Size: px
Start display at page:

Download ""

Transcription

1 The Journal of Emergency Medicine, Vol. 49, No. 6, pp , 2015 Copyright Ó 2015 Elsevier Inc. Printed in the USA. All rights reserved /$ - see front matter Brief Reports RESISTANCE PATTERNS OF ESCHERICHIA COLI IN WOMEN WITH UNCOMPLICATED URINARY TRACT INFECTION DO NOT CORRELATE WITH EMERGENCY DEPARTMENT ANTIBIOGRAM Michelle C. Hines, PHARMD,* Tareq Al-Salamah, MBBS, MPH,* Emily L. Heil, PHARMD,* Haney Mallemat, MD, Michael D. Witting, MD, MS, Jennifer K. Johnson, PHD, Michael E. Winters, MD, and Bryan D. Hayes, PHARMD* *Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, Maryland, King Saud University, Riyadh, Kingdom of Saudi Arabia, Department of Emergency Medicine, and Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland Reprint Address: Bryan D. Hayes, PHARMD, Department of Emergency Medicine, University of Maryland School of Medicine, 22 South Greene St., Baltimore, MD 21201, Abstract Background: Urine cultures are not always performed for female Emergency Department (ED) patients with uncomplicated urinary tract infection (UTI). Accordingly, hospital, and even ED-specific, antibiograms might be skewed toward elderly patients with many comorbidities and relatively high rates of antimicrobial resistance, and thus do not accurately reflect otherwise healthy women. Our ED antibiogram indicates Escherichia coli resistance rates for ciprofloxacin, levofloxacin, and trimethoprim-sulfamethoxazole (TMP-SMX) of 42%, 26%, and 33%, respectively. Objectives: This study aims to compare resistance rates of urinary E. coli from otherwise healthy women with uncomplicated UTI and pyelonephritis in the ED to rates in our ED antibiogram. Methods: Females > 18 years old with acute onset of urinary frequency, urgency, or dysuria with pyuria identified on urinalysis (white blood cell count > 10/high-power field) were prospectively enrolled in the ED of an urban, academic medical center. Exclusion criteria indicating a complicated UTI were consistent with Infectious Diseases Society of America guidelines. Susceptibility patterns of E. coli to ciprofloxacin, levofloxacin, and TMP-SMX in the study group were compared to our ED antibiogram. Results: Forty-five patients grew E. coli. Pyelonephritis The data were presented at the American College of Emergency Physicians Scientific Assembly in October was suspected in nine (20%) subjects. Compared with the ED antibiogram, significantly lower rates of resistance to ciprofloxacin (2% vs. 42%, p < 0.001), levofloxacin (2% vs. 26%, p < 0.001), and TMP-SMX (16% vs. 33%, p = 0.016) were observed. Six patients grew non-e. coli uropathogens. All were susceptible to both levofloxacin and TMP-SMX. Conclusions: ED antibiograms may overestimate resistance rates for uropathogens causing uncomplicated UTIs. In cases where nitrofurantoin cannot be used, fluoroquinolones and possibly TMP-SMX may remain viable options for treatment of uncomplicated UTI and pyelonephritis in women. Ó 2015 Elsevier Inc., Keywords urinary tract infection; antibiotic resistance; antibiogram; community-acquired infection; pyelonephritis INTRODUCTION Uncomplicated urinary tract infection (UTI) is a common indication for antimicrobial therapy in women. The most recent guidelines issued by the Infectious Diseases Society of America (IDSA) for treatment of uncomplicated cystitis and pyelonephritis recommend that a suspected pathogen be <20% resistant to selected empiric treatment (<10% for fluoroquinolones for pyelonephritis), as use of an agent RECEIVED: 6 February 2015; FINAL SUBMISSION RECEIVED: 4 May 2015; ACCEPTED: 12 June

2 E. Coli Resistance Patterns 999 to which the uropathogen has in vitro resistance is associated with clinical failure (1 3). Recent international surveillance studies have demonstrated increasing resistance to fluoroquinolones and trimethoprimsulfamethoxazole (TMP-SMX) among communityacquired uropathogens (4). Therefore, nitrofurantoin is the recommended first-line therapy for uncomplicated cystitis in women. However, in cases where nitrofurantoin cannot be used for UTI (eg, allergy, creatinine clearance < 40 ml/min), or in cases of pyelonephritis, more information is needed to guide the clinician in prescribing effective empiric therapy (5). Urine cultures are not always performed for women presenting to the Emergency Department (ED) with a suspected uncomplicated UTI (6,7). Accordingly, susceptibility data reported in an institution s antibiogram might be skewed toward patients with many comorbidities and higher rates of antimicrobial resistance, and might not relate to the population of healthy women presenting to the ED for treatment of a community-acquired UTI and pyelonephritis (1,7). The same concept applies even for ED-specific antibiograms. In fact, the IDSA guidelines recommend considering local Escherichia coli resistance patterns to guide empiric antibiotic selection for an uncomplicated UTI (1). Although the bedside clinician may understand that the institutional antibiogram represents a population of more complicated patients, there currently are no data available demonstrating the true difference in susceptibility between an antibiogram and otherwise healthy patients who normally are not cultured. At our institution, an ED-specific antibiogram is published separately from the intensive care units (ICU) and other hospital areas. Given that the ED sees a spectrum of patients ranging from the otherwise healthy to the critically ill, it might be expected that the ED-specific antibiogram is less skewed toward the type of patients who harbor resistant pathogens than the overall institution or ICU antibiograms. According to our ED-specific antibiogram, the rates of E. coli resistance to TMP-SMX and fluoroquinolones are >20% for each (1). Although nitrofurantoin can be used in some cases, the need for alternative therapy is frequent, particularly for pyelonephritis. Our study aims to prospectively compare the resistance rate of E. coli isolated from urine of otherwise healthy women who present to the ED with symptomatic uncomplicated UTI or pyelonephritis to the E. coli resistance rate reported in our ED-specific antibiogram. MATERIALS AND METHODS Participants The study took place at a large, urban, academic medical center in Baltimore, Maryland. Institutional review board approval was obtained. Females > 18 years of age who presented to the ED with acute onset of urinary frequency, urgency, or dysuria with pyuria identified on urinalysis (white blood cell [WBC] count > 10/high power field [HPF]) and clinically suspected uncomplicated cystitis or pyelonephritis were asked if they would participate in the study; written consent was obtained from those who agreed. At our institution, patients # 18 years of age are treated in the pediatric ED. The following patients were excluded: those who had a known urologic abnormality or comorbidity, those with an indwelling Foley catheter or who had a catheter removed within the previous 14 days, anyone with a history of kidney stones, those with diabetes mellitus, those who did not speak English, those who had received TMP-SMX prophylaxis within the previous 6 months, anyone with the human immunodeficiency virus (HIV) with no CD4 count on file or a CD4 count < 350 cells/mm 3, those who had been transferred from another health care facility, and those who were pregnant (8). Pregnant women were excluded, as these patients are considered to have complicated infections according to the IDSA guidelines (1). Design The design is a prospective cohort study. E. coli resistance rates in urine cultures from a convenience sample of prospectively enrolled women with uncomplicated UTI were compared to retrospective data from an ED-specific antibiogram from 2 years prior to the study. Because the study period was restricted to staff hours, an attempt was made to identify patients consecutively. The study period was January to July Measurements Urine cultures were obtained on all urine specimens that demonstrated a WBC count > 10/HPF on urinalysis. At our institution, bacteria colony counts $ 10 3 colonyforming units (CFU)/mL are reported as a positive culture. Urine cultures containing three or more organisms of approximately the same quantity are reported as mixed microbial flora and were considered contaminated and excluded, in accordance with standard microbiology laboratory protocol. All urine specimens were collected by midstream clean-catch technique. Antimicrobial susceptibility testing for levofloxacin and TMP-SMX was performed using Vitek2 (Biomerieux, Durham, NC), and ciprofloxacin mean inhibitory concentration was determined via EtestÒ test (Biomerieux). Mean inhibitory concentration breakpoints for ciprofloxacin, levofloxacin, and TMP- SMX susceptibility were # 1 mg/ml, # 2 mg/ml, and # 38 mg/ml SMX, respectively, in accordance with guidelines from the Clinical Laboratory Standards

3 1000 M. C. Hines et al. Institute (9). Separate ciprofloxacin susceptibility testing was not performed for non-e. coli isolates. The 2012 adult ED antibiogram is based on cultures of all specimens collected in the ED from both outpatients and admitted patients during that calendar year. Specimen transport, processing, positive-culture CFU cutoff, and susceptibility testing in the ED antibiogram were the same for specimens in the prospective cohort. The 2012 iteration was the most recent antibiogram available at the time of the study. It contains documentation of 337 E. coli isolates. It indicates resistance rates for ciprofloxacin, levofloxacin, and TMP-SMX of 42% (142/337), 26% (88/337), and 33% (111/337), respectively. Notably, the ED-specific antibiogram and the institutional antibiogram are similar with respect to susceptibility patterns of E. coli isolates for these three antibiotics. Statistical Analysis Based on the IDSA recommendation to select an antimicrobial agent with local resistance # 20%, our sample size was intended to detect, with 90% power and 5% significance, a relative decrease of 50% in the 42% ciprofloxacin resistance rate (1). Based on these goals, we calculated a sample size of 45 E. coli isolates. E. coli resistance rates for the three antimicrobials were compared to those from the ED antibiogram using Fisher s exact test. We calculated confidence intervals for proportions and differences between proportions using exact methods or normal binomial approximation, as appropriate. Statistical calculations, including prevalence ratios, were performed using EpiCalc 2000 (Brixton Health, South London, UK). Study Population RESULTS A total of 149 women with clinically suspected uncomplicated cystitis or pyelonephritis were identified between January 1 and July 31, Figure 1 shows the study flow. Forty-five patients had a urine culture positive for E. coli, and 6 grew non-e.coli uropathogens. The remaining 30 patients had contaminated specimens, no growth, or grew nonpathogenic bacteria (Figure 1).Themedianagewas35years(range,19 83 years). Of the 45 patients who grew E. coli, 35(78%) were black, 9 (20%) were white, and 1 (2%) was of Asian descent. Pyelonephritis was suspected in 9 (20%) subjects, and 22 (49%) had one or more comorbid medical conditions. Figure 1. Inclusion and exclusion pathways for patients eligible for this study. HIV = human immunodeficiency virus; SMX- TMP = trimethoprim-sulfamethoxazole.

4 E. Coli Resistance Patterns 1001 Table 1. Comparison of the Prevalence of Resistant E. coli for Uncomplicated UTI vs. ED-specific Antibiogram Antibiotic Resistant Per Antibiogram Data (%) Resistant in Uncomplicated UTI (%) Absolute Difference [95% CI] p-value Ciprofloxacin 142/337 (42) 1/45 (2) 0.4 [ ] <0.001 Levofloxacin 88/337 (26) 1/45 (2) 0.24 [ ] <0.001 TMP/SMX 111/337 (33) 7/45 (16) 0.17 [ ] UTI = urinary tract infection; ED = emergency department; CI = confidence interval; TMP/SMX = trimethoprim-sulfamethoxazole. Uropathogen Susceptibility We obtained susceptibility data from 45 E. coli isolates. Resistance to ciprofloxacin and levofloxacin was seen in one case, yielding a prevalence estimate of 0.02 (95% confidence interval [CI] ); resistance to TMP-SMX was seen in seven cases, for a prevalence estimate of 0.16 (95% CI ). Compared with the ED-specific antibiogram, significantly lower rates of resistance to ciprofloxacin (2% vs. 42%, p < 0.001), levofloxacin (2% vs. 26%, p < 0.001), and TMP-SMX (16% vs. 33%, p = 0.016) were observed (Table 1). The bacteria other than E. coli that were isolated included Proteus mirabilis (4/6), Citrobacter koseri (1/6), and Klebsiella pneumoniae (1/6); three other cultures showed isolates not generally considered pathogenic. The six uropathogens were 100% susceptible to both levofloxacin and TMP-SMX. Ciprofloxacin susceptibilities were not performed on these organisms. DISCUSSION In this prospective observational study in an urban area with high antimicrobial resistance, urinary E. coli isolated from women presenting to the ED with symptomatic uncomplicated cystitis and pyelonephritis exhibited significantly lower resistance rates to ciprofloxacin, levofloxacin, and TMP-SMX compared with those published in the ED-specific institutional antibiogram. Treatment guidelines recommend consideration of local resistance rates when choosing empiric therapy for uncomplicated UTIs. Nine patients (20%) had clinically suspected or radiographically confirmed pyelonephritis, yet still demonstrated low resistance to TMP-SMX and fluoroquinolones. The results of this study have two important clinical implications. First, even ED-specific antibiograms might greatly overestimate resistance rates for uropathogens causing uncomplicated UTIs, namely, E. coli. Despite the fact that the ED-specific antibiogram includes more otherwise healthy patients than a hospital antibiogram, we still found that it did not accurately reflect the uropathogens cultured from our cohort, comprised entirely of otherwise healthy women. Second, in cases where nitrofurantoin cannot be used, fluoroquinolones and possibly TMP-SMX may remain viable options for treatment of uncomplicated UTI and pyelonephritis in selected women. A study by Moffett et al. compared susceptibility data of E. coli obtained from urinary isolates of ambulatory women presenting to three different EDs with a suspected UTI with institution-specific antibiograms (6). No significant difference in susceptibility rates of E. coli urinary isolates to fluoroquinolones or TMP-SMX and antibiogram data was observed. Our study cohort is narrower the Moffett et al. study included Spanish-speaking patients, those with diabetes, those with HIV, and one pregnant patient. Nitrofurantoin is the first-line preferred treatment for uncomplicated cystitis in women (1).However,nitrofurantoin requires a longer treatment course than fluoroquinolones or TMP-SMX, and cannot be used in patients with significant renal impairment or in the setting of suspected pyelonephritis. Fosfomycin, another treatment option with low E. coli resistance rates, is more expensive than fluoroquinolones and TMP-SMX, and is not universally available in the outpatient setting. Beta-lactam agents are appropriate choices when other recommended agents cannot be used, though they are less well studied and require longer courses of therapy. Particularly for pyelonephritis, the IDSA guidelines state that, compared with TMP-SMX, oral beta-lactams have inferior efficacy and higher relapse rates (1). Therefore, despite high in vitro E. coli susceptibility at many institutions, beta-lactams still should be used with caution for pyelonephritis. Studies on oral cephalosporins similarly demonstrate worse clinical cure rates when compared to fluoroquinolones (10). Because the IDSA guidelines recommend that empiric therapy be based on E. coli resistance patterns, we chose to compare the resistance rates of E. coli isolates only to our institutional antibiogram. However, 12% of the uropathogens isolated in the cultures used for this study were not E. coli. The resistance rates of those pathogens could affect empiric therapy decisions. We observed that all of the non-e. coli uropathogens detected through culture were susceptible to levofloxacin and TMP-SMX. The exclusion criteria were designed to enable us to focus on a generalizable population of otherwise healthy women with uncomplicated UTI and pyelonephritis. To increase the clinical utility of our study, we did not exclude patients for whom antibiotics were recently prescribed (other than those on long-term TMP-SMX for an

5 1002 M. C. Hines et al. immunosuppressed condition), because this information might not be available to the emergency care provider. Additionally, we did not exclude patients based on recent hospitalization, unless a Foley catheter had been removed within the preceding 14 days. We did, however, exclude patients with diabetes, because some clinicians treat UTI in diabetic patients as a complicated infection (1). Limitations Several limitations of this study should be noted. Although consecutive patients were enrolled when study staff was available, a convenience sample was used. We do not anticipate that patients presenting to the ED at times when the study staff was unavailable would be different than those enrolled. Because this was a singleinstitution study, the marked difference in susceptibility patterns between our antibiogram and the study patients may have limited generalizability to all institutions. Antimicrobial resistance varies by region, and medical centers differ in antibiotic prescribing trends, formularies, and stewardship. Excluding non-english-speaking patients could be a potential problem in some regions, because there is some evidence that Hispanic women have higher resistance rates (6). Pregnant women were excluded, as these patients are considered to have complicated infections according to the IDSA guidelines (1). The EDspecific antibiogram does not differentiate the anatomical origin of cultures; therefore, our prospective cohort consisting solely of urinary isolates was compared to a sample that likely contained a minority of specimens obtained from nonurine sources. Finally, resistance data reflected by the antibiogram lag by 2 years, although this is a clinical reality of antibiogram use, and a large shift in resistance is not expected to occur during this timeframe. CONCLUSIONS Institutional, and even ED-specific, antibiograms appear to be skewed toward patients with many comorbidities and higher rates of antimicrobial resistance, and may greatly overestimate the resistance of urinary pathogens in otherwise healthy women presenting to the ED. Based on our results, we suggest reporting separately the E. coli susceptibilities in patients with uncomplicated UTI to prevent the unnecessary use of broad-spectrum antibiotics. In cases of pyelonephritis, fluoroquinolones can still be considered first-line agents according to the IDSA guidelines. At our institution, fluoroquinolone resistance did not cross the 10% threshold outlined by the IDSA guidelines for which an alternative treatment would be needed. Based on the results of this study, fluoroquinolones, and possibly TMP-SMX, can still be considered for treatment of uncomplicated UTI in women when nitrofurantoin cannot be used at our institution. Further comparative investigations of institutional antibiograms to otherwise healthy patients presenting to EDs could have critical implications for antimicrobial stewardship by reserving broad-spectrum antibiotics for specific patients and thus diminishing the threat of drug-resistant microorganisms. Our study suggests that even ED-specific antibiograms can greatly overestimate resistance rates for uropathogens causing uncomplicated UTIs, namely E. coli. Acknowledgment This study was sponsored by a resident research grant from the Maryland Emergency Medicine Network. We thank the microbiology laboratory staff at the University of Maryland Medical Center for performing specimen workup and microbiological analysis. We thank Linda J. Kesselring, MS, ELS, for copyediting the manuscript. REFERENCES 1. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;52:e Gupta K, Hooton TM, Roberts PL, Stamm WE. Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women. Arch Intern Med 2007;167: Raz R, Chazan B, Kennes Y, et al. Empiric use of trimethoprimsulfamethoxazole (TMP-SMX) in the treatment of women with uncomplicated urinary tract infections, in a geographical area with a high prevalence of TMP-SMX-resistant uropathogens. Clin Infect Dis 2002;34: Kahlmeter G, Poulsen HO. Antimicrobial susceptibility of Escherichia coli from community-acquired urinary tract infections in Europe: the ECO-SENS study revisited. Int J Antimicrob Agents 2012; 39: Oplinger M, Andrews CO. Nitrofurantoin contraindication in patients with a creatinine clearance below 60 ml/min: looking for the evidence. Ann Pharmacother 2013;47: Moffett SE, Frazee BW, Stein JC, et al. Antimicrobial resistance in uncomplicated urinary tract infections in 3 California EDs. Am J Emerg Med 2012;30: Talan DA, Krishnadasan A, Abrahamian FM, et al. Prevalence and risk factor analysis of trimethoprim-sulfamethoxazole- and fluoroquinolone-resistant Escherichia coli infection among emergency department patients with pyelonephritis. Clin Infect Dis 2008;47: Padmavathy K, Padma K, Rajasekaran S. Extended-spectrum b-lactamase/ampc-producing uropathogenic Escherichia coli from HIV patients: do they have a low virulence score? J Med Microbiol 2013; 62: Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; twenty-third informational supplement. CLSI Document M100 S24. Wayne, PA: Clinical and Laboratory Standards Institute; Cronberg S, Banke S, Bergman B, et al. Fewer bacterial relapses after oral treatment with norfloxacin than with ceftibuten in acute pyelonephritis initially treated with intravenous cefuroxime. Scand J Infect Dis 2001;33:

6 E. Coli Resistance Patterns 1003 ARTICLE SUMMARY 1. Why is this topic important? Susceptibility data reported in institutional, and even emergency department (ED)-specific antibiograms, might be skewed toward patients with many comorbidities and higher rates of antimicrobial resistance, and thus may not relate to the population of healthy women presenting to the ED for treatment of community-acquired urinary tract infection (UTI) and pyelonephritis. Whereas nitrofurantoin may be an option for some patients, fluoroquinolones and trimethoprim-sulfamethoxazole (TMP-SMX) demonstrate superior clinical cure rates to other options, particularly in pyelonephritis. 2. What does this study attempt to show? This study aims to prospectively compare the resistance rate of Escherichia coli isolated from urine of otherwise healthy women who present to the ED with symptomatic uncomplicated UTI or pyelonephritis to the E. coli resistance rate reported in our ED-specific antibiogram. Fluoroquinolones and TMP-SMX might still be viable treatment options despite high resistance rates in institutional and ED-specific antibiograms. 3. What are the key findings? Compared with the ED antibiogram, significantly lower rates of resistance to ciprofloxacin (2% vs. 42%, p < 0.001), levofloxacin (2% vs. 26%, p < 0.001), and TMP- SMX (16% vs. 33%, p = 0.016) were observed. Even in the patients who grew non-e. coli uropathogens, all were susceptible to both levofloxacin and TMP-SMX. 4. How is patient care impacted? ED antibiograms may overestimate resistance rates for uropathogens causing uncomplicated UTIs. In cases where nitrofurantoin cannot be used, fluoroquinolones, and possibly TMP-SMX, remain viable options for treatment of uncomplicated UTI and pyelonephritis in women.

Guidelines for Treatment of Urinary Tract Infections

Guidelines for Treatment of Urinary Tract Infections Guidelines for Treatment of Urinary Tract Infections Overview This document details the Michigan Hospital Medicine Safety (HMS) Consortium preferred antibiotic choices for treatment of uncomplicated and

More information

1. The preferred treatment option for an initial UTI episode in a 22-year-old female patient

1. The preferred treatment option for an initial UTI episode in a 22-year-old female patient 1 Chapter 79, Self-Assessment Questions 1. The preferred treatment option for an initial UTI episode in a 22-year-old female patient with normal renal function is: A. Trimethoprim-sulfamethoxazole B. Cefuroxime

More information

Antibiotic Susceptibility Patterns of Community-Acquired Urinary Tract Infection Isolates from Female Patients on the US (Texas)- Mexico Border

Antibiotic Susceptibility Patterns of Community-Acquired Urinary Tract Infection Isolates from Female Patients on the US (Texas)- Mexico Border Antibiotic Susceptibility Patterns of Community-Acquired Urinary Tract Infection Isolates from Female Patients on the US (Texas)- Mexico Border Yvonne Vasquez, MPH W. Lee Hand, MD Department of Research

More information

A retrospective analysis of urine culture results issued by the microbiology department, Teaching Hospital, Karapitiya

A retrospective analysis of urine culture results issued by the microbiology department, Teaching Hospital, Karapitiya A retrospective analysis of urine culture results issued by the microbiology department, Teaching Hospital, Karapitiya LU Edirisinghe 1, D Vidanagama 2 1 Senior Registrar in Medicine, 2 Consultant Microbiologist,

More information

Urinary Tract Infection Workshop

Urinary Tract Infection Workshop Urinary Tract Infection Workshop Diagnosis, sampling, antibiotic selection, recurrence, prophylaxis Nick Francis, Robin Howe, Harry Ahmed Outline Diagnosis and sampling Nick 10 min Choice of antibiotic

More information

UTI Dr S Mathijs Department of Pharmacology

UTI Dr S Mathijs Department of Pharmacology UTI Dr S Mathijs Department of Pharmacology Introduction Responsible for > 7 million consultations annually 15% of all antibiotic prescriptions 40% of all hospital acquired infections Significant burden

More information

Regional community-acquired urinary tract infections in Israel: diagnosis, pathogens, and antibiotic guidelines adherence: A prospective study

Regional community-acquired urinary tract infections in Israel: diagnosis, pathogens, and antibiotic guidelines adherence: A prospective study International Journal of Infectious Diseases (2007) 11, 245 250 http://intl.elsevierhealth.com/journals/ijid Regional community-acquired urinary tract infections in Israel: diagnosis, pathogens, and antibiotic

More information

Antimicrobial Stewardship Strategy: Antibiograms

Antimicrobial Stewardship Strategy: Antibiograms Antimicrobial Stewardship Strategy: Antibiograms A summary of the cumulative susceptibility of bacterial isolates to formulary antibiotics in a given institution or region. Its main functions are to guide

More information

THE SENSITIVITY OF PATHOGENS OF COMMUNITY-ACQUIRED URINARY TRACT INFECTIONS IN KARAGANDA Ye. A. Zakharova 1, Chesca Antonella 2, I. S.

THE SENSITIVITY OF PATHOGENS OF COMMUNITY-ACQUIRED URINARY TRACT INFECTIONS IN KARAGANDA Ye. A. Zakharova 1, Chesca Antonella 2, I. S. THE SENSITIVITY OF PATHOGENS OF COMMUNITY-ACQUIRED URINARY TRACT INFECTIONS IN KARAGANDA Ye. A. Zakharova 1, Chesca Antonella 2, I. S. Azizov 1 1 THE SHARED LABORATORY OF SCIENCE RESERCH CENTER, KARAGANDA

More information

Title: Antibacterial resistances in uncomplicated urinary tract infections in women: ECO * SENS II data from primary health care in Austria

Title: Antibacterial resistances in uncomplicated urinary tract infections in women: ECO * SENS II data from primary health care in Austria Author's response to reviews Title: Antibacterial resistances in uncomplicated urinary tract infections in women: ECO * SENS II data from primary health care in Austria Authors: Gustav Kamenski (kamenski@aon.at)

More information

Inappropriate Use of Antibiotics and Clostridium difficile Infection. Jocelyn Srigley, MD, FRCPC November 1, 2012

Inappropriate Use of Antibiotics and Clostridium difficile Infection. Jocelyn Srigley, MD, FRCPC November 1, 2012 Inappropriate Use of Antibiotics and Clostridium difficile Infection Jocelyn Srigley, MD, FRCPC November 1, 2012 Financial Disclosures } No conflicts of interest } The study was supported by a Hamilton

More information

Community Antibiotic Stewardship Hot Topic: Urinary Tract Infections in Post-Acute Patients and Long-Term Care Residents

Community Antibiotic Stewardship Hot Topic: Urinary Tract Infections in Post-Acute Patients and Long-Term Care Residents Community Antibiotic Stewardship Hot Topic: Urinary Tract Infections in Post-Acute Patients and Long-Term Care Residents Great Plains QIN Support 2 How to Get Involved 3 We Have Gone Social Like Us and

More information

ABSTRACT ORIGINAL RESEARCH. Gunnar Kahlmeter. Jenny Åhman. Erika Matuschek

ABSTRACT ORIGINAL RESEARCH. Gunnar Kahlmeter. Jenny Åhman. Erika Matuschek Infect Dis Ther (2015) 4:417 423 DOI 10.1007/s40121-015-0095-5 ORIGINAL RESEARCH Antimicrobial Resistance of Escherichia coli Causing Uncomplicated Urinary Tract Infections: A European Update for 2014

More information

Impact of an Antimicrobial Stewardship Intervention on Urinary Tract Infection Treatment in the Emergency Department

Impact of an Antimicrobial Stewardship Intervention on Urinary Tract Infection Treatment in the Emergency Department Southern Illinois University Edwardsville SPARK SIUE Faculty Research, Scholarship, and Creative Activity 9-2015 Impact of an Antimicrobial Stewardship Intervention on Urinary Tract Infection Treatment

More information

Best Practice Guidelines for Treatment of Uncomplicated UTIs in Women While Decreasing Risk of Antibiotic Resistance

Best Practice Guidelines for Treatment of Uncomplicated UTIs in Women While Decreasing Risk of Antibiotic Resistance The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based

More information

Host, Syndrome, Bug, Drug: Introducing 2 Frameworks to Approach Infectious Diseases Cases with an Antimicrobial Stewardship Focus

Host, Syndrome, Bug, Drug: Introducing 2 Frameworks to Approach Infectious Diseases Cases with an Antimicrobial Stewardship Focus Host, Syndrome, Bug, Drug: Introducing 2 Frameworks to Approach Infectious Diseases Cases with an Antimicrobial Stewardship Focus Montana ACP Meeting 2018 September 8, 2018 Staci Lee, MD, MEHP Billings

More information

URINARY TRACT INFECTION TREATMENT IN COMMUNITY PRACTICE. Clinical Assistant Professor School of Pharmacy LIU

URINARY TRACT INFECTION TREATMENT IN COMMUNITY PRACTICE. Clinical Assistant Professor School of Pharmacy LIU URINARY TRACT INFECTION TREATMENT IN COMMUNITY PRACTICE Jihan Sf Safwan, Pharm.D. Clinical Assistant Professor School of Pharmacy LIU LEARNING OBJECTIVES Identify patients with uncomplicated cystitis (UC)

More information

JMSCR Vol 05 Issue 07 Page July 2017

JMSCR Vol 05 Issue 07 Page July 2017 www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i7.202 Original Research Article Profile of

More information

Antibiotic Updates: Part II

Antibiotic Updates: Part II Antibiotic Updates: Part II Fredrick M. Abrahamian, DO, FACEP, FIDSA Health Sciences Clinical Professor of Emergency Medicine David Geffen School of Medicine at UCLA Los Angeles, California Financial Disclosures

More information

Original Article INTRODUCTION

Original Article INTRODUCTION Original Article ISSN 2465-8243(Print) / ISSN: 2465-8510(Online) https://doi.org/10.14777/uti.2017.12.1.28 Urogenit Tract Infect 2017;12(1):28-34 http://crossmark.crossref.org/dialog/?doi=10.14777/uti.2017.12.1.28&domain=pdf&date_stamp=2017-04-25

More information

Update on Fluoroquinolones. Charles Krasner, M.D. June 16, 2016 Antibiotic Stewardship Program -ECHO

Update on Fluoroquinolones. Charles Krasner, M.D. June 16, 2016 Antibiotic Stewardship Program -ECHO Update on Fluoroquinolones Charles Krasner, M.D. June 16, 2016 Antibiotic Stewardship Program -ECHO Potential fluoroquinolone side-effects Increased risk, greater than with most other antibiotics, for

More information

ESBL Positive E. coli and K. pneumoneae are Emerging as Major Pathogens for Urinary Tract Infection

ESBL Positive E. coli and K. pneumoneae are Emerging as Major Pathogens for Urinary Tract Infection ESBL Positive E. coli and K. pneumoneae are Emerging as Major Pathogens for Urinary Tract Infection Muhammad Abdur Rahim*, Palash Mitra*. Tabassum Samad*. Tufayel Ahmed Chowdhury*. Mehruba Alam Ananna*.

More information

Barriers to Intravenous Penicillin Use for Treatment of Nonmeningitis

Barriers to Intravenous Penicillin Use for Treatment of Nonmeningitis JCM Accepts, published online ahead of print on 7 July 2010 J. Clin. Microbiol. doi:10.1128/jcm.01012-10 Copyright 2010, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights

More information

Appropriate Management of Common Pediatric Infections. Blaise L. Congeni M.D. Akron Children s Hospital Division of Pediatric Infectious Diseases

Appropriate Management of Common Pediatric Infections. Blaise L. Congeni M.D. Akron Children s Hospital Division of Pediatric Infectious Diseases Appropriate Management of Common Pediatric Infections Blaise L. Congeni M.D. Akron Children s Hospital Division of Pediatric Infectious Diseases It s all about the microorganism The common pathogens Viruses

More information

Understanding the Hospital Antibiogram

Understanding the Hospital Antibiogram Understanding the Hospital Antibiogram Sharon Erdman, PharmD Clinical Professor Purdue University College of Pharmacy Infectious Diseases Clinical Pharmacist Eskenazi Health 5 Understanding the Hospital

More information

Guidelines on prescribing antibiotics. For physicians and others in Denmark

Guidelines on prescribing antibiotics. For physicians and others in Denmark Guidelines on prescribing antibiotics 2013 For physicians and others in Denmark Guidelines on prescribing antibiotics For physicians and others in Denmark 2013 by the Danish Health and Medicines Authority.

More information

Resistance of uropathogens in symptomatic urinary tract infections in León, Nicaragua

Resistance of uropathogens in symptomatic urinary tract infections in León, Nicaragua Chapter 2 Resistance of uropathogens in symptomatic urinary tract infections in León, Nicaragua A.J. Matute a, E. Hak b, C.A.M. Schurink c, A. McArthur d, E. Alonso e, M. Paniagua e, E. van Asbeck c, A.M.

More information

Concise Antibiogram Toolkit Background

Concise Antibiogram Toolkit Background Background This toolkit is designed to guide nursing homes in creating their own antibiograms, an important tool for guiding empiric antimicrobial therapy. Information about antibiograms and instructions

More information

Protocol for Surveillance of Antimicrobial Resistance in Urinary Isolates in Scotland

Protocol for Surveillance of Antimicrobial Resistance in Urinary Isolates in Scotland Protocol for Surveillance of Antimicrobial Resistance in Urinary Isolates in Scotland Version 1.0 23 December 2011 General enquiries and contact details This is the first version (1.0) of the Protocol

More information

International Journal of Infectious Diseases

International Journal of Infectious Diseases International Journal of Infectious Diseases 14 (2010) e770 e774 Contents lists available at ScienceDirect International Journal of Infectious Diseases journal homepage: www.elsevier.com/locate/ijid Increasing

More information

Antimicrobial Stewardship in Continuing Care. Urinary Tract Infections Clinical Checklist

Antimicrobial Stewardship in Continuing Care. Urinary Tract Infections Clinical Checklist Antimicrobial Stewardship in Continuing Care Urinary Tract Infections Clinical Checklist December 2014 What is Antimicrobial Stewardship? Using the: right antimicrobial agent for a given diagnosis at the

More information

Risk factors for extended-spectrum b-lactamase positivity in uropathogenic Escherichia coli isolated from community-acquired urinary tract infections

Risk factors for extended-spectrum b-lactamase positivity in uropathogenic Escherichia coli isolated from community-acquired urinary tract infections ORIGINAL ARTICLE 10.1111/j.1469-0691.2009.02941.x Risk factors for extended-spectrum b-lactamase positivity in uropathogenic Escherichia coli isolated from community-acquired urinary tract infections Ö.

More information

Single-Dose and Three-Day Regimens of Ofloxacin versus Trimethoprim-Sulfamethoxazole for Acute Cystitis in Women

Single-Dose and Three-Day Regimens of Ofloxacin versus Trimethoprim-Sulfamethoxazole for Acute Cystitis in Women ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, JUlY 1991, P. 1479-1483 0066-4804/91/071479-05$02.00/0 Copyright 1991, American Society for Microbiology Vol. 35, No. 7 Single-Dose and Three-Day Regimens of Ofloxacin

More information

GENERAL NOTES: 2016 site of infection type of organism location of the patient

GENERAL NOTES: 2016 site of infection type of organism location of the patient GENERAL NOTES: This is a summary of the antibiotic sensitivity profile of clinical isolates recovered at AIIMS Bhopal Hospital during the year 2016. However, for organisms in which < 30 isolates were recovered

More information

11/10/2016. Skin and Soft Tissue Infections. Disclosures. Educational Need/Practice Gap. Objectives. Case #1

11/10/2016. Skin and Soft Tissue Infections. Disclosures. Educational Need/Practice Gap. Objectives. Case #1 Disclosures Selecting Antimicrobials for Common Infections in Children FMR-Contemporary Pediatrics 11/2016 Sean McTigue, MD Assistant Professor of Pediatrics, Pediatric Infectious Diseases Medical Director

More information

URINARY TRACT infections

URINARY TRACT infections National Patterns in the Treatment of Urinary Tract Infections in Women by Ambulatory Care Physicians Elbert S. Huang, MD, MPH; Randall S. Stafford, MD, PhD ORIGINAL INVESTIGATION Background: Trimethoprim-sulfamethoxazole

More information

Author's response to reviews

Author's response to reviews Author's response to reviews Title: The Influence of Chronic Renal Failure on the Spectrum and Antimicrobial Susceptibility of Uropathogens in Community-Acquired Acute Pyelonephritis Presenting as a Positive

More information

Surveillance for Antimicrobial Resistance and Preparation of an Enhanced Antibiogram at the Local Level. janet hindler

Surveillance for Antimicrobial Resistance and Preparation of an Enhanced Antibiogram at the Local Level. janet hindler Surveillance for Antimicrobial Resistance and Preparation of an Enhanced Antibiogram at the Local Level janet hindler At the conclusion of this talk, you will be able to Describe CLSI M39-A3 recommendations

More information

Cipro for gram positive cocci in urine

Cipro for gram positive cocci in urine Buscar... Cipro for gram positive cocci in urine 20-6-2017 Pneumonia can be generally defined as an infection of the lung parenchyma, in which consolidation of the affected part and a filling of the alveolar

More information

Extended-release ciprofloxacin (Cipro XR) for treatment of urinary tract infections

Extended-release ciprofloxacin (Cipro XR) for treatment of urinary tract infections International Journal of Antimicrobial Agents 23S1 (2004) S54 S66 Extended-release ciprofloxacin (Cipro XR) for treatment of urinary tract infections David A. Talan a,, Kurt G. Naber b, Juan Palou c, David

More information

IDSA GUIDELINES EXECUTIVE SUMMARY

IDSA GUIDELINES EXECUTIVE SUMMARY IDSA GUIDELINES International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and

More information

3/23/2017. Kathryn G. Smith, PharmD PGY1 Pharmacy Resident Via Christi Hospitals Wichita, Inc. Kathryn G. Smith: Nothing to disclose

3/23/2017. Kathryn G. Smith, PharmD PGY1 Pharmacy Resident Via Christi Hospitals Wichita, Inc. Kathryn G. Smith: Nothing to disclose Kathryn G. Smith, PharmD PGY1 Pharmacy Resident Via Christi Hospitals Wichita, Inc Kathryn G. Smith: Nothing to disclose Describe the new updates and rationale for them Relay safety concerns with use of

More information

1 Carle Foundation Hospital, Urbana, IL, USA. 2 University of Illinois College of Medicine, Urbana, IL, USA

1 Carle Foundation Hospital, Urbana, IL, USA. 2 University of Illinois College of Medicine, Urbana, IL, USA 588822CPJXXX10.1177/0009922815588822Clinical PediatricsAhmed et al research-article2015 Article First-Line Antimicrobial Resistance Patterns of Escherichia coli in Children With Urinary Tract Infection

More information

Adult and Pediatric Intra-Institutional Trends of Ciprofloxacin Susceptibility in E. coli Positive Urinary Cultures

Adult and Pediatric Intra-Institutional Trends of Ciprofloxacin Susceptibility in E. coli Positive Urinary Cultures Antibiotics 2014, 3, 163-173; doi:10.3390/antibiotics3020163 Article OPEN ACCESS antibiotics ISSN 2079-6382 www.mdpi.com/journal/antibiotics Adult and Pediatric Intra-Institutional Trends of Ciprofloxacin

More information

Stewardship: Challenges & Opportunities in the Gulf Region

Stewardship: Challenges & Opportunities in the Gulf Region Stewardship: Challenges & Opportunities in the Gulf Region Mushira Enani, MBBS, FRCPE, FACP,CIC Head- Infectious Disease Section King Fahad Medical City Outline Background of Healthcare system in GCC GCC

More information

Prevalence of Antimicrobial Resistance in Uropathogens among Patients Visiting Primary Health Centers: Implications for Empiric Therapy

Prevalence of Antimicrobial Resistance in Uropathogens among Patients Visiting Primary Health Centers: Implications for Empiric Therapy Prevalence of Antimicrobial Resistance in Uropathogens among Patients Visiting Primary Health Centers: Implications for Empiric Therapy Ebrahim Al Romaihi, MBBS, MRCP* Safaa Al Khawaja, MBBS, ABIM** Nermin

More information

Antibiotic stewardship in long term care

Antibiotic stewardship in long term care Antibiotic stewardship in long term care Shira Doron, MD Associate Professor of Medicine Division of Geographic Medicine and Infectious Diseases Tufts Medical Center Boston, MA Consultant to Massachusetts

More information

Acute Pyelonephritis POAC Guideline

Acute Pyelonephritis POAC Guideline Acute Pyelonephritis POAC Guideline Refer full regional pathway http://aucklandregion.healthpathways.org.nz/33444 EXCLUSION CRITERIA: COMPLICATED PYELONEPHRITIS Discuss with relevant specialist for advice

More information

A Study on Urinary Tract Infection Pathogen Profile and Their In Vitro Susceptibility to Antimicrobial Agents

A Study on Urinary Tract Infection Pathogen Profile and Their In Vitro Susceptibility to Antimicrobial Agents Original Article Print ISSN: 2321-6379 Online ISSN: 2321-595X DOI: 10.17354/ijss/2017/65 A Study on Urinary Tract Infection Pathogen Profile and Their In Vitro Susceptibility to Antimicrobial Agents M

More information

Childrens Hospital Antibiogram for 2012 (Based on data from 2011)

Childrens Hospital Antibiogram for 2012 (Based on data from 2011) Childrens Hospital Antibiogram for 2012 (Based on data from 2011) Prepared by: Department of Clinical Microbiology, Health Sciences Centre For further information contact: Andrew Walkty, MD, FRCPC Medical

More information

Antimicrobial resistance of Escherichia coli urinary isolates in the Veterans Affairs Healthcare. System

Antimicrobial resistance of Escherichia coli urinary isolates in the Veterans Affairs Healthcare. System AAC Accepted Manuscript Posted Online 13 February 2017 Antimicrob. Agents Chemother. doi:10.1128/aac.02236-16 Copyright 2017 American Society for Microbiology. All Rights Reserved. 1 2 Antimicrobial resistance

More information

Antibacterial Resistance: Research Efforts. Henry F. Chambers, MD Professor of Medicine University of California San Francisco

Antibacterial Resistance: Research Efforts. Henry F. Chambers, MD Professor of Medicine University of California San Francisco Antibacterial Resistance: Research Efforts Henry F. Chambers, MD Professor of Medicine University of California San Francisco Resistance Resistance Dose-Response Curve Antibiotic Exposure Anti-Resistance

More information

Key words: Urinary tract infection, Antibiotic resistance, E.coli.

Key words: Urinary tract infection, Antibiotic resistance, E.coli. Original article MICROBIOLOGICAL STUDY OF URINE ISOLATES IN OUT PATIENTS AND ITS RESISTANCE PATTERN AT A TERTIARY CARE HOSPITAL IN KANPUR. R.Sujatha 1,Deepak S 2, Nidhi P 3, Vaishali S 2, Dilshad K 2 1.

More information

Appropriate antimicrobial therapy in HAP: What does this mean?

Appropriate antimicrobial therapy in HAP: What does this mean? Appropriate antimicrobial therapy in HAP: What does this mean? Jaehee Lee, M.D. Kyungpook National University Hospital, Korea KNUH since 1907 Presentation outline Empiric antimicrobial choice: right spectrum,

More information

Antimicrobial Stewardship in the Hospital Setting

Antimicrobial Stewardship in the Hospital Setting GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER 12 Antimicrobial Stewardship in the Hospital Setting Authors Dan Markley, DO, MPH, Amy L. Pakyz, PharmD, PhD, Michael Stevens, MD, MPH Chapter Editor

More information

Crescent Journal of Medical and Biological Sciences Vol. 2, No. 2, Spring 2015, 48-52

Crescent Journal of Medical and Biological Sciences Vol. 2, No. 2, Spring 2015, 48-52 http://www.cjmb.org Open Access Original Article Crescent Journal of Medical and Biological Sciences Vol. 2, No. 2, Spring 2015, 48-52 eissn: 2148-9696 Study of the Resistance of Escherichia Coli Which

More information

PHARMA SCIENCE MONITOR

PHARMA SCIENCE MONITOR PHARMA SCIENCE MONITOR AN INTERNATIONAL JOURNAL OF PHARMACEUTICAL SCIENCES A STUDY ON PRESCRIPTION PATTERN OF ANTIBIOTICS FOR URINARY TRACT INFECTIONS IN SHIMOGA DISTRICT OF KARNATAKA Ramoji Alla *, I.

More information

Antimicrobial Susceptibility Patterns

Antimicrobial Susceptibility Patterns Antimicrobial Susceptibility Patterns KNH SURGERY Department Masika M.M. Department of Medical Microbiology, UoN Medicines & Therapeutics Committee, KNH Outline Methodology Overall KNH data Surgery department

More information

Citation for published version (APA): Spoorenberg, V. (2014). Improving antibiotic use for complicated urinary tract infections

Citation for published version (APA): Spoorenberg, V. (2014). Improving antibiotic use for complicated urinary tract infections UvA-DARE (Digital Academic Repository) Improving antibiotic use for complicated urinary tract infections Spoorenberg, V. Link to publication Citation for published version (APA): Spoorenberg, V. (2014).

More information

Antibiotics in the trenches: An ER Doc s Perspective

Antibiotics in the trenches: An ER Doc s Perspective Antibiotics in the trenches: An ER Doc s Perspective Peter Currie, MD Medical Director for Quality Emergency Physicians Professional Association (EPPA) Agenda Emergency Medicine Specific Disease Processes

More information

Cork and Kerry SARI Newsletter; Vol. 2 (2), December 2006

Cork and Kerry SARI Newsletter; Vol. 2 (2), December 2006 Cork and SARI Newsletter; Vol. 2 (2), December 6 Item Type Newsletter Authors Murray, Deirdre;O'Connor, Nuala;Condon, Rosalind Download date 31/1/18 15:27:31 Link to Item http://hdl.handle.net/1147/67296

More information

Infectious Disease 101: Helping the Consultant Pharmacist with Stewardship Principles

Infectious Disease 101: Helping the Consultant Pharmacist with Stewardship Principles Infectious Disease 101: Helping the Consultant Pharmacist with Stewardship Principles Conflicts of Interest None at this time May be discussing off-label indications KALIN M. CLIFFORD, PHARM.D., BCPS,

More information

Isolation of Urinary Tract Pathogens and Study of their Drug Susceptibility Patterns

Isolation of Urinary Tract Pathogens and Study of their Drug Susceptibility Patterns International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 5 Number 4 (2016) pp. 897-903 Journal homepage: http://www.ijcmas.com Original Research Article http://dx.doi.org/10.20546/ijcmas.2016.504.101

More information

Antimicrobial practice. Laboratory antibiotic susceptibility reporting and antibiotic prescribing in general practice

Antimicrobial practice. Laboratory antibiotic susceptibility reporting and antibiotic prescribing in general practice Journal of Antimicrobial Chemotherapy (2003) 51, 379 384 DOI: 10.1093/jac/dkg032 Advance Access publication 6 January 2003 Antimicrobial practice Laboratory antibiotic susceptibility reporting and antibiotic

More information

a. 379 laboratories provided quantitative results, e.g (DD method) to 35.4% (MIC method) of all participants; see Table 2.

a. 379 laboratories provided quantitative results, e.g (DD method) to 35.4% (MIC method) of all participants; see Table 2. AND QUANTITATIVE PRECISION (SAMPLE UR-01, 2017) Background and Plan of Analysis Sample UR-01 (2017) was sent to API participants as a simulated urine culture for recognition of a significant pathogen colony

More information

Acute pyelonephritis in emergency medicine ward: a four years retrospective review

Acute pyelonephritis in emergency medicine ward: a four years retrospective review Hong Kong Journal of Emergency Medicine Acute pyelonephritis in emergency medicine ward: a four years retrospective review TWT Chan, SK Lam, HT Fung Objective: To study the characteristics of patients

More information

Distinguishing between complicated and uncomplicated UTI is important because the duration of antimicrobial therapy is typically longer in complicated

Distinguishing between complicated and uncomplicated UTI is important because the duration of antimicrobial therapy is typically longer in complicated CONCISE REVIEW FOR CLINICIANS TREATMENT OF UNCOMPLICATED URINARY TRACT INFECTIONS Treatment of Uncomplicated Urinary Tract Infections in an Era of Increasing Antimicrobial Resistance LOREN G. MILLER, MD,

More information

Yeon Soon Jung, Ho Sik Shin * and Hark Rim. Abstract

Yeon Soon Jung, Ho Sik Shin * and Hark Rim. Abstract RESEARCH ARTICLE Open Access The influence of chronic renal failure on the spectrum and antimicrobial susceptibility of uropathogens in community-acquired acute pyelonephritis presenting as a positive

More information

Abstract. Introduction. Editor: M. Paul

Abstract. Introduction. Editor: M. Paul ORIGINAL ARTICLE INFECTIOUS DISEASES Effects of gentamicin monotherapy for the initial treatment of community-onset complicated non-obstructive acute pyelonephritis due to Enterobacteriaceae in elderly

More information

ANTIBIOTIC USE GUIDELINES FOR URINARY TRACT AND RESPIRATORY DISEASE

ANTIBIOTIC USE GUIDELINES FOR URINARY TRACT AND RESPIRATORY DISEASE ANTIBIOTIC USE GUIDELINES FOR URINARY TRACT AND RESPIRATORY DISEASE Jane Sykes, BVSc(Hons), PhD, DACVIM (SAIM) School of Veterinary Medicine Dept. of Medicine & Epidemiology University of California Davis,

More information

Prevention & Management of Infection post Trans Rectal Ultrasound (TRUS) biopsy

Prevention & Management of Infection post Trans Rectal Ultrasound (TRUS) biopsy Prevention & Management of Infection post Trans Rectal Ultrasound (TRUS) biopsy Dr. Fidelma Fitzpatrick Consultant Microbiologist, Co-chair, NCCP Prostate Bx Infection Project Board Fidelma.fitzpatrick@hse.ie

More information

Antibiotic Duration for Common Infections

Antibiotic Duration for Common Infections Antibiotic Duration for Common Infections Emily Spivak, MD, MHS Division of Infectious Diseases Medical Director, Antimicrobial Stewardship Program University of Utah Hospitals and Clinics Learning Objectives

More information

ANTIBIOTIC RESISTANCE OF FLUOROQUINOLONES AMONG THE GRAM NEGATIVE BACTERIAL UROPATHOGENS AT A TERITIARY CARE CENTRE. R.Sujatha 1, Nidhi Pal 2

ANTIBIOTIC RESISTANCE OF FLUOROQUINOLONES AMONG THE GRAM NEGATIVE BACTERIAL UROPATHOGENS AT A TERITIARY CARE CENTRE. R.Sujatha 1, Nidhi Pal 2 Original Article ANTIBIOTIC RESISTANCE OF FLUOROQUINOLONES AMONG THE GRAM NEGATIVE BACTERIAL UROPATHOGENS AT A TERITIARY CARE CENTRE R.Sujatha 1, Nidhi Pal 2 1. Professor & Head, Department of Microbiology,

More information

Acute Uncomplicated Cystitis in an Era of Increasing Antibiotic Resistance: A Proposed Approach to Empirical Therapy

Acute Uncomplicated Cystitis in an Era of Increasing Antibiotic Resistance: A Proposed Approach to Empirical Therapy VIEWPOINTS Acute Uncomplicated Cystitis in an Era of Increasing Antibiotic Resistance: A Proposed Approach to Empirical Therapy Thomas M. Hooton, 1 Richard Besser, 2 Betsy Foxman, 3 Thomas R. Fritsche,

More information

Please distribute a copy of this information to each provider in your organization.

Please distribute a copy of this information to each provider in your organization. HEALTH ADVISORY TO: Physicians and other Healthcare Providers Please distribute a copy of this information to each provider in your organization. Questions regarding this information may be directed to

More information

Community-Acquired Urinary Tract Infection. (Etiology and Bacterial Susceptibility)

Community-Acquired Urinary Tract Infection. (Etiology and Bacterial Susceptibility) ISSN 222-28 (Paper) ISSN 222-9X (Online) Community-Acquired Urinary Tract Infection (Etiology and Bacterial Susceptibility) Nawal S Faris Department of Allied medical sciences /Zarqa University) ABSTRACT

More information

Dr Eleri Davies. Consultant Microbiologist and Infection Control Doctor, Public Health Wales NHS Trust

Dr Eleri Davies. Consultant Microbiologist and Infection Control Doctor, Public Health Wales NHS Trust Dr Eleri Davies Consultant Microbiologist and Infection Control Doctor, Public Health Wales NHS Trust Antimicrobial stewardship What is it? Why is it important? Treatment and management of catheter-associated

More information

Healthcare Facilities and Healthcare Professionals. Public

Healthcare Facilities and Healthcare Professionals. Public Document Title: DOH Guidelines for Antimicrobial Stewardship Programs Document Ref. Number: DOH/ASP/GL/1.0 Version: 1.0 Approval Date: 13/12/2017 Effective Date: 14/12/2017 Document Owner: Applies to:

More information

Antibiotic Stewardship Program (ASP) CHRISTUS SETX

Antibiotic Stewardship Program (ASP) CHRISTUS SETX Antibiotic Stewardship Program (ASP) CHRISTUS SETX Program Goals I. Judicious use of antibiotics Decrease use of broad spectrum antibiotics and deescalate use based on clinical symptoms Therapeutic duplication:

More information

Cephalosporins, Quinolones and Co-amoxiclav Prescribing Audit

Cephalosporins, Quinolones and Co-amoxiclav Prescribing Audit Cephalosporins, Quinolones and Co-amoxiclav Prescribing Audit Executive Summary Background Antibiotic resistance poses a significant threat to public health, as antibiotics underpin routine medical practice.

More information

11/22/2016. Antimicrobial Stewardship Update Disclosures. Outline. No conflicts of interest to disclose

11/22/2016. Antimicrobial Stewardship Update Disclosures. Outline. No conflicts of interest to disclose Antimicrobial Stewardship Update 2016 APIC-CI Conference November 17 th, 2016 Jay R. McDonald, MD Chief, ID Section VA St. Louis Health Care System Assistant Professor of medicine Washington University

More information

Safe Patient Care Keeping our Residents Safe Use Standard Precautions for ALL Residents at ALL times

Safe Patient Care Keeping our Residents Safe Use Standard Precautions for ALL Residents at ALL times Safe Patient Care Keeping our Residents Safe 2016 Use Standard Precautions for ALL Residents at ALL times #safepatientcare Do bugs need drugs? Dr Deirdre O Brien Consultant Microbiologist Mercy University

More information

Examples of Antimicrobial Stewardship Interventions: a couple of starter projects

Examples of Antimicrobial Stewardship Interventions: a couple of starter projects Examples of Antimicrobial Stewardship Interventions: a couple of starter projects Jennifer Ott, PharmD, BCPS Clinical Pharmacist Specialist Infectious Diseases Billings Clinic jott4@billingsclinic.org

More information

Principles and Practice of Antimicrobial Susceptibility Testing. Microbiology Technical Workshop 25 th September 2013

Principles and Practice of Antimicrobial Susceptibility Testing. Microbiology Technical Workshop 25 th September 2013 Principles and Practice of Antimicrobial Susceptibility Testing Microbiology Technical Workshop 25 th September 2013 Scope History Why Perform Antimicrobial Susceptibility Testing? How to Perform an Antimicrobial

More information

Detection of ESBL Producing Gram Negative Uropathogens and their Antibiotic Resistance Pattern from a Tertiary Care Centre, Bengaluru, India

Detection of ESBL Producing Gram Negative Uropathogens and their Antibiotic Resistance Pattern from a Tertiary Care Centre, Bengaluru, India ISSN: 2319-7706 Volume 4 Number 12 (2015) pp. 578-583 http://www.ijcmas.com Original Research Article Detection of ESBL Producing Gram Negative Uropathogens and their Antibiotic Resistance Pattern from

More information

Int.J.Curr.Microbiol.App.Sci (2017) 6(3):

Int.J.Curr.Microbiol.App.Sci (2017) 6(3): International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 6 Number 3 (2017) pp. 891-895 Journal homepage: http://www.ijcmas.com Original Research Article https://doi.org/10.20546/ijcmas.2017.603.104

More information

Carbapenemase-producing Enterobacteriaceae (CRE) T H E L A T E S T I N T H E G R O W I N G L I S T O F S U P E R B U G S

Carbapenemase-producing Enterobacteriaceae (CRE) T H E L A T E S T I N T H E G R O W I N G L I S T O F S U P E R B U G S Carbapenemase-producing Enterobacteriaceae (CRE) T H E L A T E S T I N T H E G R O W I N G L I S T O F S U P E R B U G S CRE Enterobacteriaceae (Gram Negative Bacilli) Citrobacter species Escherichia coli***

More information

Urinary Tract Infection: Study of Microbiological Profile and its Antibiotic Susceptibility Pattern

Urinary Tract Infection: Study of Microbiological Profile and its Antibiotic Susceptibility Pattern International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 4 Number 9 (2015) pp. 592-597 http://www.ijcmas.com Original Research Article Urinary Tract Infection: Study of

More information

Antibiotic Stewardship in the Long Term Care Setting. Lisa Venditti, R.Ph., FASCP, Founder and CEO Long Term Solutions Inc LTSRX.

Antibiotic Stewardship in the Long Term Care Setting. Lisa Venditti, R.Ph., FASCP, Founder and CEO Long Term Solutions Inc LTSRX. Antibiotic Stewardship in the Long Term Care Setting Lisa Venditti, R.Ph., FASCP, Founder and CEO Long Term Solutions Inc. 845.208.3328 LTSRX.com 1 Resistant Bacteria Crisis The Centers for Medicare &

More information

Preventing and Responding to Antibiotic Resistant Infections in New Hampshire

Preventing and Responding to Antibiotic Resistant Infections in New Hampshire Preventing and Responding to Antibiotic Resistant Infections in New Hampshire Benjamin P. Chan, MD, MPH NH Dept. of Health & Human Services Division of Public Health Services May 23, 2017 To bring a greater

More information

levofloxacin (LVFX) LVFX LVFX LVFX Key words: Levofloxacin Escherichia coli LVFX levofloxacin (LVFX) Vol. 18 No

levofloxacin (LVFX) LVFX LVFX LVFX Key words: Levofloxacin Escherichia coli LVFX levofloxacin (LVFX) Vol. 18 No 2008 221 20 3 14 20 8 1 2001 1 2005 12 5 levofloxacin (LVFX) 5 811 125 27 LVFX (MIC: 4 mg/ml) LVFX LVFX Key words: Levofloxacin Escherichia coli 1) 2 5) 6) ( 203 0036) 2 1 2 TEL: 042 338 5111 2254 FAX:

More information

CARBAPENEM RESISTANT ENTEROBACTERIACEAE (KPC CRE)

CARBAPENEM RESISTANT ENTEROBACTERIACEAE (KPC CRE) CARBAPENEM RESISTANT ENTEROBACTERIACEAE (KPC CRE) Bartsch SM et al. Potential economic burden of carbapenem-resistent Enterobacteriaceae (CRE) in the United States. Clin Microbiol Infect 2017;23(1):48e9-e16.

More information

Scottish Medicines Consortium

Scottish Medicines Consortium Scottish Medicines Consortium tigecycline 50mg vial of powder for intravenous infusion (Tygacil ) (277/06) Wyeth 9 June 2006 The Scottish Medicines Consortium (SMC) has completed its assessment of the

More information

Antibiotic Stewardship at MetroWest Medical Center. Colleen Grocer, RPh, BCOP Co-Chair, Antibiotic Stewardship Committee

Antibiotic Stewardship at MetroWest Medical Center. Colleen Grocer, RPh, BCOP Co-Chair, Antibiotic Stewardship Committee Antibiotic Stewardship at MetroWest Medical Center Colleen Grocer, RPh, BCOP Co-Chair, Antibiotic Stewardship Committee Antibiotic Stewardship Committee Subcommittee of Pharmacy and Therapeutics. Also

More information

Objectives. Antibiotic Prophylaxis in Urologic Procedures: A Review of the CUA Guidelines & Local Epidemiology of Drug Resistance

Objectives. Antibiotic Prophylaxis in Urologic Procedures: A Review of the CUA Guidelines & Local Epidemiology of Drug Resistance Antibiotic Prophylaxis in Urologic Procedures: A Review of the CUA Guidelines & Local Epidemiology of Drug Resistance David Hogarth UBC Urology PGY-1 May 24, 2017 Objectives 1. To review the current CUA

More information

GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS Version 3.1 GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS Date ratified June 2008 Updated March 2009 Review date June 2010 Ratified by Authors Consultation Evidence base Changes

More information

ABSTRACT INTRODUCTION

ABSTRACT INTRODUCTION Infect Dis Ther (2015) 4:425 432 DOI 10.1007/s40121-015-0089-3 ORIGINAL RESEARCH In Vitro Activity of Oral Cephalosporins (Cefprozil and Cefixime) Against -Resistant Enterobacteriaceae from Community-Acquired

More information

Control emergence of drug-resistant. Reduce costs

Control emergence of drug-resistant. Reduce costs ...PRESENTATIONS... Guidelines for the Management of Community-Acquired Pneumonia Richard E. Chaisson, MD Presentation Summary Guidelines for the treatment of community-acquired pneumonia (CAP) have been

More information

Aerobic bacteriological profile of urinary tract infections in a tertiary care hospital

Aerobic bacteriological profile of urinary tract infections in a tertiary care hospital ISSN: 2319-7706 Volume 3 Number 3 (2014) pp. 120-125 http://www.ijcmas.com Original Research Article Aerobic bacteriological profile of urinary tract infections in a tertiary care hospital V.Vijaya Swetha

More information

1. List three activities pharmacists can implement to support. 2. Identify potential barriers to implementing antimicrobial

1. List three activities pharmacists can implement to support. 2. Identify potential barriers to implementing antimicrobial OPTIMIZING ANTIMICROBIAL STEWARDSHIP: IT STARTS IN THE EMERGENCY DEPARTMENT! 1 2 Objectives 1. List three activities pharmacists can implement to support health-system antimicrobial stewardship programs

More information