinogen is deposited on catheters due to catheter-induced inflammation and is recognized by the N-terminal domain of EbpA (EbpANTD), the Ebp pilus's adhesin. In a murine model, vaccination with EbpANTD confers significant protection against CAUTI. Here, we explored the mechanism of protection using passive transfer of immune sera to show that antisera blocking EbpANTD-fibrinogen interactions not only is prophylactic but also can act therapeutically to reduce bacterial titers of an existing infection. Analysis of 55 clinical CAUTI, bloodstream, and gastrointestinal isolates, including E. faecalis, E. faecium, and vancomycin-resistant enterococci (VRE), revealed a diversity of levels of EbpA expression and fibrinogen-binding efficiency in vitro Strikingly, analysis of 10 strains representative of fibrinogen-binding diversity demonstrated that, irrespective of EbpA levels, EbpANTD antibodies were universally protective. The results indicate that, despite diversity in levels of fibrinogen binding, strategies that target the disruption of EbpANTD-fibrinogen interactions have considerable promise for treatment of CAUTI. Urinary catheterization is a routine medical procedure, and it has been estimated that 30 million Foley catheters are used annually in the United States. Importantly, placement of a urinary catheter renders the patient susceptible to developing a catheter-associated urinary tract infection, accounting for 1 million cases per year. Additionally, these infections can lead to serious complications, including bloodstream infection and death. Enterococcus strains are a common cause of these infections, and management of enterococcal infections has been more difficult in recent years due to the development of antibiotic resistance and the ability of strains to disseminate, resulting in a major threat in hospital settings. In this study, we developed an antibiotic-sparing treatment that is effective against diverse enterococcal isolates, including vancomycin-resistant enterococci, during catheter-associated urinary tract infections.

Dataset Information

Bacterial species and antimicrobial resistance differ between catheter and non-catheter-associated urinary tract infections: Data from a national surveillance network.

Objective

Methods

Results

Conclusion

Publications

Bacterial species and antimicrobial resistance differ between catheter and non-catheter-associated urinary tract infections: Data from a national surveillance network.

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