Uropathogens Based on Antibiotic Susceptibility

Sang Wook Lee; Young Ho Kim

doi:10.14777/uti.2015.10.02.67

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Lee and Kim: Uropathogens Based on Antibiotic Susceptibility

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Urogenit Tract Infect 2015;10(2):67-73.

Published online: 19 October 2015

DOI: https://doi.org/10.14777/uti.2015.10.02.67

Uropathogens Based on Antibiotic Susceptibility

Sang Wook Lee, Young Ho Kim

Department of Urology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea

Correspondence to: Young Ho Kim http://orcid.org/0000-0003-3959-0928 Department of Urology, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea Tel: +82-32-621-5058, Fax: +82-32-621-5016 E-mail: yhkuro@schmc.ac.kr

Received 30 June 2015 Revised 9 July 2015 Accepted 14 August 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Urinary tract infections are one of the most commonly encountered infections in clinical practice. Due to the emergence of and increase in urinary tract bacteria that are resistant to trimethoprim-sulfamethoxazole, penicillin, cephalosporins, and fluoroquinolones, selection of appropriate antibiotics in treatment of these infections is important. In addition, the emergence of extended-spectrum beta-lactamase-producing organisms makes antibiotic selection difficult. This article provides a review of disease-specific uropathogens and their susceptibilities to antimicrobial agents.

Keywords: Anti-infective agents

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Table 1.

Distribution of urinary isolates from acute uncomplicated cystitis patients (n=301)

Species	Isolates, n (%)
Enterobateriaceae	246 (81.7)
Escherichia coli	214 (71.1)
Klebsiella spp.	11 (3.7)
Enterobacter spp.	9 (3.0)
Citrobacter spp.	9 (3.0)
Proteus spp.	3 (1.0)
Non-enterobateriaceae	55 (18.3)
Enterococci	39 (13.0)
CoNS	16 (5.3)

Adapted from the article of Kim et al. Int J Antimicrob Agents 2008;31 Suppl 1:S15-8 [4] with permission.

spp.: species, CoNS: coagulation-negative staphylococci.

Table 2.

Susceptability of urinary Enterobacteriaceae isolates from female outpatients with acute uncomplicated cystitis to various antimicrobial agents

	Susceptable strains in 2006/2002 (%)
	Escherichia coli (n=214/191)	Other Enterobacteriaceae (n=32/20)	Total (n=246/211)
Ampicillin	35.2/37.2	6.3/15.0	31.4/35.5
Ampicillin/sulbactam	52.4/44.5	51.6/50.0	52.3/45.0
Piperacillin/tazobactam	98.6/97.4	90.6/95.0	97.6/97.2
Ciprofloxacin	76.6/84.8	93.8/95.0	78.9/85.7
Gatifloxacin	78.2/NA	93.8/NA	80.3/NA
Cefazolin	92.4/92.2	50.0/60.0	86.8/89.1
Amikacin	99.5/99.0	100/100	99.6/99.1
Gentamicin	77.6/81.7	100/80.0	80.5/81.5
Tobramycin	78.2/85.9	100/80.0	81.1/85.3
TMP/SMX	70.6/61.3	96.8/70.0	73.9/62.1

Adapted from the article of Kim et al. Int J Antimicrob Agents 2008;31 Suppl 1:S15-8 [4] with permission.

NA: not available, TMP/SMX: trimethoprim/sulfamethoxazole.

Table 3.

Microbial prevalence in pyelonephritis requiring hospital admission and ED related UTI

	Pyelonephritis		ED related UTI
	Case	Total (%)	Case T	Total (%)
Escherichia coli	230	92.4	30,687	66
Klebsiella spp.	8	3.2	3,108	6.6
E. faecalis	-	-	3,153	6.7
Proteus spp.	6	2.5	2,497	5.3
Pseudomonas spp.	2	0.8	1,939	4.1
Enterobacter spp.	3	0.8	-	-
Citrobacter spp. Group B Streptococcus	- -	- -	340 4,726	0.72 10.1
Staphylococcus saprophyticus	-	-	210	0.45

Adapted from the article of Prabhu et al. Nephrology (Carlton) 2013;18:463-7 [5] with permission.

ED: emergency department, UTI: urinary tract infection, spp.: species.

Table 4.

Resistance of Escherichia coli for all UTI presenting to the ED and pyelonephritis patients

	Pyelonephritis		ED related UTI
	Case	Total (%)	Case	Total (%)
Ampicillin	120	52.1	14,120	46
Trimethoprim	81	32.5	6,214	10.4
Gentamicin	9	3.9	1,169	3.8
Cephalexin	4	1.7	1,079	3.5
Ceftriaxone	3	1.3	875	2.8
Norfloxacin	2	0.8	1,360	4.4

Adapted from the article of Prabhu et al. Nephrology (Carlton) 2013;18:463-7 [5] with permission.

UTI: urinary tract infection, ED: emergency department.

Table 5.

Microbial spectrum of patients with acute bacterial prostatitis

	Total (n=115)	With prior manipulation (n=39)	Without prior manipulation (n=76)	p-value
Escherichia coli	60 (52.2)	18 (46.2)	42 (55.3)	0.3546
Pseudomonas spp.	18 (15.7)	12 (30.8)	6 (7.9)	0.0014
Klebsiella spp.	11 (9.6)	4 (10.3)	7 (9.2)	0.8567
Enterobacter spp.	4 (3.5)	1 (2.6)	3 (3.9)	-
Streptococcus agalactiae	4 (3.5)	1 (2.6)	3 (3.9)	-
Serratia marcescens	2 (1.7)	1 (2.6)	1 (1.3)	-
CoNS	3 (2.6)	1 (2.6)	2 (2.6)	-
Enterococci	3 (2.6)	0 (0)	3 (3.9)	-
Mixed infection	5 (4.3)	3 (7.7)	2 (2.6)	0.2077
Others^a)	5 (4.3)	1 (2.6)	4 (5.3)	-

Values are presented as number (%). Adapted from the article of Ha et al. Int J Antimicrob Agents 2008;31 Suppl 1:S96-101 [8] with permission. spp.: species, CoNS: coagulase-negative staphylococci.

^a) Neisseria gonorrhoeae, Salmonella and Candida.

Table 6.

Antibiotic susceptibility (%) of pathogens isolated in patients with acute bacterial prostatitis, according to prior manipulation

	Total (n=115)	With prior manipulation (n=39)	Without prior manipulation (n=76)	p-value
Ampicillin	29.8	21.4	32.6	0.4292
Ampicillin/sulbactam	38.9	45.5	36.0	0.5919
Piperacillin/tazobactam	88.9	84.6	90.2	0.5737
First-generation cephalosporins	60.0	53.8	61.9	0.8965
Second-generation cephalosporins	82.0	75.0	84.2	0.4691
Third-generation cephalosporins	82.5	78.6	83.7	0.6599
Fourth-generation cephalosporins	84.2	80.0	85.7	0.6706
Ciprofloxacin	73.8	53.3	80.4	0.0383
Ofloxacin	88.5	91.5	85.7	0.3689
Amikacin	94.3	92.3	95.0	0.7152
Gentamicin	82.3	66.7	87.2	0.0695
Tobramycin	85.1	66.8	91.4	0.0376
Imipenem	99.4	99.3	99.5	0.8985
Trimethoprim/sulfamethoxazole	67.4	54.6	71.9	0.2900

Adapted from the article of Ha et al. Int J Antimicrob Agents 2008;31 Suppl 1:S96-101 [8] with permission.

Table 7.

Co-resistence profiles of 121 ciprofloxacin-resistent Escherichia coli rectal and clinical isolates from men undergoing transrectal prostate biopsy

Drug	Prevalance of resistence, n (%)
Ampicillin	120 (99)
Trimethoprim-sulfamethoxazole	41 (34)
Gentamicin	31 (26)
Tobramycin	22 (18)
Cefazolin	20 (17)
Nitrofurantoin	18 (15)
Ceftriaxone	8 (7)
Aztreonam	6 (5)
Imipenem	2 (2)
Piperacillin-tazobactam	1 (1)
Ertapenem	1 (1)
Tigecycline	1 (1)
Meropenem	0 (0)
Amikacin	0 (0)

Adapted from the article of Liss et al. Clin Infect Dis 2015;60:979-87 [19] with permission.

Table 8.

Comparison of antimicrobial susceptibilities between O-UTI and I-UTI

	Antimicrobial susceptibility of Escherichia coli
	O-UTI (n, %)	I-UTI (n, %)	OR	95% CI^a)
Ampicillin/clavulanate	667 (66.0)	151 (54.5)	1.63	1.24-2.13
Cefazolin	769 (76.1)	192 (69.3)	1.41	1.05-1.89
Cefotaxime	885 (87.6)	216 (78.0)	1.99	1.42-2.81
Cefotetan	994 (98.4)	258 (93.1)	4.57	2.32-9.02
Ceftazidime	943 (93.4)	234 (84.5)	2.59	1.71-3.89
Ceftriaxone	887 (87.8)	213 (76.9)	2.05	1.49-2.89
Cefuroxime	848 (84.0)	192 (69.3)	2.32	1.71-3.15
Ciprofloxacin	688 (68.1)	160 (57.8)	1.56	1.19-2.05
Imipenem	1,003 (99.3)	271 (97.8)	3.17	1.05-9.51
Trimethoprim/sulfamethoxazole	619 (61.3)	141 (50.9)	1.53	1.17-1.99
ESBL	122 (12.1)	64 (23.1)	2.19	1.56-3.07

Adapted from the article of Lee et al. Korean J Urol 2010;51:492-7 [21].

O-UTI: outpatient urinary tract infection, I-UTI: inpatient urinary tract infection, OR: odds ratio, CI: confidence interval, ESBL: extended spectrum beta-lactamase.

^a) p＜0.01 except for imipenem (p=0.047).

Table 9.

Antibiotic susceptibility patterns of extended spectrum beta-lactamase-producing Escherichia coli

Antibiotic susceptibility	Value (%)
Ampicillin/clavulanate	3.8
Cefazolin	1.3
Cefotetan	95.9
Cefotaxim	3.8
Ceftazidime	42.3
Ceftriaxone	3.8
Ciprofloxacin	28.2
Imipenem	98.7
Trimethoprim/sulfamethoxazole	42.3

Adapted from the article of Lee et al. Korean J Urol 2010;51:492-7 [21].

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