Antimicrobial susceptibility in urinary tract pathogens from acute and primary care in England (2015-2017)
PHE ePoster Library. Wilson K. Apr 10, 2019; 257499; 15390
Kate Wilson
Kate Wilson
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Abstract Urinary Tract Infections (UTIs) are one of the most common infections in both community and hospital settings and a risk factor for development of bloodstream infection. The National Institute for Health and Care Excellence (NICE) empirical treatment guidelines for UTIs include nitrofurantoin, trimethoprim, ciprofloxacin, fosfomycin and pivmecillinam. The aim of our study was to assess suitability of these recommendations for treating UTIs in acute and primary care in England.Descriptive analyses were performed on UTI specimen results submitted to PHE's Second Generation Surveillance System (SGSS) from England between 1st January 2015 and 31st December 2017. Only the first patient specimen within a 14 day period was included. UTI samples are not cultured routinely for uncomplicated UTI in adult women.Between 2015 and 2017, 128 genera of bacteria were identified from 6,096,670 urine isolates: 43% of urine isolates were reported from acute healthcare (2,612,091); 53% from GPs (3,252,752), with 4% from other community care settings (231,827). The most prevalent bacterial genera isolated in acute care were Escherichia (54% of isolates), Enterococcus (9%), Proteus (5%), Klebsiella (4%), Pseudomonas (4%) and Staphylococcus (3%). A similar distribution was recorded in GP specimens.In acute care isolates resistance was 37% for trimethoprim, 13% for nitrofurantoin, 16% for ciprofloxacin, 14% for (piv-)mecillinam and 12% for fosfomycin. Comparable GP isolate resistances were 34%, 10%, 11%, 10% and 9%, respectively.High levels of resistance to trimethoprim in both acute and community healthcare settings risk high rates of empirical treatment failure of UTIs with trimethoprim. Resistance to nitrofurantoin, ciprofloxacin, (piv-)mecillinam and fosfomycin generally remains lower, however, high levels of resistance to nitrofurantoin were observed in Klebsiella in both acute and community settings.Further characterisation of organisms and resistance by setting and patient demographics is required to help inform decision tools to aid empirical UTI treatment based on patient characteristics.
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