trimethoprim--sulfamethoxazole-drug-combination and Escherichia-coli-Infections

Haemolytic uraemic syndrome (HUS) is a common cause of acquired kidney failure in children and rarely in adults. The most important risk factor for development of HUS is a gastrointestinal infection by Shiga toxin-producing Escherichia coli (STEC). This review addressed the interventions aimed at secondary prevention of HUS in patients with diarrhoea who were infected with a bacteria that increase the risk of HUS.. Our objective was to evaluate evidence regarding secondary preventative strategies for HUS associated with STEC infections. In doing so, we sought to assess the effectiveness and safety of interventions as well as their potential to impact the morbidity and death associated with this condition.. We searched the Cochrane Kidney and Transplant Register of Studies up to 12 November 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov.. Studies were considered based on the methods, participants, and research goals. Only randomised controlled trials were considered eligible for inclusion. The participants of the studies were paediatric and adult patients with diarrhoeal illnesses due to STEC. The primary outcome of interest was incidence of HUS.. We used standard methodological procedures as recommended by Cochrane. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.. We identified four studies (536 participants) for inclusion that investigated four different interventions including antibiotics (trimethoprim-sulfamethoxazole), anti-Shiga toxin antibody-containing bovine colostrum, Shiga toxin binding agent (Synsorb Pk: a silicon dioxide-based agent), and a monoclonal antibody against Shiga toxin (urtoxazumab). The overall risk of bias was unclear for selection, performance and detection bias and low for attrition, reporting and other sources of bias. It was uncertain if trimethoprim-sulfamethoxazole reduced the incidence of HUS compared to no treatment (47 participants: RR 0.57, 95% CI 0.11-2.81, very low certainty evidence). Adverse events relative to this review, need for acute dialysis, neurological complication and death were not reported. There were no incidences of HUS in either the bovine colostrum group or the placebo group. It was uncertain if bovine colostrum caused more adverse events (27 participants: RR 0.92, 95% CI 0.42 to 2.03; very low certainty evidence). The need for acute dialysis, neurological complications or death were not reported. It is uncertain whether Synsorb Pk reduces the incidence of HUS compared to placebo (353 participants: RR 0.93, 95% CI 0.39 to 2.22; very low certainty evidence). Adverse events relevant to this review, need for acute dialysis, neurological complications or death were not reported. One study compared two doses of urtoxazumab (3.0 mg/kg and 1.0 mg/kg) to placebo. It is uncertain if either 3.0 mg/kg urtoxazumab (71 participants: RR 0.34, 95% CI 0.01 to 8.14) or 1.0 mg/kg urtoxazumab (74 participants: RR 0.95, 95% CI 0.79 to 1.13) reduced the incidence of HUS compared to placebo (very low certainty evidence). Low certainty evidence showed there may be little or no difference in the number of treatment-emergent adverse events with either 3.0 mg/kg urtoxazumab (71 participants: RR 1.00, 95% CI 0.84 to 1.18) or 1.0 mg/kg urtoxazumab (74 participants: RR 0.95, 95% CI 0.79 to 1.13) compared to placebo. There were 25 serious adverse events reported in 18 patients: 10 in the placebo group, and 9 and 6 serious adverse events in the 1.0 mg/kg and 3.0 mg/kg urtoxazumab groups, respectively. It is unclear how many patients experienced these adverse events in each group, and how many patients experienced more than one event. It is uncertain if either dose of urtoxazumab increased the risk of neurological complications or death (very low certainty evidence). Need for acute dialysis wa. The included studies assessed antibiotics, bovine milk, and Shiga toxin inhibitor (Synsorb Pk) and monoclonal antibodies (Urtoxazumab) against Shiga toxin for secondary prevention of HUS in patients with diarrhoea due to STEC. However, no firm conclusions about the efficacy of these interventions can be drawn given the small number of included studies and the small sample sizes of those included studies. Additional studies, including larger multicentre studies, are needed to assess the efficacy of interventions to prevent development of HUS in patients with diarrhoea due to STEC infection.

Topics: Adult; Animals; Antibodies, Monoclonal, Humanized; Bias; Cattle; Child; Colostrum; Diarrhea; Escherichia coli Infections; Hemolytic-Uremic Syndrome; Humans; Incidence; Organosilicon Compounds; Placebos; Randomized Controlled Trials as Topic; Secondary Prevention; Shiga-Toxigenic Escherichia coli; Trimethoprim, Sulfamethoxazole Drug Combination; Trisaccharides

Already used in various countries, trimethoprim (TMP) was withdrawn from the French market in 1990, but should be soon available again. This article reviews the experience of TMP use around the world and its current use in Europe. Label use and guidelines only recommend the use of TMP for the treatment of urinary tract infections (UTI). Compared with co-trimoxazole (Co-T), a combination of TMP and sulfamethoxazole (SMX), TMP has (a) a similar resistance rate among Escherichia coli strains (estimated between 10 and 20% in uncomplicated cystitis), (b) a similar clinical efficacy for cystitis prevention and treatment, (c) a lower toxicity (as severe toxicity adverse effects of Co-T come from its sulfonamide component), (d) limited data for the treatment of pyelonephritis and male UTIs, and (e) an important impact on the microbiota. TMP should thus be indicated in the third-line empirical treatment of acute uncomplicated cystitis (sparing fluoroquinolones and nitrofurantoin), in the prevention of recurrent acute cystitis when an antibiotic prophylaxis is required (possibly in first line), and in the treatment of documented acute cystitis at risk of complications. Updated data on the epidemiology of resistance to TMP per clinical pictures is now required. The bactericidal effect of TMP should also be confirmed on recent strains (although limited recent data suggests a bactericidia similar to that of Co-T) and its clinical efficacy should be evaluated in pyelonephritis and male UTI.

Topics: Anti-Bacterial Agents; Cystitis; Drug Resistance, Bacterial; Drug Utilization; Escherichia coli; Escherichia coli Infections; Fosfomycin; France; Humans; Practice Guidelines as Topic; Product Recalls and Withdrawals; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Hemolytic Uremic Syndrome (HUS) may follow infection with Shiga-toxin-producing organisms, principally E. coli O157: H7 (STEC), causing high morbidity and mortality. Our aim was to identify interventions to prevent diarrhea-associated HUS.. Systematic search of the literature for relevant systematic reviews (SRs), randomised controlled trials (RCTs) and public health guidelines.. Of 1097 animal and 762 human studies, 18 animal studies (2 SRs, 2 reviews, plus 14 RCTs) and 6 human studies (3 SRs, plus 3 RCTs) met inclusion criteria. E. coli O157: H7 Type III secreted protein vaccination decreased fecal E. coli O157 shedding in cattle (P = 0.002). E. coli O157: H7 siderophore receptor and porin proteins (SRP) vaccines reduced fecal shedding in cows (OR 0.42 (95% CI 0.25 to 0.73) and increased anti-E. coli 0157: H7 SRP antibodies in their calves (P < 0.001). Bacterin vaccines had no effect. Probiotic or sodium chlorate additives in feeds reduced fecal E. coli O157 load as did improved farm hygiene (P < 0.05). Solarization of soil reduced E. coli O157: H7 contamination in the soil (P < 0.05). In an RCT examining the role of antibiotic treatment of E. coli O157: H7 diarrhea, HUS rates were similar in children treated with Trimethoprim-sulfamethoxazole and controls (RR 0.57; 95% CI 0.11 to 2.81). In another RCT, HUS rates were similar in children receiving Synsorb-Pk and placebo (RR 0.93; 95% CI 0.39 to 2.22). In one SR, hand washing reduced diarrhea by 39% in institutions (IRR 0.61; 95% CI 0.40 to 0.92) and 32% in community settings (IRR 0.68; 95% CI 0.52 to 0.90) compared to controls. Guidelines contained recommendations to prevent STEC transmission from animals and environments to humans, including appropriate food preparation, personal hygiene, community education, and control of environmental contamination, food and water quality.. Animal carriage of STEC is decreased by vaccination and improved farm practices. Treatment of STEC diarrhea with antibiotics and toxin-binders did not prevent HUS. Public health interventions are the key to preventing STEC-associated diarrhea and HUS.

Topics: Animal Husbandry; Animals; Anti-Infective Agents; Cattle; Child; Diarrhea; Escherichia coli Infections; Escherichia coli O157; Hemolytic-Uremic Syndrome; Humans; Meat; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination; Vaccination

A review on the etiological profile of urinary tract infections in childhood and the sensitivity pattern of urinary pathogens in Spain is presented. Escherichia coli continues to be the main etiological agent of urinary tract infection in childhood. Consequently, its sensitivity pattern will usually determine the choice of empirical therapy. The predominance of E. coli is reduced in certain circumstances, in which the presence of other microorganisms is increased. However, the clinical information available at diagnosis does not allow accurate identification of the etiology; only staining and microscopic urine examination can help in treatment selection. In Spain, E. coli presents a high percentage of resistance to ampicillin and cotrimoxazole, whereas second- and third-generation cephalosporins, fosfomycin, aminoglycosides and amoxicillin-clavulanate maintain high sensitivity. In some areas, amoxicillin-clavulanate and first-generation cephalosporins show high levels of resistance, which can limit their empirical use.

Topics: Adult; Age Factors; Aminoglycosides; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Bacteria; Cephalosporins; Child; Child, Preschool; Clinical Trials as Topic; Consensus Development Conferences as Topic; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Evidence-Based Medicine; Fosfomycin; Hospitalization; Humans; Infant; Infant, Newborn; Microbial Sensitivity Tests; Risk Factors; Spain; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Symptomatic urinary tract infections (UTIs) constitute a major health problem throughout the Western world. In the USA, UTIs are responsible for 7-8 million outpatient visits each year and for over one-third of all hospital-acquired infections. Empiric antimicrobial therapy for UTIs, which are primarily caused by Escherichia coli, is increasingly being complicated by the emergence of resistance to the most widely used agents. Recent studies indicate that the prevalence of E. coli resistance to trimethoprim/sulphamethoxazole (TMP/SMX), the current first-line therapy for UTIs, exceeds 20% in many North American regions. Importantly, antibiotic resistance often translates into clinical failure. The use of antibiotics with favourable pharmacokinetic/pharmacodynamic profiles and convenient dosing schedules, which effectively increase bacterial eradication and patient compliance, can help to curb the current epidemic of resistance and reduce the rate of clinical failure associated with resistance. Fluoroquinolones have well-established efficacy in the treatment of multiple bacterial infections and, over the years, the rates of resistance to these antibiotics have remained very low. Fluoroquinolones are currently recommended for therapy of uncomplicated UTIs when the local incidence of TMP/SMX resistance is >or=10-20%, as well as for the treatment of complicated UTIs and acute pyelonephritis. Ciprofloxacin, one of the most widely used fluoroquinolones, has a potent bactericidal effect across the full spectrum of uropathogens, as well as a long and excellent efficacy and safety record in the management of UTI and other infections. A recently developed extended (modified)-release formulation of ciprofloxacin (Cipro XR or Cipro XL) provides higher maximum plasma concentrations with lower inter-patient variability than the conventional, immediate-release, twice-daily formulation. Additionally, therapeutic drug levels with extended-release ciprofloxacin are achieved rapidly and maintained over the course of 24 h, allowing once-daily dosing. Clinical trials in patients with cystitis and those with complicated UTIs or acute uncomplicated pyelonephritis indicate that extended-release ciprofloxacin is at least as effective as the immediate-release formulation. These studies have also confirmed good tolerability and safety of extended-release ciprofloxacin, similar to the immediate-release formulation. Therefore, extended-release ciprofloxacin is a convenient, well-tolera

Topics: Bacterial Infections; Ciprofloxacin; Delayed-Action Preparations; Escherichia coli Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Empirical antimicrobial treatment for acute cystitis in women requires continuing reassessment as the antimicrobial susceptibility of community isolates of Escherichia coli evolves. Current recommendations for 3 days trimethoprim or trimethoprim/sulphamethoxazole are compromised by increasing resistance of community E. coli to these agents. Fluoroquinolones are an alternate 3-day therapy, but increasing resistance is being reported from some countries, and widespread community use may promote resistance, limiting effectiveness of these agents for more serious infections. Alternate regimens supported by recent clinical trials suggest pivmecillinam given twice daily for 7 days is as effective as 3 days of quinolone therapy, while microbiological cure is 80% with 3 days therapy twice daily, and 90% with 3 days therapy thrice daily. Nitrofurantoin given for 7 days has a cure rate of 80-85%. Fosfomycin trometamol as a single dose has cure rates of 75-85%. All these agents are effective, but a compromise in efficacy or duration of therapy compared with current 3-day regimens may have to be considered.

Topics: Acute Disease; Anti-Bacterial Agents; Anti-Infective Agents; Clinical Trials as Topic; Cystitis; Drug Resistance, Bacterial; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications, Infectious; Trimethoprim, Sulfamethoxazole Drug Combination

Recurrent urinary tract infections (UTIs) are observed in 30-50% of children after the first UTI. Of these, approximately 90% occur within 3 months of the initial episode. The basic aim of antibiotic prophylaxis in children with malformative uropathy and/or recurrent UTIs, is to reduce the frequency of UTIs. The bacteria most frequently responsible for UTI are gram-negative organisms, with Escherichia coli accounting for 80% of urinary tract pathogens. In children with recurrent UTIs and in those treated with antibiotic prophylaxis there is a greater incidence of UTI due to Proteus spp., Klebsiella spp. and Enterobacter spp., whereas Pseudomonas spp., Serratia spp. and Candida spp. are more frequent in children with urogenital abnormalities and/or undergoing invasive instrumental investigations. Several factors are involved in the pathogenesis of UTI, the main ones being circumcision, periurethral flora, micturition disorders, bowel disorders, local factors and hygienic measures. Several factors facilitate UTI relapse: malformative uropathies, particularly of the obstructive type; vesico-ureteric reflux (VUR); previous repeated episodes of cystitis and/or pyelonephritis (3 or more episodes a year), even in the absence of urinary tract abnormalities; a frequently catheterized neurogenic bladder; kidney transplant. The precise mechanism of action of low-dose antibiotics is not yet fully known. The characteristics of the ideal prophylactic agent are presented in this review, as well as indications, dosages, side effects, clinical data of all molecules. While inappropriate use of antibiotic prophylaxis encourages the emergence of microbial resistance, its proper use may be of great value in clinical practice, by reducing the frequency and clinical expression of UTIs and, in some cases such as VUR, significantly helping to resolve the underlying pathology.

Topics: Anti-Infective Agents; Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Cephalosporins; Child; Escherichia coli Infections; Fluoroquinolones; Humans; Nitrofurantoin; Penicillins; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract; Urinary Tract Infections

Topics: Anti-Infective Agents; Bacterial Infections; Campylobacter Infections; Child; Dysentery, Bacillary; Enteritis; Escherichia coli Infections; Humans; Salmonella Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Escherichia coli Infections; Flavobacterium; Gram-Negative Bacterial Infections; Humans; Kidney Failure, Chronic; Male; Middle Aged; Pefloxacin; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

A pure seminal vesicle abscess is a rare condition. We report case 7 in the literature and to our knowledge the first patient who has been managed successfully by noninvasive, conservative antibiotic treatment alone. All previously reported cases of seminal vesicle abscesses have been managed with invasive therapy. In 5 cases the seminal vesicle abscess was incised and drained surgically, while in 1 the abscess was drained percutaneously. We describe a patient with a seminal vesicle abscess, review the literature and recommend a more conservative method of management.

Topics: Abscess; Anti-Infective Agents; Drug Combinations; Escherichia coli Infections; Genital Diseases, Male; Humans; Male; Middle Aged; Seminal Vesicles; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

This review paper is concerned with antibacterial therapy of mastitis caused by Escherichia coli. The choice of an antibacterial agent is discussed, and nine criteria are referred to, on which this choice should be based. In the second part possible forms of antibacterial treatment are discussed. Literature on parenteral and local treatment of mastitis due to E. coli is scarcely available. The evaluation of antibacterial drugs is mainly based on MIC values and pharmacokinetic studies in normal animals. Unfortunately, results of clinical trials are hardly available. Today combinations of trimethoprim/sulphonamide apparently are the best available choice for the parenteral treatment of mastitis caused by E. coli. Infusion of polymyxins or gentamycin is discussed as a method of intramammary therapy.

Topics: Animals; Anti-Bacterial Agents; Cattle; Chloramphenicol; Drug Resistance, Microbial; Escherichia coli Infections; Female; Gentamicins; Mastitis, Bovine; Microbial Sensitivity Tests; Polymyxin B; Trimethoprim, Sulfamethoxazole Drug Combination

Pyogenic sacroiliitis is rare and usually occurs in patients with an underlying illness. Typically, the responsible organisms are Staphylococcus aureus or Streptococcus pneumoniae. We describe a healthy 17-year-old boy with bacterial sacroiliitis caused by Escherichia coli. This case illustrates the importance of considering this diagnosis in febrile patients with no obvious source of infection.

Topics: Adolescent; Arthritis, Infectious; Cefazolin; Drug Combinations; Escherichia coli Infections; Gallium Radioisotopes; Humans; Male; Radionuclide Imaging; Sacroiliac Joint; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Amoxicillin; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cross Infection; Drug Combinations; Escherichia coli Infections; Female; Humans; Penicillin Resistance; Premedication; Proteus Infections; Pseudomonas Infections; Pyelonephritis; Sulfamethoxazole; Surgical Wound Infection; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Antidiarrheals; Chloramphenicol; Chlorpromazine; Cholera; Diarrhea; Drug Combinations; Enterotoxins; Escherichia coli; Escherichia coli Infections; Fluid Therapy; Furazolidone; Humans; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Water-Electrolyte Balance

Multidrug resistant (MDR)

Topics: Animals; Anti-Bacterial Agents; Cattle; Cephalosporins; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Male; Meropenem; Microbial Sensitivity Tests; Trimethoprim, Sulfamethoxazole Drug Combination

While trimethoprim-sulfamethoxazole (TMP-SMX) is recommended as one of the first-line empiric therapies for treatment of acute uncomplicated cystitis, institutions that observe resistance rates exceeding 20% for Escherichia coli (E. coli) should utilize alternative empiric antibiotic therapy per the Infectious Diseases Society of America (IDSA). Identifying risk factors associated with TMP-SMX resistance in E. coli may help guide empiric antibiotic prescribing for urinary tract infections (UTIs).. This multicenter, retrospective study included adult patients who were discharged from 12 emergency departments (EDs) with a urine culture positive for E. coli between January 1, 2019 and December 31, 2019. Logistic regression was used to assess the relationship between potential risk factors and TMP-SMX resistance. The overall institutional antimicrobial resistance rates for E. coli were compared to the rates seen in the study population of ED urinary isolates.. Among 427 patients included from a randomized sample of 500 with a urine culture positive for E. coli, 107 (25.1%) were resistant to TMP-SMX. Three predictors of TMP-SMX resistance were identified: recurrent UTI (OR 2.27 [95% CI 1.27-3.99]), genitourinary abnormalities (OR 2.31 [95% CI 1.17-4.49]), and TMP-SMX use within 90 days (OR 8.77 [95% CI 3.19-28.12]). When the antibiotic susceptibilities for this ED cohort were compared to the institutional antibiogram, the TMP-SMX resistance rate was found to be higher in the ED population (25.1% vs 20%).. TMP-SMX should likely be avoided as first-line therapy for UTI in patients who have recurrent UTIs, genitourinary abnormalities, or have previously received TMP-SMX within the past 90 days. The use of an ED-specific antibiogram should be considered for assessing local resistance rates in this population.

Topics: Adult; Anti-Bacterial Agents; Cystitis; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Bacterial resistance to antibiotics is an increasingly threatening consequence of antimicrobial exposure for many decades now. In urinary tract infections (UTIs), antibiotic prophylaxis (AP) increases bacterial resistance. We studied the resistance patterns of positive urinary cultures in spina bifida children on clean intermittent catheterization, both continuing and stopping AP.. In a cohort of 176 spina bifida patients, 88 continued and 88 stopped using AP. During 18 months, a fortnightly catheterized urine sample for bacterial pathogens was cultured. UTIs and significant bacteriuria (SBU) were defined as a positive culture with a single species of bacteria, respectively with and without clinical symptoms and leukocyturia. We compared the percentage of resistance to commonly used antibiotics in the isolated bacteria in both groups.. In a total of 4917 cultures, 713 (14.5%) had a positive monoculture, 54.3% of which were Escherichia coli. In the group stopping AP, the resistance percentage to antibiotics in UTI / SBU bacteria was lower than in the group remaining on AP, even when excluding the administered prophylaxis.. Stopping antibiotic prophylaxis for urinary tract infections is associated with reduced bacterial resistance to antibiotics in children with spina bifida.. ISRCTN ISRCTN56278131 . Registered 20 December 2005.

Topics: Adolescent; Aminoglycosides; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteriuria; Child; Deprescriptions; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Fluoroquinolones; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Male; Nitrofurantoin; Penicillins; Spinal Dysraphism; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Women suffering from recurrent urinary tract infections (rUTIs) are routinely treated for asymptomatic bacteriuria (AB), but the consequences of this procedure on antibiotic resistance are not fully known. The aim of this study was to evaluate the impact of AB treatment on antibiotic resistance among women with rUTIs.. The study population consisted of 2 groups of women who had previously been enrolled in a randomized clinical trial: group A was not treated, and group B was treated. All women were scheduled for follow-up visits every 6 months, or more frequently if symptoms arose. Microbiological evaluation was performed only in symptomatic women. All women were followed up for a mean of 38.8 months to analyze data from urine cultures and antibiograms.. The previous study population consisted of 673 women, but 123 did not attend the entire follow-up period. For the final analysis, 257 of the remaining 550 patients were assigned to group A, and 293 to group B. At the end of follow-up, the difference in recurrence rates was statistically significant (P < .001): 97 (37.7%) in group A versus 204 (69.6%) in group B. Isolated Escherichia coli from group B showed higher resistance to amoxicillin-clavulanic acid (P = .03), trimethoprim-sulfamethoxazole (P = .01), and ciprofloxacin (P = .03) than that from group A.. This study shows that AB treatment is associated with a higher occurrence of antibiotic-resistant bacteria, indicating that AB treatment in women with rUTIs is potentially dangerous.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Asymptomatic Infections; Bacteriuria; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Follow-Up Studies; Humans; Italy; Microbial Sensitivity Tests; Middle Aged; Prevalence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinalysis; Urinary Tract Infections

The increasing prevalence of uropathogens resistant to antimicrobial agents has stimulated interest in cranberries to prevent recurrent urinary tract infections (UTIs).. In a double-blind, double-dummy noninferiority trial, 221 premenopausal women with recurrent UTIs were randomized to 12-month prophylaxis use of trimethoprim-sulfamethoxazole (TMP-SMX), 480 mg once daily, or cranberry capsules, 500 mg twice daily. Primary end points were the mean number of symptomatic UTIs over 12 months, the proportion of patients with at least 1 symptomatic UTI, the median time to first UTI, and development of antibiotic resistance in indigenous Escherichia coli.. After 12 months, the mean number of patients with at least 1 symptomatic UTI was higher in the cranberry than in the TMP-SMX group (4.0 vs 1.8; P = .02), and the proportion of patients with at least 1 symptomatic UTI was higher in the cranberry than in the TMP-SMX group (78.2% vs 71.1%). Median time to the first symptomatic UTI was 4 months for the cranberry and 8 months for the TMP-SMX group. After 1 month, in the cranberry group, 23.7% of fecal and 28.1% of asymptomatic bacteriuria E coli isolates were TMP-SMX resistant, whereas in the TMP-SMX group, 86.3% of fecal and 90.5% of asymptomatic bacteriuria E coli isolates were TMP-SMX resistant. Similarly, we found increased resistance rates for trimethoprim, amoxicillin, and ciprofloxacin in these E coli isolates after 1 month in the TMP-SMX group. After discontinuation of TMP-SMX, resistance reached baseline levels after 3 months. Antibiotic resistance did not increase in the cranberry group. Cranberries and TMP-SMX were equally well tolerated.. In premenopausal women, TMP-SMX, 480 mg once daily, is more effective than cranberry capsules, 500 mg twice daily, to prevent recurrent UTIs, at the expense of emerging antibiotic resistance.. isrctn.org Identifier: ISRCTN50717094.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Capsules; Ciprofloxacin; Double-Blind Method; Drug Administration Schedule; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Middle Aged; Plant Preparations; Premenopause; Secondary Prevention; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vaccinium macrocarpon

Urinary tract infection (UTI), a major cause of morbidity in renal transplant recipients, has also been found to increase mortality. The first month post-kidney transplantation is considered the critical time, with most UTI episodes during this period. The aim of this study was to compare the efficacy of various doses of trimethoprim-sulfamethoxazole (TMP/SXT) for the prophylaxis of the posttransplant UTI within the first month after kidney transplantation. In a prospective, double-blind, randomized, clinical trial, 95 kidney allograft recipients were divided into two groups: group 1 (n = 63) received low to moderate doses of TMP/SXT (either 80/400 mg or 160/800 mg, daily) and group 2 (n = 32), high doses of TMP/SXT (320/1600 mg, daily in two divided doses). These groups were comparable regarding age, gender, type of donor, and ureteral anastomosis and immunosuppressive therapy. UTI was defined as a urine culture containing more than 10(5) colonies. The mean age of the patients was 37 +/- 12.2 years with a male/female ratio of 0.98/1. The urine culture was positive in 39 patients (41.1%). UTI was more common among female than male patients (P = .003). Escherichia coli was the most common isolated organism in both groups (53.8%). UTI was observed in about 25% of patients on the high-dose versus 49.2% of those on low- to moderate-dose prophylaxis (P < .05). In conclusion, prophylaxis with high-dose TMP/SXT (320/1600 mg, daily) is preferred for renal transplant recipients during the first month posttransplantation.

Topics: Adult; Anti-Infective Agents; Dose-Response Relationship, Drug; Double-Blind Method; Escherichia coli Infections; Female; Humans; Iran; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

The study was undertaken to compare the safety and efficacy of twice-daily ciprofloxacin for 3 days with standard 7 day therapy with either co-trimoxazole or nitrofurantoin in the treatment of women with acute, uncomplicated urinary tract infections (UTI). This multicentre, prospective, randomized, double-blind trial compared oral ciprofloxacin (100 mg bd) for 3 days with co-trimoxazole (160/800 mg bd) or nitrofurantoin (100 mg bd) for 7 days. Bacteriological and clinical evaluations were performed at study entry, during therapy and 4-10 days and 4-6 weeks after the completion of therapy. The primary efficacy parameter was eradication of the causative organism 4-10 days following treatment. Of 713 women enrolled and evaluable for safety, 521 were evaluable for efficacy (168 ciprofloxacin, 174 co-trimoxazole, 179 nitrofurantoin). Escherichia coli (83%) was the most frequently isolated pathogen in all treatment groups. Bacteriological eradication was reported in 88% of ciprofloxacin patients, 93% of co-trimoxazole patients and 86% of nitrofurantoin patients. At the 4-6 week follow-up, ciprofloxacin had statistically significantly higher eradication rates (91%) than co-trimoxazole (79%; 95% confidence limit (CL) = -20.6%, -3.9%) and nitrofurantoin (82%; 95% CL = -17.1%, -0.9%). Clinical resolution 4-10 days after therapy and at the 4-6 week follow-up was similar among the three treatment groups. The overall incidence of treatment-emergent adverse events was not significantly different (P = 0.093) among the three drug regimens, although co-trimoxazole was associated with a greater number of adverse events than ciprofloxacin (P < or = 0.05). Ciprofloxacin also caused fewer episodes of nausea than either of the other agents (P < or = 0.01).

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Anti-Infective Agents, Urinary; Ciprofloxacin; Cystitis; Dose-Response Relationship, Drug; Double-Blind Method; Escherichia coli Infections; Female; Humans; Middle Aged; Nitrofurantoin; Prospective Studies; Staphylococcal Infections; Streptococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The objective of the study was to monitor the effect of two therapy regimens on experimental Escherichia coli mastitis. Single udder quarters of 12 cows that were at least 30 d postpartum were inoculated with 1500 cfu of E. coli. The inoculation was repeated in the contralateral quarter after a 3- to 4-wk interval. Initially, half of the cows were treated with antimicrobials, and the remaining half were left untreated. At the second inoculation, the cows that were originally treated were not treated, and vice versa. Therapy began 12 h after inoculation and consisted of parenteral trimethoprim-sulfadiazine (6 cows) or intramammary colistin sulfate (6 cows). Clinical signs, daily milk yield, bacterial count, and endotoxin content of the milk were recorded. Milk SCC, NAGase activity, and trypsin inhibitor capacity were also monitored. The response to bacterial challenge varied greatly among cows. Bacteria were eliminated from the quarters within 7 d in all but 1 cow. Treatment did not significantly affect the elimination rate of bacteria or any of the measured parameters. Significant positive correlations existed among milk bacterial counts, endotoxin concentrations, and clinical signs at the acute stage of the infection. Based on these findings, antimicrobial therapy of E. coli mastitis during lactation apparently is no more beneficial than no treatment.

Topics: Acetylglucosaminidase; Animals; Cattle; Colistin; Colony Count, Microbial; Endotoxins; Escherichia coli Infections; Female; Mastitis, Bovine; Milk; Pregnancy; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Trypsin Inhibitors

A total of 63 adult patients with uncomplicated acute pyelonephritis were enrolled in a multicenter, randomized comparison of lomefloxacin (400 mg orally once daily for 14 days) and trimethoprim/sulfamethoxazole (TMP/SMX, 160/800 mg orally twice daily for 14 days). Study participants were predominantly female (70% in the lomefloxacin group and 80% in the TMP/SMX group). Escherichia coli was isolated from pretreatment urine cultures in 87.5% of the lomefloxacin group and 80.0% of the TMP/SMX group. Baseline pathogens were eradicated in 100% of evaluable patients in the lomefloxacin group 5-9 days after the end of therapy and in 88.9% of patients in the TMP/SMX group (p = 0.05). The clinical cure rate 5-9 days after therapy with lomefloxacin was 65.0% and for TMP/SMX was 68.4%. At the 4-6 week follow-up in the lomefloxacin group, nine pathogens remained eradicated, one E. coli was isolated, and the results for 14 pathogens were unknown or unevaluable. In the TMP/SMX group, 12 pathogens remained eradicated, three E. coli and one Group D Streptococcus were isolated, and the results for nine pathogens were unknown or unevaluable. Both treatment regimens were well tolerated; adverse events occurred in 12% of patients in the lomefloxacin group and in 17% in the TMP/SMX group. Events considered by the investigators to be probably related to treatment occurred in three patients in each group. In conclusion, once-daily lomefloxacin (400 mg) was a well tolerated and effective alternative to twice-daily TMP/SMX (160/800 mg) for the treatment of adults with uncomplicated acute pyelonephritis.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Male; Middle Aged; Pyelonephritis; Quinolones; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Data were collected from 14 French centres which participated in a randomized study to compare the safety and efficacy of 400 mg lomefloxacin taken orally once daily by 62 patients with 160/800 mg trimethoprim/sulphamethoxazole (TMP/SMX) taken orally twice daily by 64 patients with uncomplicated urinary tract infections. Most patients were infected with Escherichia coli at baseline (72.4% in the lomefloxacin group and 69.0% in the TMP/SMX group) and all patients were treated for 5 days. At 5-9 days post-treatment, lomefloxacin had eradicated the causative organism of infection in 100% of evaluable patients treated with lomefloxacin compared with 86.7% of those treated with TMP/SMX. At 4-6 weeks post-treatment, there were no marked differences in eradication rates between the two treatment groups: 83.3% and 80.0% for the lomefloxacin and TMP/SMX groups, respectively. Clinical cure rates showed no marked differences between treatment groups at 5-9 days or at 4-6 weeks post-treatment. At 5-9 days post-treatment, lomefloxacin achieved a clinical cure rate of 78.6% compared with 86.7% for TMP/SMX evaluable patients. At 4-6 weeks post-treatment, the clinical cure rates were 66.7% and 86.7% for the evaluable lomefloxacin- and TMP/SMX-treated patients, respectively. Both treatment regimens were well tolerated with a low incidence of adverse events. In conclusion, once-daily oral dosing with lomefloxacin is a safe and efficacious alternative to twice-daily dosing with TMP/SMX in the treatment of uncomplicated urinary tract infections.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Drug Administration Schedule; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Male; Middle Aged; Prospective Studies; Quinolones; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A large-scale, randomised, multicentre single-blind clinical trial was conducted to assess the comparative efficacy and tolerance of ofloxacin, trimethoprim and co-trimoxazole in the treatment of uncomplicated urinary tract infection in general practice. A total of 1,069 patients from 76 centres across the UK were enrolled in the study, and randomised to one of the following treatment groups: ofloxacin (200 mg od), trimethoprim (200 mg bd) or co-trimoxazole (trimethoprim 160 mg and sulphamethoxazole 800 mg bd). Each patient received five days of medication. Clinically, ofloxacin was as effective as trimethoprim and co-trimoxazole. However, the bacteriological cure rate was significantly better for ofloxacin, with eradication of the initial causative pathogen by the end of treatment in 92% of patients in the ofloxacin group, compared with 81% for trimethoprim and co-trimoxazole (P = 0.0002). There was also a lower relapse rate for ofloxacin. Ofloxacin was well tolerated: adverse events were reported by 67 (12.4%) patients in the ofloxacin group, compared with 48 (18.7%) patients in the co-trimoxazole group and 37 (13.6%) patients in the trimethoprim group. Ofloxacin can therefore be considered a suitable alternative for the treatment of uncomplicated urinary tract infection.

Topics: Adult; Aged; Escherichia coli Infections; Family Practice; Female; Humans; Male; Middle Aged; Ofloxacin; Single-Blind Method; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In a prospective randomized study at two clinical sites, ceftibuten was compared with trimethoprim-sulfamethoxazole (TMP-SMX), both given orally for a period of 5 days, for the treatment of dysentery. Twenty-two children were found to have bacillary dysentery caused by Shigella and/or enteroinvasive Escherichia coli. All organisms isolated were susceptible to ceftibuten; 6 of 20 Shigella strains and 4 of 5 enteroinvasive E. coli were resistant to TMP-SMX. The diarrhea persisted for a mean (+/- SD) period of 2.4 +/- 1.4 days in the ceftibuten-treated patients vs. 3.4 +/- 1.7 days in the TMP-SMX-treated patients. The duration of fever was similar for both treatment groups. Patients treated with ceftibuten or TMP-SMX had equivalent clinical responses unless the pathogen was found to be TMP-SMX-resistant. Those who were randomized to receive TMP-SMX but who were eventually found to have TMP-SMX-resistant organisms had significantly more stools at days 3, 4 and 5 (P less than 0.02 to less than 0.00006) with more watery consistency for these days (P less than 0.02 to less than 0.005) compared to patients treated with ceftibuten. No clinical relapses were reported and no drug-related side effects were observed. We conclude that ceftibuten is at least as effective as TMP-SMX in the treatment of diarrhea caused by Shigella and enteroinvasive E. coli in children.

Topics: Adolescent; Ceftibuten; Cephalosporins; Child; Child, Preschool; Dysentery, Bacillary; Escherichia coli Infections; Humans; Infant; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

A randomized treatment trial of travelers' diarrhea was carried out among U.S. military personnel participating in routine exercises in several port cities in South America and West Africa. A 5-day, twice daily course of either norfloxacin (400 mg) or trimethoprim/sulfamethoxazole (TMP/SMX, 160/800 mg) was given to 142 volunteers. At the end of 5 days of treatment, diarrhea had resolved in 100% of 73 patients receiving norfloxacin and 97.1% (67/69) receiving TMP/SMX. A probable bacterial pathogen was determined in 44% of 142 subjects: 49% of the norfloxacin group and 39% of the TMP/SMX group. The most common pathogens detected were enterotoxigenic Escherichia coli in 20% of cases and rotavirus in 15%. Resistance to TMP/SMX was present in 20 (27%) bacterial isolates, while no resistance to norfloxacin was found. Eight of 10 patients in the TMP/SMX treatment group who had TMP/SMX-resistant bacterial enteropathogens improved clinically. Both norfloxacin and TMP/SMX were clinically effective in the treatment of travelers' diarrhea in this military population.

Topics: Acute Disease; Adolescent; Adult; Africa, Western; Bacterial Infections; Diarrhea; Escherichia coli Infections; Feces; Humans; Male; Middle Aged; Military Personnel; Norfloxacin; South America; Surveys and Questionnaires; Travel; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Virus Diseases

To test whether longer duration of treatment of asymptomatic bacteriuria in old age could improve the efficacy of cotrimoxazole therapy, three regimens were given to 75 ambulant bacteriuric residents of a retirement home, aged greater than or equal to 68 years. The groups and regimens were: A:23 subjects (160/800 mg b.i.d. orally x 3 days). B: 24 subjects (160/800 mg i.m. x 10 days); C: 28 subjects (160/800 mg b.i.d. orally x 20 days). One week, one month and five months post-therapy urines were negative in 78.3% vs 52.9% vs 42.9% of group A, in 54.2% vs 56.5% vs 50% of group B and in 57.1% vs 60.7% vs 68% of group C subjects respectively. The data indicate that: 1) the efficacy of any schedule is only moderate irrespective of the presence of antibody-coated bacteria in urine; 2) a 3-day course appears more effective at one week post-therapy; 3) at one and five months greater than or equal to 50% of the subjects were infection-free, the 20 day treatment resulting in fewer failures; 4) subjects with long-term eradication had no mobility problem, low serum creatinine and a normal urinary tract as seen by ultrasound.

Topics: Administration, Oral; Aged; Aged, 80 and over; Bacteriuria; Creatinine; Drug Administration Schedule; Escherichia coli; Escherichia coli Infections; Female; Humans; Injections, Intramuscular; Male; Trimethoprim, Sulfamethoxazole Drug Combination

We undertook a prospective, controlled study to evaluate the effect of trimethoprim-sulfamethoxazole in children with proven Escherichia coli O157:H7 enteritis on the duration fo symptoms, on fecal excretion of pathogen, and on the risk of progression to hemolytic-uremic syndrome. There was no statistically significant effect of treatment on progression of symptoms, fecal pathogen excretion, or the incidence of HUS (2/22 vs 4/25; p = 0.67). Our results suggest that a multicentric trial using rapid diagnostic methods to permit early randomization should be carried out.

Topics: Child; Child, Preschool; Enteritis; Escherichia coli; Escherichia coli Infections; Feces; Female; Hemolytic-Uremic Syndrome; Humans; Infant; Male; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Norfloxacin, a broad-spectrum antimicrobial analog of nalidixic acid, was evaluated by comparing it to trimethoprim-sulfamethoxazole in 93 office patients with recurrent urinary tract infections. In this prospective randomized study, norfloxacin and trimethoprim-sulfamethoxazole were given on the same dosage schedule with the former drug given as a 400-mg tablet twice daily and the latter drug given as a double strength tablet twice daily. Overall, 50 patients received norfloxacin and 43 patients received trimethoprim-sulfamethoxazole with a cure rate of 96 percent and 79 percent, respectively. Whether a patient had one infection or multiple previous infections, norfloxacin appeared to be superior to trimethoprim-sulfamethoxazole. Only minor side effects were noted in either group, and no patient withdrew from this study as a direct result of these side effects. Minor complaints of nausea, dizziness, and headache were found in the norfloxacin group (24%) and in the trimethoprim-sulfamethoxazole group (16%). Both agents are effective in treating urinary tract infections but norfloxacin is superior to trimethoprim-sulfamethoxazole in patients with either recurrent complicated infections or one previous uncomplicated urinary tract infection.

Topics: Adult; Aged; Aged, 80 and over; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Norfloxacin; Prospective Studies; Randomized Controlled Trials as Topic; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In a double-blind, randomized, controlled trial, 249 patients with complicated urinary tract infections received either 400 mg. enoxacin or 160 mg. trimethoprim plus 800 mg. sulfamethoxazole orally every 12 hours for 14 days. The clinical outcome at the end of treatment revealed that all 89 evaluable patients (100 per cent) in the enoxacin group and 88 of 90 (98 per cent) in the trimethoprim-sulfamethoxazole group had satisfactory clinical responses (cure or improvement). Bacteriological effectiveness was measured cumulatively based on responses during and at the end of treatment, and 7 days later at followup. Satisfactory bacteriological responses (eradication or superinfection at all evaluations throughout the study) were achieved in significantly more (p equals 0.03) patients treated with enoxacin (93 per cent) than in those treated with trimethoprim-sulfamethoxazole (83 per cent). Both study medications were well tolerated. These results indicate that oral enoxacin was more effective clinically and bacteriologically (the latter statistically so) than trimethoprim-sulfamethoxazole when given as empiric therapy in the treatment of complicated urinary tract infections.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Urinary; Double-Blind Method; Drug Combinations; Enoxacin; Escherichia coli Infections; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Multicenter Studies as Topic; Pseudomonas Infections; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

One hundred six patients with acute, uncomplicated lower urinary tract infections participated in a randomized study that compared cefixime (one 400-mg tablet once daily) with trimethoprim (160 mg)/sulfamethoxazole (800 mg) (one tablet every 12 hours). Two cefixime recipients and 3 patients given trimethoprim/sulfamethoxazole had courses that were not evaluable for efficacy. At five to nine days post-therapy, 98 percent of the patients in each treatment group had clinical cure and bacteriologic eradication. At four to six weeks post-therapy, 87 percent (34/39) of the cefixime-treated patients and 83 percent (33/40) of those given trimethoprim/sulfamethoxazole had clinical cure and 90 percent (35/39) and 93 percent (37/40) of the patients in the respective treatment groups had bacteriologic eradication. Adverse clinical experiences or changes in the results of laboratory tests were few. Thus, a once-daily dose of cefixime was as safe and as effective as a twice-daily regimen of trimethoprim/sulfamethoxazole.

Topics: Anti-Infective Agents, Urinary; Cefixime; Cefotaxime; Drug Administration Schedule; Escherichia coli Infections; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Randomized Controlled Trials as Topic; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

An outpatient study of 125 children with acute invasive diarrhea was conducted at the Hospital Infantil de Mexico Federico Gomez. Through a single-blind randomization, we compared the efficacy of furazolidone, 7.5 mg/kg/day (49 patients), with trimethoprim-sulfamethoxazole (TMP-SMX), 8 mg/40 mg/kg/day (52 patients), each given for 5 days. A control group of 24 patients received no antimicrobials. Stool samples were collected from all patients at the time of admission, and active drugs were administered before the stool culture results were available. At baseline, 48 of 125 patients (38.5%) had negative stool cultures. In the other patients, the most frequently isolated pathogens were Shigella sp and enteropathogenic Escherichia coli. Of the total population who completed the study 43 of 49 (87.8%) of the patients in the furazolidone group and 43 of 52 (82.7%) of the patients in the TMP-SMX group achieved clinical cure by day 3, compared with 10 of 22 (45.5%) of the patients in the control group. Day 3 cure rates were similar between groups, independent of baseline stool culture results. Of those patients who had positive stool cultures on day 1, 20 of 34 (58.8%) in the furazolidone group and 19 of 29 (65.5%) in the TMP-SMX group had negative culture results on day 6, compared with 4 of 12 (33.3%) in the control group. Overall, clinical and bacteriologic success was achieved in 31 of 49 (63%) patients treated with furazolidone and in 36 of 52 (69%) patients treated with TMP-SMX, compared with 5 of 22 (23%) patients in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Child, Preschool; Diarrhea; Diarrhea, Infantile; Dysentery, Bacillary; Escherichia coli Infections; Female; Furazolidone; Humans; Infant; Male; Randomized Controlled Trials as Topic; Single-Blind Method; Trimethoprim, Sulfamethoxazole Drug Combination

Vaginal colonization with Escherichia coli is an integral step in the development of acute cystitis, and persistent vaginal coliform colonization may also be a predisposing step to recurrent urinary tract infections. For this reason, we evaluated antibiotic concentrations in the vaginal fluid, serum, and urine and the vaginal colonization by E. coli of 56 women receiving either ofloxacin (200 mg orally twice a day) or trimethoprim-sulfamethoxazole (TMP-SMX) (160/800 mg orally twice a day) for the treatment of acute cystitis. Ofloxacin and trimethoprim both penetrated into vaginal fluid to a considerably greater extent than sulfamethoxazole. Among 33 patients given ofloxacin, the concentration of the drug in vaginal fluid during one dosage interval ranged from 1.6 to 21.6 micrograms/ml. In 21 women given TMP-SMX the range of drug concentrations in vaginal fluid was 2.6 to 32.5 micrograms/ml for TMP and 1.0 to 6.2 micrograms/ml for SMX. Treatment with both ofloxacin and TMP-SMX remarkably reduced vaginal colonization by E. coli during and up to 30 days after therapy. For the ofloxacin-treated women, eradication of vaginal E. coli was associated with a high ratio of drug concentration in vaginal fluid to that in serum. We conclude that ofloxacin and TMP both achieve high concentrations in vaginal fluid and are equally successful in eradicating E. coli from the vagina.

Topics: Administration, Oral; Adult; Body Fluids; Cystitis; Drug Administration Schedule; Drug Combinations; Escherichia coli Infections; Female; Humans; Ofloxacin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vagina; Vaginal Smears

In a prospective, coordinated, double-blind multicentre trial, outpatients with urinary tract infections were randomized to 7 days b.i.d. treatment with norfloxacin 200 mg or 400 mg or trimethoprim/sulfamethoxazole. The most prevalent species was Escherichia coli (76.6%) followed by Staphylococcus saprophyticus (14.1%), the latter of which showed a marked seasonal variation with peak incidence during late summer. Minimum inhibitory concentrations (MICs) of 11 antibiotics for 651 pre-treatment bacterial strains were studied. Norfloxacin was found to be active against all isolates with MICs less than or equal to mg/l for gram-negative and less than or equal to 8 mg/l for gram-positive isolates. Reduced susceptibility to norfloxacin was seen in 2 strains of E. coli and 1 of Klebsiella pneumoniae from patients with persisting or relapsing infections following treatment with norfloxacin 400 mg b.i.d. Of other antibiotics tested, ampicillin, cephalothin and sulfamethoxazole were found to have poor activity against many gram-negative isolates while nalidixic acid and mecillinam lacked activity against all gram-positives. Cefotaxime, gentamicin, trimethoprim and trimethoprim/sulfamethoxazole were generally highly active against the isolated bacterial strains.

Topics: Anti-Bacterial Agents; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Escherichia coli Infections; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Microbial Sensitivity Tests; Norfloxacin; Prospective Studies; Random Allocation; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A single dose of 100 mg ofloxacin was compared with a multiple dose of cotrimoxazole in lower urinary tract infections in 137 women. The elimination rate was significantly lower in the single dose treated group of patients in spite of all strains being in vitro susceptible in this group.

Topics: Anti-Infective Agents, Urinary; Clinical Trials as Topic; Drug Combinations; Escherichia coli Infections; Female; Humans; Ofloxacin; Oxazines; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Single-dose therapy of uncomplicated urinary tract infection (UTI) has been shown to be effective in many trials in adult women. The question which will be explored in this presentation is what properties constitute the ideal agent for the therapy of UTI. Important microbiological properties include spectrum of activity to include all common urinary pathogens, bactericidal action in urine and low prevalence of resistant bacteria. The vital feature of an antibacterial drug useful in the therapy of UTI is prolonged urinary concentrations. The agent must therefore be well absorbed and have slow renal excretion. Most beta-lactam drugs do not have these combined properties. Aminoglycosides are effective drugs but cannot be administered orally. Quinolones and the calcium salt of fosfomycin are useful but do not have an ideal pharmacokinetic profile. Cotrimoxazole, trimethoprim alone and the trometamol salt of fosfomycin all have good antibacterial activity combined with slow urinary excretion.

Topics: Aminoglycosides; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Clinical Trials as Topic; Drug Combinations; Escherichia coli Infections; Fosfomycin; Humans; Kinetics; Lactams; Microbial Sensitivity Tests; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Single-dose antibiotic therapy for urinary tract infections in which no underlying structural or neurologic lesions are present holds the promise of greater patient compliance and convenience. We present the results of a study comparing a single intramuscular dose of a long-acting, third-generation cephalosporin, ceftriaxone, with a standard, five-day regimen of trimethoprim-sulfamethoxazole (TMS). Fifty-two patients were entered into the study. After randomization, 26 were assigned to the TMS group and 26 were assigned to the ceftriaxone group. Of the patients who completed the study, 13 of the TMS group had positive cultures at the time of initial presentation, and 20 of the ceftriaxone group had positive cultures. There was no statistical difference between the groups in symptoms of dysuria, hematuria, frequency, flank pain, and nocturia (alpha = .05). The physical parameters of age, blood pressure, pulse, and temperature were similar in the two groups (alpha = .05), as were the types of infecting organisms (alpha = .05). When comparing the two regimens, the ceftriaxone group cure rate (18 of 20, 90%) was not found to be significantly different from that of the TMS-treated control group (13 of 13) (alpha = .05).

Topics: Administration, Oral; Cefotaxime; Ceftriaxone; Drug Combinations; Drug Evaluation; Escherichia coli Infections; Female; Humans; Injections, Intramuscular; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Women with uncomplicated urinary tract infections were randomly allocated to either a single 150 mg intramuscular dose of netilmicin or a standard five-day course of oral co-trimoxazole. Twenty-one of 22 were cured with netilmicin and all 20 with co-trimoxazole. No patient treated with netilmicin developed any side effects or obvious toxicity. Following co-trimoxazole one woman developed a severe skin rash and another nausea. Netilmicin is another drug which is highly effective when used in a single dose regimen for the treatment of uncomplicated urinary tract infections. There are many advantages of this approach to the management of a common clinical problem.

Topics: Administration, Oral; Adolescent; Adult; Clinical Trials as Topic; Drug Combinations; Escherichia coli Infections; Female; Gentamicins; Humans; Injections, Intramuscular; Middle Aged; Netilmicin; Prospective Studies; Random Allocation; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The efficacy of a single-dose (4 tablets) trimethoprim-sulfamethoxazole (TMP-SMX) was compared with that of a 3-day and 10-day treatment with TMP-SMX, 2 tablets twice daily, in 464 female out-patients with symptoms denoting acute, uncomplicated urinary tract infection (UTI). 321 patients (70%) had significant bacteriuria. Treatment effect could be assessed in 279 women. Comparable results were obtained with the 3 regimens 2 and 6 weeks after treatment. Eradication of the initial organism occurred in 96% with single-dose, in 96-94% with a 3-day, and in 98% with a 10-day course. The incidence of adverse reactions was significantly greater in patients treated with a 10-day (28%) than in those treated with a single-dose (5%), or 3-day (9%) regimen (p less than 0.01). This study suggests that short treatment regimens for uncomplicated UTI in women are as effective as and cause fewer side-effects than the conventional 10-day chemotherapy.

Topics: Acute Disease; Adolescent; Adult; Anti-Infective Agents, Urinary; Cystitis; Drug Administration Schedule; Drug Combinations; Escherichia coli Infections; Female; Humans; Middle Aged; Random Allocation; Staphylococcal Infections; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Diarrhea; Drug Combinations; Dysentery, Bacillary; Escherichia coli Infections; Female; Humans; Male; Premedication; Salmonella Infections; Sulfamethoxazole; Time Factors; Travel; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Diarrhea; Doxycycline; Drug Combinations; Erythromycin; Escherichia coli Infections; Humans; Premedication; Sulfamethoxazole; Travel; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A randomised single-blind clinical trial compared cinoxacin (500 mg every 12 hours) to co-trimoxazole (160 mg trimethoprim, 800 mg sulphamethoxazole every 12 hours) in the treatment of 63 patients with urinary tract infections. The symptomatic response was 73% for both drugs. Bacterial eradication was achieved in 81% and 100% of patients receiving cinoxacin and co-trimoxazole respectively. Three patients receiving co-trimoxazole stopped treatment because of adverse reactions. We conclude that cinoxacin is an effective and safe antibacterial agent in the treatment of urinary tract infections.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Bacteriuria; Cinoxacin; Clinical Trials as Topic; Cystitis; Drug Combinations; Drug Hypersensitivity; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Nausea; Pyelonephritis; Pyridazines; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Sixty-four women with an uncomplicated urinary tract infection were randomly allocated to receive treatment with either an 0.96 g, 1.92 g or 2.88 g single oral dose of co-trimoxazole or a conventional five-day course of co-trimoxazole. The success of each group was comparable although it is suggested that a single dose should be at least 1.92 g (four tablets Septrin or Bactrim). This study confirmed previous work that single dose therapy was effective and well tolerated, preferred by the patients and side effects were minimal. This approach to treatment should be strongly encouraged.

Topics: Adolescent; Adult; Bacterial Infections; Drug Combinations; Escherichia coli Infections; Female; Humans; Middle Aged; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Forty-eight women with urinary tract infection due to Co-trimoxazole sensitive organisms were randomly allocated to receive either two tablets (0.96 grams) of Co-trimoxazole twice a day for one day, four tablets (1.92 grams) of Co-trimoxazole as a single dose, or, two tablets of Co-trimoxazole twice a day for seven days. The infection cure rate was comparable in each group being 82%, 87% and 81% respectively. The patients who received the single dose had a high incidence of minor side effects. Accordingly one-day treatment appears to be the treatment mode of choice. Failure to respond to single dose or single day treatment may indicate those patients requiring investigation of their urinary tract.

Topics: Drug Administration Schedule; Drug Combinations; Escherichia coli Infections; Female; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Spontaneous bacterial peritonitis (SBP) is a major cause of mortality. Although SBP primary prophylaxis (SBPPr) with fluoroquinolones and trimethoprim-sulfamethoxazole (TMP-SMX) is often used, resistance could reduce its benefit.. Analyze peritoneal fluid resistance patterns in patients with a first SBP episode with/without SBPPr using the Veterans Health Administration corporate data warehouse and to evaluate national antibiograms. Corporate data warehouse data were extracted using validated International Classification of Disease-9/10 codes, culture, resistance data, and outcomes of 7553 patients who developed their first inpatient SBP between 2009 and 2019 and compared between those with/without SBPPr. Escherichia coli ( E. coli ) and Klebsiella pneumoniae ( K. pneumoniae ) sensitivity to ciprofloxacin and TMP-SMX was calculated using 2021 Veterans Health Administration antibiogram data from all states. The most common isolates were E. coli , K. pneumoniae , and Staphylococcus species. Veterans taking ciprofloxacin SBBPr had higher fluoroquinolone resistance (34% vs 14% no SBPPr, p <0.0001); those taking TMP-SMX had higher TMP-SMX resistance (40% vs 14%, p <0.0001). SBPPr patients showed higher culture positivity, greater length of stay, higher second SBP, and higher probability of liver transplant rates versus no SBPPr. Multivariable models showed SBBPr to be the only variable associated with gram-negative resistance, and SBPPr was associated with a trend toward longer length of stay. E. coli ciprofloxacin sensitivity rates were 50%-87% and 43%-92% for TMP-SMX. K. pneumoniae ciprofloxacin sensitivity was 76%-100% and 72%-100% for TMP-SMX.. Among patients who developed their first SBP episode, there was a higher prevalence of antibiotic resistance in those on SBPPr, with a high rate of fluoroquinolone resistance across the Veterans Health Administration sites.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Ciprofloxacin; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Humans; Klebsiella pneumoniae; Peritonitis; Trimethoprim, Sulfamethoxazole Drug Combination; Veterans Health

Topics: Anti-Bacterial Agents; beta-Lactamases; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Microbial Sensitivity Tests; Prospective Studies; Staphylococcus saprophyticus; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

IntroductionEmpirical therapy for the treatment of urinary tract infections should be tailored to the current distribution and susceptibility of potential pathogens to ensure optimal treatment.AimWe aimed to provide an up-to-date overview of the epidemiology and susceptibility of Enterobacterales isolated from urine in Germany.MethodsWe retrospectively analysed antimicrobial susceptibility data from 201,152 urine specimens collected between January 2016 and June 2021 from in- and outpatients. Multiple logistic regression analysis was used to evaluate the association between year of investigation and antibiotic resistance, adjusted for age, sex and species subgroup. Subgroup analyses were performed for midstream urine samples obtained from (i) female outpatients aged 15 to 50 years, (ii) female outpatients older than 50 years and (iii) male outpatients.ResultsResistance rates of less than 20% were observed for nitroxoline (3.9%), fosfomycin (4.6%), nitrofurantoin (11.7%), cefuroxime (13.5%) and ciprofloxacin (14.2%). Resistance to trimethoprim/sulfamethoxazole (SXT) (20.1%), amoxicillin-clavulanic acid (20.5%), trimethoprim (24.2%), pivmecillinam (29.9%) and ampicillin (53.7%) was considerably higher. In the subgroup of outpatient women aged 15-50 years, resistance rates were generally lower. Resistance rates of all antibiotics decreased from 2016 to 2021. Multiple logistic regression revealed the lowest adjusted odds ratio (ORadj) of 0.838 (95% confidence interval (CI): 0.819-0.858; p < 0.001) for pivmecillinam and the highest ORadj of 0.989 (95% CI: 0.972-1.007; p = 0.226) for nitrofurantoin.ConclusionsResistance has generally decreased over the past years, independent of sex, age and causative pathogen. Our data provide an important basis for empirical antibiotic recommendations in various settings and patient collectives.

Topics: Amdinocillin Pivoxil; Anti-Bacterial Agents; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Germany; Humans; Male; Microbial Sensitivity Tests; Nitrofurantoin; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Recurrent urinary tract infection (UTI) occurs in sizable percentages of patients after a single episode and is a frequent cause of primary healthcare visits and hospital admissions, accounting for up to one quarter of emergency department visits. We aim to describe the pattern of continuous antibiotic prophylaxis prescription for recurrent urinary tract infections, in what group of adult patients they are prescribed and their efficacy.. A retrospective chart review of all adult patients diagnosed with single and recurrent symptomatic urinary tract infection in the period of January 2016 to December 2018.. A total of 250 patients with a single UTI episode and 227 patients with recurrent UTI episodes were included. Risk factors for recurrent UTI included diabetes mellitus, chronic renal disease, and use of immunosuppressive drugs, renal transplant, any form of urinary tract catheterization, immobilization and neurogenic bladder. E. coli infections were the most prevalent organism in patients with UTI episodes. Prophylactic antibiotics were given to 55% of patients with UTIs, Nitrofurantoin, Bactrim or amoxicillin clavulanic acid. Post renal transplant is the most frequent reason to prophylaxis antibiotics (44%). Bactrim was more prescribed in younger patients (P < 0.001), in post-renal transplantation (P < 0.001) and after urological procedures (P < 0.001), while Nitrofurantoin was more prescribed in immobilized patients (P = 0.002) and in patients with neurogenic bladder (P < 0.001). Patients who received continuous prophylactic antibiotics experienced significantly less episodes of urinary tract infections (P < 0.001), emergency room visits and hospital admissions due to urinary tract infections (P < 0.001).. Despite being effective in reducing recurrent urinary tract infection rate, emergency room visits and hospital admissions due to UTI, continuous antibiotic prophylaxis was only used in 55% of patients with recurrent infections. Trimethoprim/sulfamethoxazole was the most frequently used prophylactic antibiotic. Urology and gynecological referral were infrequently requested as part of the evaluation process for patients with recurrent UTI. There was a lack of use of other interventions such as topical estrogen in postmenopausal women and documentation of education on non-pharmacological methods to decrease urinary tract infections.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Escherichia coli; Escherichia coli Infections; Female; Humans; Nitrofurantoin; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder, Neurogenic; Urinary Tract Infections

Urinary tract infection (UTI) caused by Escherichia coli is a significant health issue in children. Today especially E.coli O25b/ST131, defined as a pandemic clone, is a serious public health problem due to its high virulence and antimicrobial resistance rates. In this study, a total of 200 (100 first and 100 recurrent UTI-causing) E.coli isolates from urine samples sent to the Ankara University School of Medicine Cebeci Training and Research Hospital Central Laboratory between January and September 2021 with the preliminary diagnosis of UTI in pediatric patients aged three to 18 years were analyzed for antimicrobial resistance rates, phylogenetic group distributions, virulence factor frequencies and whether they belong to the O25b/ST131 clone. It is aimed in this study that, the obtained data will shed light on new studies for diagnosis, treatment and prophylaxis options that can be developed for more effective UTI management by contributing to the surveillance studies in our country. Antimicrobial susceptibility of E.coli isolates identified by conventional methods was evaluated by Kirby-Bauer disc diffusion method and extended spectrum beta-lactamase (ESBL) production was evaluated by double disc synergy test. Polymerase chain reaction (PCR) was used for the investigation of phylogenetic grouping, the O25b/ST131 clone, virulence genes and the molecular level classification of the isolates detected as uropathogenic E.coli (UPEC). Pulsed-field gel electrophoresis (PFGE) was performed with the isolates collected at different times from the same patient. The highest antimicrobial resistance rates observed were against ampicillin (n= 100, 50%), cefazolin (n= 99, 49.5%), trimethoprim-sulfamethoxazole (n= 55, 27.5%), amoxicillin-clavulanic acid (n= 43, 21.5%) and cefotaxime (n= 43, 21.5%). In recurrent UTI agents, resistance rates were higher for cefotaxime (n= 29, 29%), trimethoprim-sulfamethoxazole (n= 35, 35%) and cefepime (n= 25, 25%) and in O25b/ST131 isolates (n= 67) the rates were higher for amikacin (n= 3, 4.5%), gentamicin (n= 10, 14.9%) and ciprofloxacin (n= 17, 25.4%) when compared to the first UTI agents and non-O25b/ ST131 isolates (p< 0.05). It was found that 29% (n = 58) of the isolates were multidrug resistant (MDR) and 19% (n = 38) produced ESBL.The rate of recurrent UTI agents was found to be higher among ESBL producing isolates and/or MDR isolates (n= 36, 62% and n= 27, 71%, respectively, p< 0.05). It was found that 45.5% (n= 91) of the iso

Topics: Anti-Bacterial Agents; Anti-Infective Agents; beta-Lactamases; Cefotaxime; Child; Clone Cells; Escherichia coli; Escherichia coli Infections; Humans; Phylogeny; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Virulence Factors

Colibacillosis is one of the most important diseases in poultry production. The use of antimicrobials remains a therapeutic cornerstone for avian pathogenic

Topics: Amoxicillin; Ampicillin; Animals; Anti-Bacterial Agents; Chickens; Doxycycline; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Neomycin; Poultry Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Antibiotic-resistant E. coli infections represent a major cause of morbidity and mortality and pose a challenge to antibiotic stewardship. We analyzed a large outpatient data set of E. coli urinary isolates to determine whether resistance patterns vary between types of outpatient practices. Using deidentified data from a clinical reference laboratory over 5 years and logistic regression, we examined the association of antibiotic resistance with outpatient practice type, controlling for testing year, patient sex, and patient age. The odds of antibiotic resistance were significantly higher in urology/nephrology practices for ampicillin (odds ratio [OR] 1.36; 95% CI, 1.10 to 1.69), ciprofloxacin (OR 2.29; 95% CI, 1.77 to 2.94), trimethoprim-sulfamethoxazole (OR 1.52; 95% CI, 1.18 to 1.94), and gentamicin (OR 1.72; 95% CI, 1.16 to 2.46). Odds of resistance were also higher for ciprofloxacin in oncology practices (OR 1.54; 95% CI, 1.08 to 2.15) and "all other specialties" (OR 1.33; 95% CI, 1.13 to 1.56). In contrast, specimens from obstetrics and gynecology practices had lower odds of having resistance to ampicillin (OR 0.90; 95% CI, 0.82 to 0.99) and trimethoprim-sulfa (OR 0.83; 95% CI, 0.73 to 0.93) but higher odds of having resistance to nitrofurantoin (OR 1.33; 95% CI, 1.03 to 1.70). Other findings included lower odds of having resistance to trimethoprim-sulfa in pediatric practices (OR 0.78; 95% CI, 0.64 to 0.94) and lower odds of having resistance to gentamicin in isolates from internal medicine practices (OR 0.66; 95% CI, 0.51 to 0.84) (all

Topics: Ampicillin; Anti-Bacterial Agents; Child; Ciprofloxacin; Drug Resistance, Bacterial; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Gentamicins; Humans; Microbial Sensitivity Tests; Outpatients; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Thymine auxotrophic in vitro mutants of Escherichia coli were first reported in the mid-20th century. Later, thymine-dependent clinical strains of E. coli as well as other Enterobacterales, Enterococcus faecalis and Staphylococcus aureus have been recognized as the cause of persistent and recurrent infections.. The aim of this study was to characterize the phenotype and investigate the molecular basis of thymine auxotrophy in ten E. coli isolates obtained at different time points from a patient with recurrent bloodstream infection (BSI) due to a chronic aortic graft infection treated with Trimethoprim/sulfamethoxazole (TMP-SMX).. Clinical data was obtained from hospital records. Growth characterization and antimicrobial susceptibility testing to TMP-SMX was performed on M9 agar and in MH broth with different thymine concentrations (0.5, 2, 5, 10 and 20 μg/mL), on Mueller-Hinton (MH) and blood agar. Whole genome sequencing (WGS) was performed on all E. coli isolates.. E. coli were isolated from ten consecutive BSI episodes from a patient with chronic aortic graft infection. Six of these isolates were resistant to TMP-SMX when assayed on blood agar. Growth experiments with added thymine confirmed that these isolates were thymine-dependent (thy-), and revealed growth defects (slower growth rate and smaller colony size) in these isolates relative to thy+ isolates (n = 4). WGS indicated that all isolates were of the same clonal lineage of sequence type 7358. Genomic analysis revealed a G172C substitution in thyA in all TMP-SMX resistant isolates, while mutations affecting genes involved in the deoxyribose salvage pathway (deoB and deoC) were identified in eight isolates.. This case highlights the risk of resistance development to TMP-SMX, especially for long-term treatment, and the possible pitfalls in detection of growth-deficient subpopulations from chronic infections, which could lead to treatment failure.

Topics: Agar; Anti-Bacterial Agents; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Phenotype; Reinfection; Sepsis; Thymine; Trimethoprim, Sulfamethoxazole Drug Combination

Urinary tract infections (UTIs) and bacterial resistance to antibiotics is global health problem and a threat to public health in many countries.. The study aimed to determine the prevalence of MDR Escherichia coli and Klebsiella pneumoniae in UTI patients.. The midstream urine samples of 120 patients were collected and cultured as described by the protocols at the respective sample collection sites on MacConkey Blood agar. Samples were tested by using the fully automated VITEK 2 Compact system for Gram-negative identification and detection of antimicrobial susceptibility of microorganisms.. The most prevalent pathogen was E. coli, which was found in 82 (68.3%) urine samples, followed by K. pneumonia, found in 38 (31.7%) urine samples. As far as antibiotic resistance is concerned, E. coli isolates were found to be highly resistant for ceftriaxone (89.0% of the isolates), ampicillin (86.6%), levofloxacin (82.9%), cefotaxime (79.3%), aztreonam (74.4%), ceftazidime (68.3%) and gentamicin, piperacillin, and trimethoprim-sulfamethoxazole, 54.9 and 53.7%, respectively. The E. coli isolates were found to be relatively less resistant to imipenem (2.4%), cefepime (34.1%), and ciprofloxacin (35.4%). For K. pneumonia isolates, high resistance rates were observed for piperacillin (81.6%), levofloxacin (78.9%), ampicillin (76.3%), cefotaxime (73.7%), trimethoprim-sulfamethoxazole (71.1%), ceftazidime (65.8%), gentamicin (63.2%), cefepime (50.0%), and aztreonam (44.7%). However, moderate resistance rates were detected for these were found to be less resistant for imipenem (13.2%), ceftriaxone (31.6%), and ciprofloxacin (36.8%).. E. coli and K. pneumoniae from the clinical isolates displayed high resistance to many antibiotics in UTI patients.

Topics: Ampicillin; Anti-Bacterial Agents; Aztreonam; Cefepime; Ceftazidime; Ceftriaxone; Ciprofloxacin; Drug Resistance, Multiple; Escherichia coli; Escherichia coli Infections; Gentamicins; Humans; Imipenem; Klebsiella Infections; Klebsiella pneumoniae; Levofloxacin; Microbial Sensitivity Tests; Piperacillin; Prevalence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Amoxicillin; Anti-Bacterial Agents; beta-Lactamases; Carbapenems; Cefotaxime; Ceftazidime; Ciprofloxacin; Clavulanic Acid; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Extraintestinal Pathogenic Escherichia coli; Gentamicins; Hospitals; Humans; Iron; Mozambique; Piperacillin; Tazobactam; Trimethoprim, Sulfamethoxazole Drug Combination

Dogs are a potential source of drug-resistant Escherichia coli, but very few large-scale antimicrobial resistance surveillance studies have been conducted in the canine population. Here, we assess the antimicrobial susceptibility patterns, identify temporal resistance and minimum inhibitory concentration (MIC) trends, and describe associations between resistance phenotypes among canine clinical E. coli isolates in the northeastern United States. Through a retrospective study design, we collected MICs from 7709 E. coli isolates from canine infections at the Cornell University Animal Health Diagnostic Center between 2007 and 2020. The available clinical data were limited to body site. Isolates were classified as resistant or susceptible to six (urinary) and 22 (non-urinary) antimicrobials based on Clinical and Laboratory Standards Institute breakpoints. We used the Mann-Kendall test (MKT) and Sen's slope to identify the presence of a significant trend in the percent of resistant isolates over the study period. Multivariable logistic regression (MLR) models were built with ceftiofur, enrofloxacin, or trimethoprim-sulfamethoxazole resistance as the outcome and either body site and isolation date, or resistance to other antimicrobials as predictors. MIC trends were characterized with survival analysis models, controlling for body site and year of isolation. Overall, 16.4% of isolates were resistant to enrofloxacin, 14.3% to ceftiofur, and 14% to trimethoprim-sulfamethoxazole. The MKT and Sen's slope revealed a significant decreasing temporal trend for gentamicin and trimethoprim-sulfamethoxazole resistance among non-urinary isolates. No significant temporal resistance trends were detected by MKT for other antimicrobials. However, controlling for body-site in MLR models identified a decrease in resistance rates to enrofloxacin and trimethoprim-sulfamethoxazole after 2010. Similarly, survival analysis data confirmed these findings and showed a decrease in MIC values after 2010 for gentamicin and trimethoprim-sulfamethoxazole, but an increase in cephalosporin MICs. MLR showed that non-urinary isolates were significantly more likely than urinary isolates to demonstrate in vitro resistance to ceftiofur, enrofloxacin, and trimethoprim-sulfamethoxazole after controlling for year of isolation. We identified a higher level of ceftiofur resistance among enrofloxacin resistant isolates from urinary and non-urinary origins. Our findings confirmed that dogs are still a non

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents; Cephalosporins; Dog Diseases; Dogs; Drug Resistance, Bacterial; Enrofloxacin; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Gentamicins; Microbial Sensitivity Tests; New York; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

To describe the susceptibility of Escherichia coli to medically important antibiotics, collected over four periods (2004-2006, 2008-2009, 2013-2014, 2017-2018), from food-producing animals at slaughter.. Intestinal contents from cattle, pigs and broilers were randomly sampled (5-6 countries/host; ≥4 abattoirs/country; one sample/animal/farm) for isolation of Escherichia coli; antimicrobial susceptibilities were centrally determined by CLSI agar dilution. Clinical breakpoints (CLSI) and epidemiological cut-off values (EUCAST) were applied for data interpretation.. In total, 10 613 E. coli strains were recovered. In broilers, resistance percentages were the lowest (P ≤ 0.01) in the latest time period. A significant decrease in MDR over time was also observed for broilers and a tendency for a decrease for pigs. Resistance to meropenem and tigecycline was absent, and resistance to azithromycin was 0.2%-2.0%. Also, low resistance to third-generation cephalosporins (1.1%-7.4%) was detected in broilers. Resistance to colistin varied between 0.1%-4.8%. E. coli from broilers showed high resistance to ciprofloxacin (7.3%-23.3%), whereas for cattle and pigs this was 0.2%-2.5%. Low/moderate resistance to chloramphenicol (9.3%-21.3%) and gentamicin (0.9%-7.0%) was observed in pigs and broilers. The highest resistance was noted for ampicillin (32.7%-65.3%), tetracycline (41.3%-67.5%), trimethoprim (32.0%-35.7%) and trimethoprim/sulfamethoxazole (27.5%-49.7%) from pigs and broilers, with marked country differences. MDR peaked in pigs and broilers with 24 and 26 phenotypes, with 21.9%-26.2% and 18.7%-34.1% resistance, respectively.. In this pan-EU survey antibiotic susceptibility of commensal E. coli varied largely between antibiotics, animal species and countries. Resistance to critically important antibiotics for human medicine was absent or low, except for ciprofloxacin in broilers and ampicillin in pigs and broilers.

Topics: Ampicillin; Animals; Anti-Bacterial Agents; Cattle; Chickens; Ciprofloxacin; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Swine; Trimethoprim, Sulfamethoxazole Drug Combination

This experiment was carried out to provide a basis for the treatment of clinical bloodstream infections by analyzing the drug resistance characteristics and integrated gene distribution of Escherichia coli in bloodstream infections in elderly patients. For this aim, E. coli were collected for bacterial identification and drug sensitivity testing from bloodstream infections in elderly patients in the hospital from January 2016 to December 2019. ESBLs positive strains were assayed for genotypes and their integron carriage rates by PCR amplification. The characteristics and differences of various genotype rates were compared and analyzed. Results showed that a total of 230 E. coli strains were isolated. The detection rate of ESBLs-producing bacteria was 37.39 %. ESBLs-producing E. coli showed a high rate of resistance to cefepime, levofloxacin, cotrimoxazole, and ticarcillin/clavulanic acid (>40%). The resistance rate of 230 strains of E. coli to meropenem, minocycline, amikacin, gentamicin and cefoxitin was less than 20%. Among the ESBLs-producing E. coli in bloodstream infections in elderly patients, CTX-M-9 accounted for 27.91%, CTX-M-2 for 17.44%, and SHV for 13.95%. The detection rate of type I integrated genes was 41.30%, and type II and III integrated genes were not detected. ESBLs-producing genotyping-positive bacteria were detected with more than 50% of type I integrated genes. It was concluded that type I integrated genes in ESBLs-producing E. coli isolated from elderly patients carried resistance genes such as CTX-M-9 and CTX-M-2 aggravating multi-drug resistance in bacteria.

Topics: Aged; Amikacin; Anti-Bacterial Agents; beta-Lactamases; Cefepime; Cefoxitin; Clavulanic Acid; Drug Resistance; Escherichia coli; Escherichia coli Infections; Gentamicins; Humans; Integrons; Levofloxacin; Meropenem; Microbial Sensitivity Tests; Minocycline; Sepsis; Ticarcillin; Trimethoprim, Sulfamethoxazole Drug Combination

Escherichia coli is a common pathogen causing invasive bacterial infections in neonates. In recent years, clinical antimicrobial susceptibility testing has demonstrated an increased rate of drug-resistant E. coli infections. This study aimed to analyse the resistance characteristics of E. coli against common antimicrobial agents, and perform multilocus sequence typing (MLST) in clinical strains of E. coli collected from Chinese neonates.. Culture-positive specimens of E. coli were collected from neonates in seven class A tertiary hospitals located in seven cities across different provinces in China between November 2019 and October 2020. E. coli isolated from these specimens were subjected to antimicrobial susceptibility testing (by broth microdilution method), extended-spectrum β-lactamase (ESBL) detection, and MLST.. A total of 223 E. coli strains were isolated, with an overall resistance rate of 87.4%, an ESBL-positive rate of 48.0%, and a multidrug resistance rate of 42.2%. Among the 20 antimicrobial agents tested, E. coli strains showed the highest resistance rates against cefotaxime (59.2%), trimethoprim/sulfamethoxazole (56.5%), doxycycline (39.9%), ciprofloxacin (36.8%), and aztreonam (31.0%). The resistance rates of E. coli strains isolated from children's hospitals against piperacillin/tazobactam, cefotaxime, ciprofloxacin, trimethoprim/sulfamethoxazole, and carbapenems, were significantly higher than those of strains isolated from maternity and child health hospitals. The primary E. coli multilocus sequence types were ST1193, ST95, ST73, ST410, and ST131. The ESBL production rates and multidrug resistance rates of ST1193, ST410, and ST131 were significantly higher than those of ST95 and ST73. Significantly, more strains of E. coli ST1193 and ST410 were isolated from children's hospitals than from maternity and child health hospitals.. The rates of antimicrobial agent resistance in E. coli isolates from hospitalised neonates in China were high. The increased number of strains of E. coli ST1193 and ST410 was the reason for higher resistance rates to multiple antimicrobial agents in E. coli from children's hospitals compared with those from maternal and child health hospitals.

Topics: Anti-Bacterial Agents; Aztreonam; beta-Lactamases; Carbapenems; Cefotaxime; Child; Ciprofloxacin; Doxycycline; Drug Resistance; Escherichia coli; Escherichia coli Infections; Female; Humans; Infant, Newborn; Microbial Sensitivity Tests; Multilocus Sequence Typing; Piperacillin; Pregnancy; Tazobactam; Tertiary Care Centers; Trimethoprim, Sulfamethoxazole Drug Combination

Context: Rising antibiotic resistance has transcended hospital boundaries and impacted individuals with community acquired urinary tract infections (UTI). Scant data on antibiotic resistance in outpatient settings exists and most studies in the United States (U.S.) have identified predictors of resistance in acute-care settings. Objective: Determine the antibiogram among Escherichia coli isolates and factors associated with ciprofloxacin and trimethoprim-sulfamethoxazole (TMP-SMX) resistant gram-negative urinary isolates. Study Design: Retrospective cohort study. Setting: Two primary care, safety-net clinics in Houston, TX between 11/2018 and 3/2020. Population studied: Patients aged 18 and older presenting with provider suspected uncomplicated or complicated UTI. Outcome measures: Resistance and predictors of resistance to UTI-relevant antibiotics. Results: Among 1265 cultures collected, 372 (28.4%) were positive. We detected E. coli (50.3%) and Group B Streptococcus (18.6%) most frequently. Our patient population consisted mostly of Hispanic (75.7%) females (92.5%) born outside the U.S. (67.3%) with a mean age of 47. Among patients with E. coli isolated (n=189), antibiotic resistance was highest to ampicillin (63%), TMP-SMX (44%), ciprofloxacin (31%), and cefazolin (30%); no or low resistance against amikacin (0%), fosfomycin (0%), and nitrofurantoin (2.7%) was detected. Approximately 12% of E. coli isolates were extended-spectrum beta-lactamase positive. Having a prior UTI caused by a TMP-SMX resistant gram-negative organism and being born outside the U.S increased the odds of TMP-SMX resistance by 3.71 (95% confidence interval: 1.6-9.2) and 3.08 (95% CI: 1.6-6.3), respectively. Having a complicated UTI (odds ratio (OR): 3.58; 95% CI: 1.1-12.1), prior fluoroquinolone use (OR: 6.81; 95% CI: 1.7-34.1) and a prior UTI with ciprofloxacin resistance (OR: 7.84; 95% CI: 3.2-20.7) increased the odds of having a ciprofloxacin resistance. Conclusion: The Infectious Disease Society of America cautions against prescribing an antibiotic if regional resistance exceeds 20%. We constructed an antibiogram and found resistance surpassed this threshold for TMP-SMX and ciprofloxacin and identified factors associated with resistance to these agents. Assessing these characteristics during clinical decision making may improve antibiotic-organism susceptibility concordance in primary care.

Topics: Anti-Bacterial Agents; Ciprofloxacin; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Outpatients; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Bacteria are the commonest etiological factor among the microbes that cause UTIs. The most prevalent bacteria identified in the lab are Escherichia coli, Klebsiella pneumonia and Pseudomonas aeruginosa. Antibiotics are the empiric therapy for such infections but the reoccurrence rate is becoming high owing to the development of resistance due to their irrational and indiscriminate use across the globe. This study was designed on UTI cases of OPD, Medical, Nephrology, Surgical, Main OT, Urology and ICU wards of Allied hospital Faisalabad. 11 antibiotics were used which showed that E. coli is sensitive to Amikacin, Gentamicin, Imipenem, Piperacillin tazobactam, and Polymyxin B. Klebsiella pneumonia showed sensitivity for Amikacin, Gentamicin, Nitrofurantoin, Imipenem, Polymyxin B, Piperacillin tazobactam and Trimethoprim-sulfamethoxazole. While Pseudomonas aurignosa showed resistance to Amikacin, Ciprofloxacin, Gentamicin, Piperacillin tazobactam, Imipenem, and Polymyxin B. E. coli exhibited the highest sensitivity for Piperacillin tazobactam, Klebsiella pneumonia for Imipenem and Pseudomonas aurignosa for Ciprofloxacin. Further, the isolated DNA samples of these microorganisms were confirmed by gel electrophoresis and subjected to molecular characterization by performing trace file and phylogenetic tree analysis.

Topics: Amikacin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Gentamicins; Humans; Imipenem; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Nitrofurantoin; Oxacillin; Pakistan; Pipemidic Acid; Piperacillin, Tazobactam Drug Combination; Polymyxin B; Pseudomonas aeruginosa; Pseudomonas Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The rising rates of antibiotic resistance increasingly compromise empirical treatment. Knowing the antibiotic susceptibility of a pathogen's close genetic relative(s) may improve empirical antibiotic selection. Using genomic and phenotypic data for

Topics: Anti-Bacterial Agents; Area Under Curve; Databases, Genetic; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Genome, Bacterial; Genomics; Humans; Microbial Sensitivity Tests; Models, Biological; Ontario; Predictive Value of Tests; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Wide-spectrum antibiotics have been favored to treat acute uncomplicated cystitis (AUC) for a long time, leading to the emergence of multi-drug resistant bacteria. We hypothesize that narrow-spectrum antibiotics might mitigate the issue and aim to investigate the clinical efficacy of cefaclor in patients with AUC.. We retrospectively reviewed the clinical data of female outpatients with AUC treated with cefaclor and evaluated the safety and clinical efficacy. Clinical cure was defined as the elimination of clinical symptom under 4 white blood cells (WBCs) per high power field on microscopy.. Overall, 223 women with AUC were enrolled. Escherichia coli was the dominant pathogen (n = 160; 68.6%), followed by Klebsiella species and E. coli-extended spectrum β-lactamase (ESBL) (n = 19; 8.1% and n = 18; 7.7%). Overall success rate was 94.0% (n = 219) and susceptibility rate of cefazolin was 84.1%, which was close to that of levofloxacin (82.9%). Ampicillin showed the lowest rate of 63.7% with a significantly greater resistance rate of 35.3% among all antibiotics (P < 0.001). In the subgroup analysis, the success rate in patients with resistance to levofloxacin or cefazolin was 100% (n = 24) or 93.3% (n = 14). The rate in patients with resistance to both antibiotics was 60.0% (n = 9), and the pathogens in the other 40.0% (n = 6) of patients with treatment failure were E. coli-ESBL.. Cefaclor showed excellent efficacy in AUC patients, even in those with in vitro resistance to cefazolin or levofloxacin. Cefaclor may be considered as a first-line option in patients with AUC and a second-line option for those with levofloxacin treatment failure.

Topics: Adult; Aged; Aged, 80 and over; Amikacin; Ampicillin; Anti-Bacterial Agents; beta-Lactam Resistance; Cefaclor; Cefazolin; Cystitis; Drug Resistance, Multiple, Bacterial; Escherichia coli Infections; Female; Fosfomycin; Humans; Klebsiella Infections; Levofloxacin; Microbial Sensitivity Tests; Middle Aged; Proteus Infections; Retrospective Studies; Staphylococcal Infections; Treatment Failure; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

Diabetic patients are more susceptible to urinary tract infection compared to nondiabetic patients,. Total of 1,099 clean-catch mid stream urine (CCMSU) was processed by standard microbiological technique; 182 were from the diabetic group and 917 nondiabetic. Following identification, all isolates were subjected to antibiotic susceptibility testing using modified Kirby-Bauer disc diffusion method. In-vitro biofilm forming capacity of the isolates were detected by Microtitre plate method. The data were analyzed using SPSS software 16.. Urinary tract infection was found to be significantly higher in diabetic patients (42.9%) compared to nondiabetic patients (17.4%) with. Elderly populations with diabetes are at a higher risk of UTI. Higher biofilm production and resistance to in-use antimicrobial agents in this study render its inefficacy for empirical treatment and point out the importance of biofilm screening to ensure the effective management of infection.

Topics: Adolescent; Adult; Aged; Amikacin; Amoxicillin; Anti-Bacterial Agents; Biofilms; Cross-Sectional Studies; Diabetes Complications; Diabetes Mellitus; Disk Diffusion Antimicrobial Tests; Drug Resistance, Multiple, Bacterial; Escherichia coli Infections; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Uropathogenic Escherichia coli; Young Adult

Bacterial infection of the urinary tract is among the common reasons for seeking medical attention in the community. Rapidly increasing antibiotic resistance of uropathogens is resulting in limited treatment options. Therefore, knowledge of the current uropathogens and their antibiotic susceptibility is important for better treatment of urinary tract infection.. A cross-sectional study design was conducted from February to September thirty, 2017 among students who came to Mekelle University student's clinics with symptomatic urinary tract infection during the study period.. Mid-stream urine specimens were collected from 341individuals with suspected urinary tract infection for bacteriological identification and antimicrobial susceptibility testing. Data on socio-demographic, clinical and risk factors were also collected using a structured questionnaire.. Among the 341 study participants, 72(21.1%) showed significant bacteriuria. Escherichia coli (48.6%), Coagulase-negative staphylococci (23%), Staphylococcus aureus (13.5%), and Klebsiella spp. (8.1%) were common bacterial isolates. Resistance to ampicillin (81-100%), amoxicillin/clavulanic acid (77-93.6%), co- trimoxazole (55 72.3%), nalidixic acid (57.4%) and tetracycline (46-55.5%) was seen by most isolates. Multidrug resistance was observed in 73% of the bacterial isolates, and 25.5% of the Gram-negative isolates were extended-spectrum beta-lactamase producers. Being female, a history of urinary tract infection, a history of catheterization and frequent sexual activity were found to be statistically associated with urinary tract infection.. Urinary tract infection is a problem among university students with a prevalence of 21.1%. All isolates have developed resistance to most of the commonly used antibiotics. Therefore, health education on the transmission and causes of urinary tract infection are recommended for the students.

Topics: Adolescent; Adult; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Bacteriuria; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Ethiopia; Female; Humans; Microbial Sensitivity Tests; Prevalence; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Students; Trimethoprim, Sulfamethoxazole Drug Combination; Universities; Young Adult

Topics: Animals; Anti-Bacterial Agents; Benzalkonium Compounds; Biguanides; Biofilms; Catheter-Related Infections; Cell Line; Ciprofloxacin; Disinfectants; Drug Resistance, Bacterial; Escherichia coli Infections; Gentamicins; L Cells; Mice; Microbial Sensitivity Tests; Moths; Nitrofurantoin; Silver Nitrate; Triclosan; Trimethoprim, Sulfamethoxazole Drug Combination; Uropathogenic Escherichia coli; Virulence

To identify plasmid-mediated colistin resistance in clinical Enterobacteriaceae isolates in Oman, where this resistance mechanism has not been encountered yet.. Twenty-two colistin-resistant Enterobacteriaceae clinical isolates collected between July 2014 and June 2016 in a tertiary care hospital in Muscat were screened by PCR for the mcr-1 and mcr-2 genes. The strain identified as mcr-1 positive was genotyped and its antibiotic susceptibility was established. The mcr-1 containing plasmid was mobilized into Escherichia coli K-12 and its sequence was determined.. A single E. coli isolate (OM97) carrying mcr-1 gene was identified, while no strains carrying the mcr-2 gene was found. E. coli OM97 was isolated in June 2016 from blood culture of a male patient with multiple comorbidities. It belonged to ST10. Beyond colistin, it was resistant to amoxicillin-clavulanic acid, piperacillin-tazobactam, amikacin, ciprofloxacin, tetracycline, and cotrimoxazole. The mcr-1 gene was located on a conjugative IncI2-type plasmid of 63722 bp size, which did not harbor any further resistance genes. The genetic surrounding of the mcr-1 gene lacked the ISApl1 element.. Although colistin resistance caused by the mcr-1 gene is not common in our collection of clinical isolates, the occurrence of the plasmid-mediated colistin resistance in an E. coli ST10 strain is of concern as this clonal group was already shown to spread ESBL genes and quinolone resistance worldwide. It is especially worrisome that as the mcr-1 gene occurred in a non-ESBL, carbapenem-susceptible E. coli strain, current susceptibility testing algorithms may not detect its presence.

Topics: Amikacin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Ciprofloxacin; Colistin; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Gene Expression; Humans; Membrane Proteins; Microbial Sensitivity Tests; Oman; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Plasmids; Protein Isoforms; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

The emergence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) infections requires re-assessment of therapeutic choices. Here we report the efficacy of cefoxitin-based antibiotic therapy for ESBL-E prostatitis. A prospective study including patients with ESBL-E prostatitis resistant to trimethoprim/sulfamethoxazole and fluoroquinolones from January 2014 to March 2016 was conducted. Cefoxitin was administered by continuous infusion for 3 weeks in the case of acute bacterial prostatitis or 6 weeks in the case of chronic bacterial prostatitis (CBP), with intravenous fosfomycin for the first 5 days. Urological investigations were performed to diagnose underlying urinary tract pathology. Clinical and microbiological efficacy were evaluated 3 months (M3) and 6 months (M6) after the end of therapy. A total of 23 patients were included in the study. The median patient age was 74 years (range 48-88 years). Of the 23 infections, 14 (61%) were CBP and 12 (52%) were healthcare-associated infections. The bacteria involved were Escherichia coli in 11 cases, Klebsiella pneumoniae in 10 cases and Klebsiella oxytoca in 2 cases. Clinical cure was observed in 19/23 patients (83%) at M3 and in 17/22 patients (77%) at M6. Urocultures were sterile in 13/23 patients (57%) at M3 and in 9/19 patients (47%) and M6. Urinary colonisation was observed in 6/19 patients (32%) with clinical cure at M3 and 5/14 patients (36%) with clinical cure at M6. No resistance to cefoxitin was detected. Surgical treatment was required for 7/23 patients (30%). In conclusion, cefoxitin-based antibiotic therapy is suitable for difficult-to-treat ESBL-E infections such as prostatitis.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactamases; Cefoxitin; Cross Infection; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Fosfomycin; Humans; Klebsiella Infections; Klebsiella oxytoca; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Middle Aged; Pilot Projects; Prospective Studies; Prostatitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To estimate the prevalence of antibiotic resistance in indicator bacteria Escherichia coli and Enterococci isolated from duck faeces in Morogoro Municipality, Tanzania.. Escherichia coli and Enterococcus isolation rates from ducks faeces were 91 and 100% respectively. The prevalence of antibiotic resistance of E. coli and Enterococcus was 70.3 and 42%, respectively. E. coli resistant to four antibiotics were 28 (30.8%) and showed high resistance to ampicillin (81.3), tetracycline (75.8) and trimethoprim-sulphamethoxine (62.3). Multiple antibiotic resistance of Enterococcus were more than 65%. High resistance rates shown by Enterococcus were observed in rifampin (62%), ampicillin (62%) and tetracycline (42%). Almost all farmers (92.3%) left their ducks to scavenge for food around their houses. Antibiotics used in animal treatments were oxytetracyclines, sulfonamides, penicillin dihydrostreptomycin while in humans were tetracycline, ampicillin, and amoxicillin.

Topics: Ampicillin; Animals; Anti-Bacterial Agents; Asymptomatic Diseases; Drug Resistance, Multiple, Bacterial; Ducks; Enterococcus; Escherichia coli; Escherichia coli Infections; Feces; Female; Humans; Male; Microbial Sensitivity Tests; Poultry; Poultry Diseases; Rifampin; Streptococcal Infections; Tanzania; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Our study aimed to investigate colistin resistance and the mechanisms involved in a collection of 35 extended-spectrum beta-lactamase (ESBL) and 13 CMY-2-producing E. coli strains which were previously recovered from chicken gut microbiota in Tunisia, as well as to determine the genetic location of mcr genes. Forty-eight ESBL and CMY-2-producing E. coli strains were obtained from 137 fecal samples of healthy chickens during 2013. These strains were tested for colistin resistance by the broth microdilution method, and screened for mcr-1 and mcr-2 genes by PCR. Two of these strains were colistin-resistant (MIC = 8 mg/L). Both harbored the mcr-1 gene, were CMY-2 producers, and were additionally resistant to tetracycline, ciprofloxacin, chloramphenicol, gentamicin, tobramycin and trimethoprim-sulfamethoxazole. They shared phylogroup A, the same pulsed-field gel electrophoresis (PFGE)-pattern, and were typed as ST2197. In both strains, ISApl1 and pap2 were detected upstream and downstream of mcr-1 gene, respectively. The analysis of the two mcr-1-positive strains and their transconjugants by PCR-based replicon typing and S1-PFGE, demonstrated that mcr-1 gene is linked to an IncP plasmid (~242 kb), and bla

Topics: Animals; Anti-Bacterial Agents; beta-Lactamases; Chickens; Colistin; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Farms; Feces; Gastrointestinal Microbiome; Gastrointestinal Tract; Humans; Microbial Sensitivity Tests; Plasmids; Poultry; Trimethoprim, Sulfamethoxazole Drug Combination; Tunisia

Avian pathogenic Escherichia coli (APEC) causes airsacculitis, polyserositis, septicemia, and other mainly extraintestinal diseases in chickens, ducks, geese, pigeons, and other avian species, and is responsible for great economic losses in the avian industry. The autoinducer 2 (AI-2) quorum sensing system is widely present in many species of gram-negative and gram-positive bacteria and has been proposed to be involved in interspecies communication. In clinical APEC strains, whether or not AI-2 affects the expression of antibiotic-related genes has not been reported. In this study, we have reported that exogenous AI-2 increase the susceptibility of APEC strains to trimethoprim-sulfamethoxazole (SXT) in a folate synthesis-dependent pathway but not in the LsrR-dependent manner. Our results further explained that exogenous AI-2 can down regulate the transcription of the folate synthetase encoding genes folA and folC, and the folate synthesis-related genes luxS, metE, and metH. Gel shift assays confirmed that LsrR, the AI-2 receptor, did not bind to the promoters of folA and folC, suggesting that exogenous AI-2 might influence folate metabolism by a feedback inhibition effect but not in the LsrR-dependent pathway. This study might provide further information in the search for potential drug targets for prophylaxis of avian colibacillosis and for auxiliary antibiotics in the treatment of avian colibacillosis.

Topics: Animals; Chickens; Columbidae; Ducks; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Folic Acid; Gene Expression Regulation, Bacterial; Homoserine; Lactones; Methyltransferases; Poultry Diseases; Quorum Sensing; Repressor Proteins; Trimethoprim, Sulfamethoxazole Drug Combination

The incidence of drug-resistant community-acquired urinary tract infections (CA-UTI) continues to increase worldwide. In 1999 to 2000, a single lineage of uropathogenic

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; California; Ciprofloxacin; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Escherichia coli Infections; Female; Genotype; Humans; Male; Microbial Sensitivity Tests; Multilocus Sequence Typing; Prevalence; School Health Services; Trimethoprim, Sulfamethoxazole Drug Combination; Universities; Urinary Tract Infections; Uropathogenic Escherichia coli

In a study of 39 isolates of Edwardsiella piscicida made from Korean aquaculture sites, sul genes were detected in 16 isolates and dfr genes in 19. Ten isolates were shown to contain both sul and dfr genes. MIC and disc diffusion zones assays were performed to measure the phenotypic susceptibilities of the 39 isolates. Normalized resistance interpretation was applied to these data to categorize isolates as either fully susceptible or as manifesting reduced susceptibility. The standard CLSI protocols specify the use of a mixture of sulfamethoxazole/trimethoprim (20:1) in both MIC and disc diffusion tests. Using the CLSI MIC protocol, 100% of the isolates containing dfr genes, but only 75% of the isolates containing sul genes, were categorized as manifesting reduced susceptibility. Using the CLSI disc diffusion protocol, only 58% of the isolates containing dfr genes and 69% of those containing sul genes were categorized as manifesting reduced susceptibility. When the single agent trimethoprim was substituted for the combined mixture in both the MIC and disc diffusion protocols, 100% of the dfr-positive isolates were categorized as NWT. When the single-agent sulfamethoxazole was substituted, the analysis of the MIC characterized 100% and the disc zone data 94% of the sul-positive isolates as manifesting reduced susceptibility. It is argued that the use of trimethoprim and sulfamethoxazole as single agents in phenotypic susceptibility tests would provide more meaningful data than the currently recommended use of these two agents combined.

Topics: Animals; Anti-Bacterial Agents; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Edwardsiella; Eels; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Genotype; Microbial Sensitivity Tests; Phenotype; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Failure to timely diagnose and treat urinary tract infections is associated with grave long term consequences. The objectives of this study included assessing the proportion and predictors of Urinary Tract Infection (UTI) as a cause of pediatric outpatient department (OPD) visits and determining common uropathogens with antimicrobial susceptibility pattern.. A cross sectional study was conducted from May to September 2015 among children of less than 15 years old at a tertiary center in Hawassa, Ethiopia. Children who fulfilled predefined eligibility criteria were recruited to undergo urine culture and urine analysis.. A total of 863 children visited the OPD during the study period among which 269(31.2%) fulfilled the predefined eligibility criteria. Urine culture was positive for 74/269(27.5%) of the clinically suspected children. Male uncircumcision (adjusted odds ratio (aOR) 3.70; 95% CI 1.34-10.16) and under nutrition (aOR 5.41; 95%CI 2.64-11.07) were independent predictors of culture positivity. More than 5 WBC per high power field (aOR 4.7, 95% CI 1.8-12.7) on microscopy, urine PH > 5.0 (aOR 2.6, 95%CI 1.2-5.8), and positive leukocyte esterase (aOR 9.9, 95%CI 4.1-25.7) independently predicted positive growth on urine culture. Escherichia coli (34/74, 45.9%) and Klebsiella spp (18/74, 24.3%) were the most frequent isolates. High resistance was noted against amoxicillin (70.6%) and cotrimoxazole (97.1%) by E. coli.. UTI accounted for a tenth of total OPD visits. Commonly used first line antibiotics showed high level resistance to common etiologies of UTI. UTI should be suspected in febrile children, and antibiograms should be done to tailor prescription of antibiotics.

Topics: Adolescent; Ambulatory Care Facilities; Amoxicillin; Anti-Bacterial Agents; Bacteria; Child; Child, Preschool; Cross-Sectional Studies; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Ethiopia; Female; Fever; Humans; Incidence; Infant; Klebsiella; Male; Microbial Sensitivity Tests; Pediatrics; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Trueperella pyogenes is one of the most important microorganisms causing metritis in post-partum cattle. Co-infection with other bacterial species such as Escherichia coli or Fusobacterium necrofurom increases the severity of the disease and the persistence of bacteria in utero. The aim of this study was to investigate the frequency of T. pyogenes strains, and their virulence and antimicrobial resistant profiles in metritis cases. The study was carried out on 200 samples obtained from metritis discharges of postpartum cattle on 18 farms around Tehran, Iran. Sixty-five T. pyogenes isolates (32.5%) were identified, of which 16 isolates were detected as pure cultures and the other 49 isolates from cultures most commonly mixed with E. coli or F. necrofurom. In terms of diversity in biochemical characteristic of T. pyogenes strains, 8 different biotypes were identified among the isolates. Single or multi antimicrobial resistance was observed in 48 isolates (73.9%), which was mostly against trimethoprim sulfamethoxazole, azithromycin, erythromycin and streptomycin. The tetracycline resistance gene tetW and macrolide resistance genes ermB and ermX were detected in 30, 18 and 25 isolates, respectively. In the screening of genes encoding virulence factors, fimA and plo genes were identified in all tested isolates. Genes encoding nanP, nanH, fimC, fimG, fimE and cbpA were detected in 50, 54, 45, 40, 50 and 37 of isolates, respectively. Thirteen different genotypes were observed in these T. pyogenes isolates. A significant association between clonal types and virulence factor genes, biochemical profile, CAMP test result, severity of the disease and sampling time was detected.

Topics: Actinomycetaceae; Actinomycetales Infections; Animals; Anti-Bacterial Agents; Azithromycin; Bacterial Typing Techniques; Cattle; Clone Cells; Drug Resistance, Multiple, Bacterial; Erythromycin; Escherichia coli; Escherichia coli Infections; Female; Fusobacterium; Fusobacterium Infections; Genes, Bacterial; Iran; Parturition; Puerperal Infection; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination; Uterus; Virulence Factors

Antibiotic resistance is a global concern, although it has been studied most extensively in developed countries. We studied

Topics: Ampicillin; Animals; Animals, Domestic; Animals, Wild; Anti-Bacterial Agents; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Feces; Humans; Integrons; Livestock; Microbial Sensitivity Tests; Primates; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination; Uganda

Antimicrobial resistance data from surveillance networks are frequently do not accurately predict resistance patterns of urinary tract infections at the bedside.. To determine simple patient- and institution-related risk factors affecting antimicrobial resistance patterns of Escherichia coli urine isolates.. From January 2012 to May 2015 all consecutive urine samples with significant growth of E. coli (≥103 CFU/ml) obtained from a tertiary care hospital were analysed for antimicrobial susceptibility and related to basic clinical data such a patient age, ward, sample type (catheter vs non-catheter urine).. Antimicrobial susceptibility testing was available for 5246 E. coli urine isolates from 4870 patients. E. coli was most commonly resistant to amoxicillin (43.1%), cotrimoxazole (24.5%) and ciprofloxacin (17.4%). Resistance rates were low for meropenem (0.0%), fosfomycin (0.9%) and nitrofurantoin (1.5%). Significantly higher rates of resistance to ciprofloxacin (32.8 vs 15.8%) and cotrimoxazole (30.6 vs 23.9%) were found in urological patients compared with patients on other wards (p <0.01). In multivariable analysis, predictors for E. coli resistance against ciprofloxacin and cotrimoxazole were: treatment in the urological unit (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.63-2.54; p <0.001 and OR 1.33, 95% CI 1.07-1.64; p = 0.010, respectively), male sex (OR 1.93, 95% CI 1.630-2.29; p <0.001 and OR 1.22, 95% CI 1.22-1.04; p = 0.015), and only to a lesser extent urine samples obtained from indwelling catheters (OR 1.30, 95% CI 1.05-1.61; p = 0.014 and OR 1.26, 95% CI 1.04-1.53; p = 0.020). Age ≥65 years was associated with higher resistance to ciprofloxacin (OR 1.42, 95% CI 1.21-1.67; p <0.001), but lower resistance to cotrimoxazole (OR 0.76, 95% CI 0.67-0.86; p <0.001).. Simple bedside patient data such as age, sex and treating hospital unit help to predict antimicrobial resistance and can improve the empirical treatment of urinary tract infections.

Topics: Age Factors; Amoxicillin; Anti-Bacterial Agents; Catheters, Indwelling; Ciprofloxacin; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Hospitals; Humans; Male; Middle Aged; Retrospective Studies; Sex Factors; Switzerland; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urology Department, Hospital

Despite the known clonal distribution of antibiotic resistance in many bacteria, empiric (pre-culture) antibiotic selection still relies heavily on species-level cumulative antibiograms, resulting in overuse of broad-spectrum agents and excessive antibiotic/pathogen mismatch. Urinary tract infections (UTIs), which account for a large share of antibiotic use, are caused predominantly by Escherichia coli, a highly clonal pathogen. In an observational clinical cohort study of urgent care patients with suspected UTI, we assessed the potential for E. coli clonal-level antibiograms to improve empiric antibiotic selection. A novel PCR-based clonotyping assay was applied to fresh urine samples to rapidly detect E. coli and the urine strain's clonotype. Based on a database of clonotype-specific antibiograms, the acceptability of various antibiotics for empiric therapy was inferred using a 20%, 10%, and 30% allowed resistance threshold. The test's performance characteristics and possible effects on prescribing were assessed. The rapid test identified E. coli clonotypes directly in patients' urine within 25-35 minutes, with high specificity and sensitivity compared to culture. Antibiotic selection based on a clonotype-specific antibiogram could reduce the relative likelihood of antibiotic/pathogen mismatch by ≥ 60%. Compared to observed prescribing patterns, clonal diagnostics-guided antibiotic selection could safely double the use of trimethoprim/sulfamethoxazole and minimize fluoroquinolone use. In summary, a rapid clonotyping test showed promise for improving empiric antibiotic prescribing for E. coli UTI, including reversing preferential use of fluoroquinolones over trimethoprim/sulfamethoxazole. The clonal diagnostics approach merges epidemiologic surveillance, antimicrobial stewardship, and molecular diagnostics to bring evidence-based medicine directly to the point of care.

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; Cohort Studies; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Evidence-Based Medicine; Gene Frequency; Genotype; Humans; Polymerase Chain Reaction; Polymorphism, Single Nucleotide; Sensitivity and Specificity; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Institutional antibiograms guide Emergency Department (ED) clinicians' empiric antibiotic selection. For this study, we created and compared antibiograms of ED patients stratified by disposition (admitted or discharged).. We conducted a cross-sectional study at two hospitals for 2014, comparing antibiograms limited to Escherichia coli urinary tract infections. Study-Specific Antibiograms, created for the study, excluded polymicrobial samples and multiple cultures from the same patient. Study-Specific Antibiograms were arranged by patient disposition: admitted (IP-Only) vs discharged from the ED (ED-Only). Antibiogram data were presented as average antibiotic sensitivities with 95% confidence intervals and demographic data as medians with interquartile ranges. Sensitivities between Study-Specific Antibiograms were compared by Fisher's Exact Test, alpha=0.05, 2 tails.. For Hospital A, 13 antibiotics were compared between Study-Specific ED-Only (n=313) vs IP-Only (n=244). We found that sensitivities to all four antibiotics appropriate for empiric outpatient therapy by Infectious Disease Society of America guidelines were significantly (p<0.0001) higher in the ED-Only compared to IP-Only groups: ciprofloxacin 80% (76-90%) vs 60% (53-69%), levofloxacin 81% (77-91%) vs 63% (57-72%), nitrofurantoin 75% (70-84%) vs 51% (44-58%), and trimethoprim/sulfamethoxazole 73% (68-82%) vs 58% (52-67%). For Hospital B, 14 antibiotics were compared between Study-Specific ED-Only (n=256) and IP-Only (n=168). Two out of the five appropriate empiric outpatient antibiotics had significantly (p<0.0001) higher sensitivities for ED-Only compared to IP-Only: ciprofloxacin 87% (83-91%) vs 71% (64-78%) and levofloxacin 86% (82-91%) vs 71% (65-78%).. We found higher antibiotic sensitivities in ED-Only than the IP-Only Study-Specific Antibiograms. Our Study-Specific Antibiograms offer an alternative guide for antibiotic selection in the ED.

Topics: Adult; Aged; Anti-Bacterial Agents; Ciprofloxacin; Cross-Sectional Studies; Drug Resistance, Bacterial; Emergency Service, Hospital; Escherichia coli; Escherichia coli Infections; Female; Humans; Levofloxacin; Male; Microbial Sensitivity Tests; Middle Aged; Nitrofurantoin; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Several studies showed that a substantial decline in the use of co-trimoxazole did not result in a decline in resistance rates among Escherichia coli isolates. Since mathematical models have shown that it may take decades before resistance rates start to decline to relevant levels, we performed a new analysis using more recently collected data.. Data were extracted from Guy's and St Thomas' Hospitals Transmission and Antimicrobial Record database which contains microbiological test results from all specimens tested between 2002 and 2014. We selected all blood samples positive for E. coli which were tested for resistance against co-trimoxazole. Prevalence of co-trimoxazole resistance among the tested samples by year was modelled by a Poisson model.. Almost all (96%) of E. coli blood isolates were tested for co-trimoxazole resistance. In total, 2070 E. coli isolates were available for analyses. Resistance to co-trimoxazole fluctuated over the years, but there was no clear increasing or decreasing trend; the annual percentage change in the prevalence of co-trimoxazole resistance was 0.52 (95% confidence interval -0.75% to 1.81%). Including co-trimoxazole or trimethoprim use in the year before the sample was taken did not improve the model.. The prevalence of co-trimoxazole resistance among E. coli blood isolates remained high, almost three decades after a substantial decline in co-trimoxazole use. Our results further emphasize the importance of prudent antibiotics use, as antibiotic resistance may not always be easily reversible.

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; England; Escherichia coli; Escherichia coli Infections; Hospitals; Humans; Microbial Sensitivity Tests; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The aim of the current study was to compare community-acquired acute pyelonephritis (CA-APN) with health care-associated acute pyelonephritis (HCA-APN), describe the outcomes, and identify variables that could predict antimicrobial susceptibility. We conducted an observational study that included all consecutive episodes of acute pyelonephritis (APN) in adults during 2014 at a Spanish university hospital. From each episode, demographic data, comorbidities, clinical presentation, microbiological data, antimicrobial therapy, and outcome were recorded. A multivariable logistic regression model was performed to define the variables associated with antimicrobial resistance. A total of 607 patients, 503 (82.9%) with CA-APN and 104 (17.1%) with HCA-APN, were included in the study. Patients with HCA-APN were older than patients with CA-APN (70.4 versus 50.6 years;

Topics: Acute Disease; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Cefuroxime; Ciprofloxacin; Cohort Studies; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Empirical Research; Escherichia coli; Escherichia coli Infections; Female; Hospitals, University; Humans; Logistic Models; Male; Microbial Sensitivity Tests; Middle Aged; Pyelonephritis; Risk Factors; Spain; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Cotrimoxazole is widely used, particularly as a prophylactic drug in HIV patients. We assessed resistance mechanisms among cotrimoxazole resistant-Gram negative bacterial isolates (n = 123) obtained from blood (n = 69) and urine (n = 54) from Tanzanian patients. sul genes were detected in 98% (121/123) of the isolates. Coexistence of sul1 and sul2 was common (49/123). The dfr genes were found in 63% (77/123) of all isolates. sul1, dfrA15, and dfrA5 genes predominated among Klebsiella pneumoniae, while sul2 and dfrA1 genes were frequent in Escherichia coli isolates. Two isolates, both K. pneumoniae, carried sul3. Integrons were detected in 81.3% (100/123) of all isolates. Class 1 integrons were found in 95% (42/44), 53% (23/43), and 80.6% (25/31) of K. pneumoniae, E. coli, and other Enterobacteriaceae isolates, respectively. Class 2 integrons were found in 14% of E. coli, but not in K. pneumoniae. All sul1 genes in K. pneumoniae were carried in class 1 integrons. Gene cassette arrays dfrA5 and dfrA15-aadA1 were most frequently associated with class 1 integrons, while class 2 integrons contained only dfrA1-sat2-aadA1 gene cassettes. This is the first report of sul3 gene in K. pneumoniae from human sources. The finding that mechanisms differ between E. coli and K. pneumoniae may broaden our understanding of cotrimoxazole resistance.

Topics: Anti-Bacterial Agents; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Genes, Bacterial; Humans; Integrons; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Prospective Studies; Tanzania; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Amoxicillin; Ampicillin; Anti-Bacterial Agents; beta-Lactamase Inhibitors; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; United States; United States Department of Veterans Affairs; Urinary Tract; Urinary Tract Infections; Veterans

The Infectious Diseases Society of America guidelines recommend either 14 days of trimethoprim-sulfamethoxazole (TMP-SMX) or 7 days of ciprofloxacin for the treatment of pyelonephritis. Antibiotic courses of 7 days of TMP-SMX vs 7 days of ciprofloxacin for pyelonephritis have not been previously compared. We evaluated the odds of a subsequent, symptomatic urinary tract infection (UTI) for women with Escherichia coli pyelonephritis receiving a 7-day course of TMP-SMX vs a 7-day course of ciprofloxacin.. Women ages 16 years and older with E. coli pyelonephritis presenting to 5 health care facilities in the greater Maryland area between 2010 and 2016 receiving either TMP-SMX or ciprofloxacin were included. Patients were excluded if they met any of the following criteria: (a) pregnancy, (b) dialysis dependency, (c) E. coli not susceptible to the treatment prescribed, (d) polymicrobial urine culture, or (e) >48 hours of antibiotic therapy other than TMP-SMX or ciprofloxacin.. Of 272 women meeting eligibility criteria, 81 (30%) and 191 (70%) received 7 days of TMP-SMX and 7 days of ciprofloxacin, respectively. In an adjusted model, the likelihood of a recurrent UTI within 30 days for the TMP-SMX and ciprofloxacin groups was similar (adjusted odds ratio 2.30; 95% confidence interval, 0.72-7.42).. Our findings suggest that 7 days of TMP-SMX therapy may result in similar clinical outcomes compared with 7 days of ciprofloxacin for the treatment of pyelonephritis. Considering the frequency of pyelonephritis and risks of antibiotic resistance and associated toxicities, decreasing the duration of antibiotic therapy for pyelonephritis may impact a large number of women.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Ciprofloxacin; Drug Administration Schedule; Drug Resistance, Bacterial; Escherichia coli Infections; Female; Humans; Middle Aged; Pyelonephritis; Recurrence; Retrospective Studies; Risk Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Diarrheagenic E. coli (DEC) isolates were recovered from local retail markets and the Osaka Municipal Central Wholesale Market in Japan. Retail food samples were collected for analysis in Osaka Japan from 2005 to 2008 and consisted of 32 beef, 28 pork, 20 poultry, 136 fish, 66 fruits and vegetables and 51 ready-to-eat (RTE) food samples. A total of 82 DEC strains were recovered from 64 (19%) food samples with the highest prevalence in poultry (100%, 20/20), followed by pork (54%, 15/28), beef (28%, 9/32), fruits and vegetables (12%, 8/66), fish (6.6%, 9/136) and RTE foods (5.9%, 3/51). Most of the strains belonged to E. coli possessing the enteroaggregative E. coli (EAEC) heat-stable enterotoxin 1 (EAST1) gene (EAST1EC; n=62, P<0.0001) and enteropathogenic E. coli (EPEC; n=16, P<0.01), whereas only 1 strain belonged to Shiga toxin-producing E. coli (STEC), 1 to EAEC and 2 to enterotoxigenic E. coli (ETEC) strains. Of the 82 DEC isolates, 22 O and 13H serogroups were detected, including some specific serogroups (O91, O103, O115, O119, O126, and O157) which have been associated with human diarrheal infections. Phylogenetic group A and B1 were predominant among the DEC isolates. Antimicrobial resistance to tetracycline was most common (49%), followed by nalidixic acid (28%), ampicillin (24%), sulfamethoxazole/trimethoprim (20%), and cephalothin (18%). All isolates were susceptible to aztreonam. Of the resistant strains, 44% (22/50) demonstrated resistance to >3 antimicrobial agents. Isolates resistant to >5 antimicrobials were only found in the meat samples, while isolates from the fruits and vegetables as well as RTE foods showed resistance to only 1 or 2 antimicrobial agents. Sixty one percent of EAST1EC, 56% of EPEC and all of the EAEC and ETEC were resistant to at least 1 antimicrobial agent. Multiple-locus variable-number tandem repeat analysis (MLVA) was used in this study for genotyping of DEC. The 82 isolates collected for this study showed 77 distinct MLVA profiles located among 3 branches. The Simpson's Index of Diversity (D) was 99.9% at its highest. The high diversity of these food strains would suggest their originating from a variety of sources and environments. In conclusion, retail food samples in Japan were contaminated with DEC; EAST1EC, a putative DEC, were detected at high rates in poultry, pork and beef. Isolates resistant to >3 antimicrobials were found only in raw meat and fish. Food animals may act as the reservoir for multi-resistant

Topics: Ampicillin; Animals; Anti-Bacterial Agents; Cattle; Cephalothin; Enteropathogenic Escherichia coli; Enterotoxigenic Escherichia coli; Enterotoxins; Escherichia coli Infections; Escherichia coli Proteins; Food Contamination; Food Microbiology; Fruit; Humans; Japan; Microbial Sensitivity Tests; Minisatellite Repeats; Nalidixic Acid; Prevalence; Red Meat; Seafood; Swine; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vegetables; Virulence Factors

To identify risk factors for antibiotic resistance to Escherichia coli (E. coli) in children with urinary tract infections (UTIs) in emergency room and primary care clinics.. This is a cross-sectional study of children 0 to 18 years of age reported to have E coli-positive UTIs whose medical and laboratory records were systematically reviewed.. Compared with girls, boys were 2.29 times (confidence interval [CI] = 1.30-4.02) more likely to have E coli isolates resistant to ampicillin and 2 times more likely (CI = 1.13-3.62) to have isolates resistant to trimethoprim-sulfamethoxazole (TMP/SMX). Patients with genitourinary abnormalities were 1.57 times more likely to be resistant to ampicillin (CI = 1.03-2.41) and 1.86 times to TMP/SMX (CI = 1.18-2.94).. Higher rates of ampicillin and TMP/SMX resistant urinary E coli isolates were observed among boys and children with a history of genitourinary abnormality. Age and recent antibiotic prescription are also potential risk factors for resistance.

Topics: Adolescent; Ampicillin; Anti-Bacterial Agents; Child; Child, Preschool; Cross-Sectional Studies; Drug Resistance, Bacterial; Emergency Service, Hospital; Escherichia coli; Escherichia coli Infections; Female; Humans; Illinois; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Primary Health Care; Retrospective Studies; Risk Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinalysis; Urinary Tract Infections

Bolivia is among the lowest-resourced South American countries, with very few data available on antibiotic resistance in bacterial pathogens. The phenotypic and molecular characterization of bacterial isolates responsible for urinary tract infections (UTIs) in the Bolivian Chaco are reported here.. All clinical isolates from UTIs collected in the Hospital Basico Villa Montes between June 2010 and January 2014 were analyzed (N=213). Characterization included susceptibility testing, extended-spectrum beta-lactamase (ESBL) detection, identification of relevant resistance determinants (e.g., CTX-M-type ESBLs, 16S rRNA methyltransferases, glutathione S-transferases), and genotyping of CTX-M producers.. Very high resistance rates were observed. Overall, the lowest susceptibility was observed for trimethoprim-sulphamethoxazole, tetracycline, nalidixic acid, amoxicillin-clavulanic acid, ciprofloxacin, and gentamicin. Of E. coli and K. pneumoniae, 11.6% were ESBL producers. Resistance to nitrofurantoin, amikacin, and fosfomycin remained low, and susceptibility to carbapenems was fully preserved. CTX-M-15 was the dominant CTX-M variant. Four E. coli ST131 (two being H30-Rx) were identified. Of note, isolates harbouring rmtB and fosA3 were detected.. Bolivia is not an exception to the very high resistance burden affecting many South American countries. Optimization of alternative approaches to monitor local antibiotic resistance trends in resource-limited settings is strongly encouraged to support the implementation of effective empiric treatment guidelines.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactamases; Bolivia; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Fosfomycin; Genotype; Humans; Klebsiella Infections; Klebsiella pneumoniae; Methyltransferases; RNA, Ribosomal, 16S; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The aim of the present study was to investigate the prevalence of Diarrheagenic Escherichia coli (DEC) pathotypes, a leading cause of diarrhea worldwide, among diarrheal and healthy children, up to 5 years of age, living in the city of Botucatu, São Paulo, Brazil. DEC, investigated by PCR detection of virulence factor-encoding genes associated with the distinct pathotypes, was isolated from 18.0% of the patients, and 19.0% of the controls, with enteroaggregative E. coli (EAEC), the most frequent pathotype, being detected in equal proportion between patients and controls (10.0%). Among the enteropathogenic E. coli (EPEC) isolates, only one isolate was able to produce the localized adherence pattern to HeLa cells, being thus the only typical EPEC identified. All the remaining EPEC were classified as atypical (aEPEC), and detected in 8.0% and 8.5% of the patients and controls, respectively. Regarding the serotypes, 26.5% of the analyzed EPEC isolates belonged to classical EPEC-serogroups, and the only two STEC found were serotyped as O26:H11 (patient) and O119:H7 (control). Antimicrobial susceptibility tests revealed that 43.6%, 29.5% and 2.6% of the DEC isolates were resistant to ampicillin, cotrimoxazole and gentamicin, respectively. Our data indicate that EAEC remains prevalent among children living in Botucatu, and revealed atypical EPEC as emerging putative diarrheal agents in this geographical region.

Topics: Ampicillin; Anti-Bacterial Agents; Bacterial Adhesion; Bacterial Typing Techniques; Brazil; Child, Preschool; Diarrhea; Drug Resistance, Bacterial; Enteropathogenic Escherichia coli; Escherichia coli Infections; Feces; Female; Genotype; Gentamicins; HeLa Cells; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Prevalence; Serogroup; Trimethoprim, Sulfamethoxazole Drug Combination; Virulence Factors

This study sought to compare the antimicrobial susceptibility rates between acute uncomplicated cystitis patients with failed initial antimicrobial treatment, who were considered unresolved cases, and newly presenting acute uncomplicated cystitis patients without recent antimicrobial use within 3 months and to determine whether different treatment strategies should be applied according to recent antimicrobial exposure (RAE). Female acute uncomplicated cystitis patients with Escherichia coli growth, who visited our hospital's urology department from 2010 to 2014, were divided according to RAE. The antimicrobial susceptibility of E. coli was compared between the group with RAE and the group with no antimicrobial exposure (NAE) within 3 months. The total number of acute uncomplicated cystitis patients with E. coli growth was 259: 40 patients comprised the RAE group and 219 patients formed the NAE group. The mean age was significantly older and previous recurrent cystitis history was higher in the RAE group (p < 0.05). Furthermore, the antimicrobial susceptibility of E. coli to amoxicillin-clavulanic acid, cefotaxime, cefoxitin, ciprofloxacin, and trimethoprim-sulfamethoxazole was significantly lower in the RAE group, with susceptibility results of 64.7%/88.0% (RAE/NAE), 77.5%/89.0%, 79.4%/95.3%, 31.3%/64.2%, and 42.5%/70.6%, respectively. RAE was an independent factor for antimicrobial resistance. This study showed that antimicrobial susceptibilities were significantly lower in acute uncomplicated cystitis patients with failed initial antimicrobial treatment, who are defined as unresolved cases. Our results suggest that first-line antimicrobials might show poor efficacy in cases of unresolved, acute uncomplicated cystitis and alternative or secondary antimicrobials should be considered in these cases.

Topics: Acute Disease; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Cefoxitin; Ciprofloxacin; Cystitis; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Recurrence; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination

A retrospective analysis was performed using The Surveillance Network, USA, to examine the prevalence of antibiotic resistance among urine isolates from U.S. female outpatients in 2012 and assessed trends in antibiotic resistance comparing data from 2003 and 2012. The most common pathogen identified in 2012 (n = 285,325) was Escherichia coli (64.9% of isolates). In 2012, E. coli resistance to nitrofurantoin was low (<3%) across all age groups. E. coli resistance to ciprofloxacin was high among adults (11.8%) and elderly outpatients (29.1%). When comparing the 2003 and 2012 data from isolates from adults, E. coli resistance to nitrofurantoin changed only slightly (from 0.7% to 0.9%), whereas increases in resistance to ciprofloxacin (3.6% to 11.8%) and trimethoprim-sulfamethoxazole (17.2% to 22.2%) changed substantially. In the United States, E. coli has become increasingly resistant to ciprofloxacin and trimethoprim-sulfamethoxazole (TMP-SMX) in adult female outpatients. Nitrofurantoin retains high levels of antibiotic activity against urinary E. coli.

Topics: Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Ciprofloxacin; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Infant; Infant, Newborn; Microbial Sensitivity Tests; Nitrofurantoin; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Escherichia coli O157 (EcO157) infections can lead to serious disease and death in humans. Although the ecology of EcO157 is complex, ruminant animals serve as an important reservoir for human infection. Dairy cattle are unique because they may be a source of contamination for milk, meat, and manure-fertilized crops. Foodborne dairy pathogens such as EcO157 are of primary importance to public health. Antimicrobial resistance (AMR) is a complex phenomenon that complicates the treatment of serious bacterial infections and is of increasing concern. In the face of recommended use restrictions for antimicrobial agents in livestock operations, current AMR patterns in known foodborne pathogens should be documented. The objective of this study was to document AMR patterns in EcO157 isolates from dairies in northern Colorado using antimicrobial agents commonly found on dairies and representative of medically important antimicrobial drug classes. Seventy-five EcO157 isolates were recovered from three dairies. Six isolates were resistant to at least 1 of the 10 tested antimicrobial agents: four were resistant to streptomycin, sulfisoxazole, and tetracycline; one was resistant to streptomycin and tetracycline; and one was resistant to only tetracycline. All resistant isolates were from a single dairy. Overall, a low prevalence (8%) of AMR was observed among the 75 EcO157 isolates. No significant effects on AMR profiles due to virulence genes, parity, or previous antimicrobial treatments within the current lactation period were detected. The results of this study provide background information for future comparative studies investigating AMR trends. Future studies should include more participating farms and more samples and should control for potential confounding factors of AMR that may underlie individual farm variation.

Topics: Animals; Anti-Bacterial Agents; Cattle; Cephalosporins; Colorado; Dairying; Drug Resistance, Multiple, Bacterial; Escherichia coli Infections; Escherichia coli O157; Fluoroquinolones; Food Contamination; Food Microbiology; Microbial Sensitivity Tests; Milk; Penicillins; Red Meat; Sulfonamides; Tetracyclines; Trimethoprim, Sulfamethoxazole Drug Combination

To find the most prevalent organism in diabetic foot ulcers and its drug sensitivity and resistance to different standard antibiotics.. Adescriptive and cross-sectional study.. Ward 7, Jinnah Postgraduate Medical Center, Karachi, from December 2010 to December 2012.. Ninety-five diabetic patients with infected foot wounds of Wegener grade 2 - 5 who had not received any previous antibiotics were included in the study by consecutive sampling. Pus culture specimen from wounds was taken and the organism isolated was identified. Also the most sensitive group of antibiotics and the most resistant one to that organism was noted.. Staphylococcus aureuswas the most prevalent organism constituting 23.16% (n=22) of the organisms isolated; Escherichia coli with 17.89% (n=17) and Klebsiella with 12.63% (n=12) followed. Males presented more with diabetic foot (n=52) out of 95 patients. The most common age group affected was 41 - 60 years (73 patients). The organisms were most sensitive to Meropenem, effective in 90 (95%) patients and most resistant to Cotrimoxazole (80, 84% patients). Out of the 95 patients, 39 (41%) patients were hypertensive, 30 (31.5%) were obese and 14 (15%) were smokers. Staphylococcus aureus was the most prevalent organism overall irrespective to gender, age groups and co-morbidity of the patients.. Staphylococcus aureuswas the most frequent organism in diabetic foot ulcers; the most effective antibiotic is Meropenem and least effective is Cotrimoxazole.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Cross-Sectional Studies; Diabetic Foot; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Klebsiella; Klebsiella Infections; Meropenem; Microbial Sensitivity Tests; Middle Aged; Pakistan; Prevalence; Staphylococcal Infections; Staphylococcus aureus; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection

Escherichia coli is the most common pathogen isolated from both nosocomial and community acquired urinary tract infections. Although there are many studies from different centers concerning the antibiotic susceptibility of E.coli isolates in Turkey, the studies are quite few about class 1 and class 2 integron cassettes in clinical E.coli isolates from urinary samples. The aim of the study was to investigate the antibiotic susceptibility and the carriage of integron gene cassettes in E.coli strains isolated from urinary samples. A total of 626 E.coli strains isolated from urine cultures in microbiology laboratories located at 10 provinces from different regions of Turkey (Denizli, Ankara, Kayseri, Niğde, Şanlıurfa, Kahramanmaras, Tokat, Malatya, Konya and Trabzon) between June 2011-June 2012 were included in the study. The identification and antibiotic susceptibility testing of the isolates were studied by conventional methods as well as Vitek® 2 Compact (bioMérieux, France) and BD Phoenix™ 100 (Becton Dickinson, USA) systems. The antibiotic susceptibilities of all the isolates were retested by Kirby-Bauer disk diffusion method according to CLSI recommendations in the main center of the study in order to achive the standardization. The presence of integrons was detected with polymerase chain reaction (PCR) method by using specific primers targeting class 1 (intI1) and class 2 (intI2) integrase gene regions. After integron amplification the samples were cloned and subjected to DNA sequencing. When the antibiotic susceptibility of the isolates were evaluated, the highest resistance was observed against most commonly used empirical antibiotics namely ampicillin and trimethoprim-sulfamethoxazole (SXT) with the mean rate of 58.6% (range: 43.8%-73.2%) and 41.2% (range: 35.4%-45.8%), respectively. The most effective antibiotics detected against the isolates were imipenem and amikacin with the lowest resistance rates of 0.2% (range: 0%-1.1%) and 0.6% (range: 0%-3.2%), respectively. The frequency of positive IntI1 gene and class 1 integron gene cassettes were found as 25.8% (162/626) and 16.6% (104/626), respectively, whereas the frequency of positive intI2 gene II and class 2 integron gene cassettes were 5.1% (32/626) and 3% (19/626), respectively. The lowest intI1 gene frequency was detected in the isolates from Kayseri (16.6%) and the highest in the isolates from Kahramanmaraş (35.4%) provinces. While there was no intI2 gene in the isolates from Denizli and Kays

Topics: Amikacin; Ampicillin; Anti-Bacterial Agents; Bacteriuria; Escherichia coli Infections; Humans; Imipenem; Integrons; Microbial Sensitivity Tests; Polymerase Chain Reaction; Sequence Analysis, DNA; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Tract Infections; Uropathogenic Escherichia coli

Infection is a major determinant of clinical outcome among patients in the intensive care unit. However, these data are lacking in most developing countries; hence, we set out to describe the profile of nosocomial infection in one of the major tertiary hospitals in northern Nigeria.. Case records of patients who were admitted into the intensive care unit over a 4-year period were retrospectively reviewed. A preformed questionnaire was administered, and data on clinical and microbiological profile of patients with documented infection were obtained.. Eighty-our episodes of nosocomial infections were identified in 76 patients. Road traffic accident (29/76, 38.2%) was the leading cause of admission. The most common infections were skin and soft tissue infections (30/84, 35.7%) followed by urinary tract infection (23/84, 27.4%). The most frequent isolates were Staphylococcus aureus (35/84, 41.7%), Klebsiella pneumoniae (18/84, 21.4%), and Escherichia coli (13/84, 15.5%). High rate of resistance to cloxacillin (19/35, 54.3%) and cotrimoxazole (17/26, 65.4%) was noted among the S aureus isolates. All the Enterobacteriaceae isolates were susceptible to meropenem, whereas resistance rate to ceftriaxone was high (E coli, 55.6%; K pneumoniae, 71.4%; Proteus spp, 50%).. Infection control practice and measures to curtail the emergence of antimicrobial resistance need to be improved.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Catheter-Related Infections; Ceftriaxone; Cloxacillin; Cross Infection; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Intensive Care Units; Klebsiella Infections; Klebsiella pneumoniae; Male; Meropenem; Microbial Sensitivity Tests; Middle Aged; Nigeria; Pneumonia, Bacterial; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Tertiary Care Centers; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

Urinary tract infections (UTIs) are among the most common bacterial infections in adult population. They are prevalent in all age groups both in women and men. Also, UTIs are the most frequent indication for empirical antibiotic treatment in emergency department. The aim of this study was to determine the antibiotic resistance rates in the treatment of uncomplicated UTIs. Adult patients admitted to emergency department with uncomplicated UTIs were included in this cross-sectional study. Mid-stream urine samples were obtained under sterile conditions and cultured quantitatively. After 24 hours, the samples showing 10(5) colony forming unit per milliliter (CFU/mL) were tested for antibiotic susceptibility. Resistance to fosfomycin-trometamol (FT), amoxicillin-clavulanic acid (AC), ciprofloxacin (CIP), trimethoprim-sulfamethoxazole (TMP-SMX) and cefpodoxime (CEF) was tested by Kirby-Bauer disc diffusion system. Escherichia (E.) coli accounted for the vast majority (93.4%) of the organisms isolated in the study. Among the E. coli positive patients, resistance to TMP-SMX was the most common antibiotic resistance. The E. coli species detected in our study group were least resistant to FT (2.4%). The resistance rates, especially to CEF, AC and CIP, were significantly higher in patients over 50 years of age. In conclusion, in the treatment of uncomplicated UTIs, TMP-SMX should be excluded from empirical treatment, while fosfomycin could be a viable option in all age groups.

Topics: Adolescent; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefpodoxime; Ceftizoxime; Ciprofloxacin; Cross-Sectional Studies; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Fosfomycin; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

The relevance of vaginal colonization of pregnant women by Escherichia coli is poorly understood, despite these strains sharing a similar virulence profile with other extraintestinal pathogenic E. coli producing severe obstetric and neonatal infections. We characterized the epidemiology, antimicrobial susceptibility and virulence profiles of 84 vaginal E. coli isolates from pregnant women from Rabat (Morocco) and Manhiça (Mozambique), two very distinct epidemiological settings. Low levels of antimicrobial resistance were observed to all drugs tested, except for trimethoprim-sulfamethoxazole in Manhiça, where this drug is extensively used as prophylaxis for opportunistic HIV infections. The most prevalent virulence factors were related to iron acquisition systems. Phylogroup A was the most common in Rabat, while phylogroups E and non-typeable were the most frequent in Manhiça. Regardless of the apparently "low virulence" of these isolates, the frequency of infections is higher and the outcomes more devastating in constrained-resources conditions, especially among pregnant women and newborns.

Topics: Anti-Bacterial Agents; beta-Lactamases; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; HIV Infections; Humans; Microbial Sensitivity Tests; Morocco; Mozambique; Phylogeny; Pregnancy; Pregnancy Complications, Infectious; Prevalence; Trimethoprim, Sulfamethoxazole Drug Combination; Vagina; Virulence; Virulence Factors

Empirical treatment of uncomplicated urinary tract infections (UTIs) in women should be based on local susceptibility data. We aimed to generate regional and provincial cumulative antibiograms combining data from different laboratory information systems and determine the impact of basic patient characteristics on susceptibility results.. All positive urine samples for Escherichia coli obtained from women aged 18-65 years old in outpatient settings between 1 April 2010 and 31 March 2015 from four hospitals in Quebec, Canada, were included. The cumulative antibiogram for ciprofloxacin, nitrofurantoin and trimethoprim/sulfamethoxazole was calculated. A clinically significant difference in susceptibility profile was defined as factor(s) that lowered the susceptibility proportion below 80%.. A total of 36 293 positive urine cultures were analysed. In the last year of the study, the proportion of susceptibility for ciprofloxacin, nitrofurantoin and trimethoprim/sulfamethoxazole was 90.3%, 95.4% and 81.9%, respectively. The susceptibility proportion was <80% for trimethoprim/sulfamethoxazole in the Montreal region (73.4%; 95% CI 71.1%-75.9%), whereas it remained >80% for the other regions. A significant decrease in susceptibility with time was identified for ciprofloxacin (92.1%-90.3%, P < 0.001) and nitrofurantoin (97.1%-95.4%, P < 0.001). Increasing age, recent hospitalization and site of collection were associated with an increase in resistance for certain antibiotics.. Overall, all first-line antimicrobials remain acceptable choices for empirical treatment of uncomplicated UTIs in women in Quebec. The regional variability in susceptibility data within a single province emphasizes the importance of local susceptibility data to inform the development of empirical treatment guidelines for UTIs.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ciprofloxacin; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Nitrofurantoin; Outpatients; Quebec; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine; Young Adult

Topics: Aged; Anti-Bacterial Agents; Drug Therapy, Combination; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Pyelonephritis; Risk Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urolithiasis; Urology

Eggs may contain extraintestinal pathogenic (ExPEC) and diarrheogenic (DEC) Escherichia coli which in addition may carry antibiotic resistance. The wide use of biocides and disinfectants in the food industry may induce biocide tolerance in bacteria. The aim of the present study was to evaluate biocide tolerance and antibiotic resistance in E. coli from hen egg shells. A total of 27 isolates obtained from a screening of 180 eggs were studied. Seven isolates carried both eae and bfpA genes of typical enteropathogenic E. coli (EPEC) strains, while 14 isolates only carried eae associated with atypical EPEC strains. Shiga toxin genes stx and stx2 were detected in four isolates. Heat-stable and heat-labile enterotoxin genes as well as aggR were also detected. Several isolates had minimum inhibitory concentrations (MICs) that were higher than the wild-type for the biocide hexadecylpyridinium chloride (HDP, 18.52%) or the commercial disinfectant P3 oxonia (OX, 14.81%). Antibiotic resistance was detected for ampicillin (37.03%), streptomycin (37.03%), tetracycline (37.03%), chloramphenicol (11.11%), nalidixic acid (18.51%) and trimethoprim-sulfamethoxazole (14.81%). Eight isolates (29.63%) were biocide tolerant and antibiotic resistant. Efflux pump genes detected included acrB (96.29%), mdfA (85.18%) and oxqA (37.03%), in addition to quaternary ammonium compound (QAC) resistance genes qacA/B (11.11%) and qacE (7.40%). Antibiotic resistance genes detected included bla

Topics: Animals; Anti-Infective Agents; Chickens; Disinfectants; Drug Resistance, Bacterial; Egg Shell; Escherichia coli; Escherichia coli Infections; Female; Genes, Bacterial; Microbial Sensitivity Tests; Temperature; Trimethoprim, Sulfamethoxazole Drug Combination; Virulence Factors

Topics: Actinomycosis; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cephalexin; Ciprofloxacin; Clindamycin; Coinfection; Drug Resistance, Bacterial; Escherichia coli Infections; Humans; Male; Pseudomonas Infections; Skin Diseases, Bacterial; Staphylococcal Skin Infections; Thigh; Trimethoprim, Sulfamethoxazole Drug Combination

Escherichia coli clonal group A (CGA) causes urinary tract and other extra-intestinal infections in humans. CGA is an important cause of trimethoprim/sulfamethoxazole (SXT) resistance in extra-intestinal pathogens. We examined the extent to which resistance in this area is related to CGA dissemination of E. coli from urinary tract infections (UTIs) in Mexico City. The virulence backgrounds of the isolates were also characterized. In this study, the frequency of resistance to SXT used for UTI treatment was high (56-65 %), and CGA isolates accounted for 9 of the 78 SXT-resistant isolates (11.5 %). Although all CGA isolates were found to be multidrug resistant (MDR), none of them were extended-spectrum β-lactamase-producing organisms. The prevalence of CGA among the 45 MDR isolates that we identified was 20 %, indicating that this clonal group moderately contributes to the antibiotic resistance of uropathogenic E. coli isolates in this region. Most of the nine CGA isolates carried transferable, large-size plasmids of approximately 80 to 100 kb, which were able to transfer antimicrobial resistance to E. coli J53 in mating assays. CGA isolates mainly belonged to phylogenetic groups F and D. We found no association between antimicrobial resistance and virulence-associated genes: the median virulence scores of CGA isolates were slightly higher (4.6) than those of non-CGA isolates, whether they were susceptible (3.7) or resistant (3.5) to SXT. Our results indicate that CGA is not a major contributor to the high level of resistance to SXT in this region but, instead, seems to be an important constituent of MDR isolates from UTIs.

Topics: Anti-Bacterial Agents; beta-Lactamases; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli Infections; Genotype; Humans; Mexico; Phylogeny; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Uropathogenic Escherichia coli; Virulence Factors

Ciprofloxacin and cotrimoxazole are recommended to treat uncomplicated pyelonephritis and uncomplicated cystitis, respectively, provided that local resistance rates of uropathogens do not exceed specified thresholds (10 and 20 %, respectively). However, Escherichia coli resistance rates in Emergency Departments (ED) remain poorly described. Our objectives were to assess E. coli ciprofloxacin and cotrimoxazole resistance rates in EDs of a French administrative region, and to determine if resistance rates differ between EDs. This was a retrospective study of E. coli urine isolates sampled in ten EDs between 2007 and 2012. The following risk factors for resistance were tested using logistic regression: ED, sex, age, sampling year, sampling month. A total of 17,527 isolates were included. Ciprofloxacin local resistance rates (range, 5.3 % [95 % CI, 4.0-7.1 %] to 11.7 % [95 % CI, 5.2-23.2 %]) were ≤10 % in nine EDs in 2012. Five EDs were risk factors for ciprofloxacin resistance, as were male sex, age and sampling in April or October. Cotrimoxazole local resistance rates (range, 13.3 % [95 % CI, 6.3-25.1 %] to 20.4 % [95 % CI, 18.9-22.0 %]) were ≤20 % in seven EDs in 2012. Five EDs were risk factors for cotrimoxazole resistance, as were age, sampling between October and December, and sampling in 2011 and 2012. We found a significant variability of E. coli ciprofloxacin and cotrimoxazole resistance rates among EDs of a small region. These differences impact on the feasibility of empirical treatment of urinary tract infections with ciprofloxacin or cotrimoxazole in a given ED. Continuous local survey of antibacterial resistance in ED urinary isolates is warranted to guide antibacterial therapy of urinary tract infections.

Topics: Adolescent; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ciprofloxacin; Drug Resistance, Bacterial; Emergency Service, Hospital; Escherichia coli; Escherichia coli Infections; Female; France; Humans; Male; Middle Aged; Prevalence; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urine; Young Adult

We described the clinical predictive role of emerging Escherichia coli O25b/sequence type 131 (ST131) in treatment failure of urinary tract infection.. In this prospective observational cohort study, the outpatients with acute cystitis with isolation of E. coli in their urine cultures were assessed. All the patients were followed up for clinical cure after 10 days of treatment. Detection of the E. coli O25:H4/ST131 clone was performed by multiplex polymerase chain reaction (PCR) for phylogroup typing and using PCR with primers for O25b rfb and allele 3 of the pabB gene.. In a cohort of patients with diagnosis of acute urinary cystitis, 294 patients whose urine cultures were positive with a growth of >10(4) colony-forming units/mL of E. coli were included in the study. In empiric therapy, ciprofloxacin was the first choice of drug (27%), followed by phosphomycin (23%), trimethoprim-sulfamethoxazole (TMP-SMX) (9%), and cefuroxime (7%). The resistance rate was 39% against ciprofloxacin, 44% against TMP-SMX, and 25% against cefuroxime. Thirty-five of 294 (12%) isolates were typed under the O25/ST131 clone. The clinical cure rate was 85% after the treatment. In multivariate analysis, detection of the O25/ST131 clone (odds ratio [OR], 4; 95% confidence interval [CI], 1.51-10.93; P = .005) and diabetes mellitus (OR, 2.1; 95% CI, .99-4.79; P = .05) were found to be significant risk factors for the treatment failure. In another multivariate analysis performed among quinolone-resistant isolates, treatment failure was 3 times more common among the patients who were infected with ST131 E. coli (OR, 3; 95% CI, 1.27-7.4; P = .012).. In urinary tract infections, the E. coli ST131 clone seems to be a consistent predictor of treatment failure.

Topics: Aged; Anti-Bacterial Agents; Bacterial Typing Techniques; Cefuroxime; Ciprofloxacin; Cohort Studies; Cystitis; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Forecasting; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Multiplex Polymerase Chain Reaction; Multivariate Analysis; Phylogeny; Prospective Studies; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Tract Infections

The prevalence of trimethoprim (TMP) and sulfamethoxazole (SMX) resistance in commensal E. coli from pigs was tested in this study. E. coli was derived from three groups of piglets in successive stages of metaphylactic therapy and from two groups of sows 10 and 18 weeks after the treatment. MIC values of TMP and SMX were determined for a total of 352 strains. The presence of resistance genes (dfrA1, dfrA5, dfrA7, dfrA12, dfrA17, sul1, sul2, sul3) and class 1 and 2 integron-associated dfrA gene cassettes was tested. Resistance to TMP was very high during the administration of the antimicrobial (from 97 to 100%) and amounted to 86% and 69% in the post-exposure period; MIC > 32 mg/L. The isolates from all groups of pigs were resistant to sulfamethoxazole, with MIC > 1028 mg/L. The dfrA1 and sul1 genes (as part of integrons) dominated in E. coli from piglets, but the dfrA12 and sul1 genes were prevalent in E. coli from sows. Coexistence of the different dfrA genes was detected in 71 isolates from all groups of swine. Transcription analysis revealed that most of these genes were not transcribed, particularly gene cassettes of class 1 integrons. The research revealed a high level of resistance associated with the metaphylactic treatment, persistence and circulation of resistance in bacterial populations. Diverse genetic background with multiple and not transcribed resistance genes was observed.

Topics: Animals; Anti-Bacterial Agents; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Gene Expression Regulation, Bacterial; Microbial Sensitivity Tests; Polymerase Chain Reaction; Swine; Swine Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Prospective studies from developing countries that have investigated risk factors for trimethoprim-sulfamethoxazole (TMP-SMX)-resistant Escherichia coli in women with uncomplicated urinary tract infection (UTI) remain scarce.. Women with acute uncomplicated UTI were enrolled prospectively. Urine was sent for antimicrobial susceptibility testing. Logistic regression analysis was used to identify risk factors for TMP-SMX resistance.. Of 405 participants, 229 (56.5%) had bacteriuria (mean age 31.9 ± 9.5 years). In the previous 12 months, 77 (33.6%) had experienced at least one UTI episode and 106 (46.3%) reported antimicrobial use. The most common uropathogens were E. coli (75.8%) and Staphylococcus saprophyticus (8.9%). For the 179 E. coli, resistance rates were highest for ampicillin (64.3%) and TMP-SMX (41.3%). Resistance to cephalosporins, nitrofurantoin, and fluoroquinolones was much lower compared with the hospital laboratory-based surveillance data. Risk factors for TMP-SMX resistance were UTI in the last 6 months (odds ratio 2.22; p = 0.04) and the number of UTI episodes in the past year (odds ratio 2.06; p = 0.004). The number of UTI episodes (adjusted odds ratio 2.21; p = 0.02) remained significant on multivariate analysis.. TMP-SMX resistance was high. Number of previous UTI episodes was associated with increased risk of resistance; prior antimicrobial use was not. Hospital antibiograms should be used with caution when treating uncomplicated UTI.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Developing Countries; Drug Resistance, Bacterial; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Prevalence; Prospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus saprophyticus; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Uropathogenic Escherichia coli; Young Adult

A case-control study to determine risk factors for clinical infection with Escherichia coli was conducted among nursing home residents colonized with fluoroquinolone-resistant E. coli. Among 94 subjects, 11 (12%) developed infections with E. coli. Risk factors included the presence of a urinary catheter or tracheostomy, diabetes mellitus, and trimethoprim-sulfamethoxazole exposure.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Case-Control Studies; Cross Infection; Diabetes Complications; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Male; Middle Aged; Nursing Homes; Risk Factors; Tracheostomy; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheters

Urinary tract infection (UTI) is a common complication after kidney transplantation, often associated to graft loss and increased healthcare costs. Kidney transplant patients (KTPs) are particularly susceptible to infection by Enterobacteriaceae-producing extended-spectrum β-lactamases (ESBLs). A retrospective case-control study was conducted to identify independent risk factors for ESBL-producing Escherichia coli and Klebsiella pneumoniae in non-hospitalized KTPs with UTI. Forty-nine patients suffering from UTI by ESBL-producing bacteria (ESBL-P) as case group and the same number of patients with UTI by ESBL negative (ESBL-N) as control-group were compared. Clinical data, renal function parameters during UTI episodes, UTI recurrence and relapsing rate, as well as risk factors for recurrence, molecular characterization of isolates and the respective antimicrobial susceptibility profile were evaluated. Diabetes mellitus (p <0.007), previous antibiotic prophylaxis (p=0.017) or therapy (p<0.001), previous UTI (p=0.01), relapsing infection (p=0.019) and patients with delayed graft function after transplant (p=0.001) represented risk factors for infection by ESBL positive Enterobacteriaceae in KTPs. Interestingly, the period of time between data of transplantation and data of UTI was shorter in case of ESBL-P case-group (28.8 months) compared with ESBL-N control-group (50.9 months). ESBL-producing bacteria exhibited higher resistance to fluoroquinolones (p=0.002), trimethoprim-sulfamethoxazole (p<0.001) and gentamicin (p<0.001). Molecular analysis showed that blaCTX-M was the most common ESBL encoding gene (65.3%), although in 55.1% of the cases more than one ESBL gene was found. In 29.4% of K. pneumoniae isolates, three bla-genes (blaCTX-M-blaTEM-blaSHV) were simultaneously detected. Low estimated glomerular filtration rate (p=0.009) was found to be risk factor for UTI recurrence. Over 60% of recurrent UTI episodes were caused by genetically similar strains. UTI by ESBL-producing Enterobacteriaceae in KTPs represent an important clinical challenge regarding not only hospitalized patients but also concerning outpatients.

Topics: Adult; Aged; Anti-Bacterial Agents; beta-Lactamases; Case-Control Studies; Escherichia coli; Escherichia coli Infections; Female; Humans; Kidney Transplantation; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Epidemiology; Retrospective Studies; Risk Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

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.. 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.. 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.. Forty-five patients grew E. coli. Pyelonephritis 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.. 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.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ciprofloxacin; Drug Resistance, Bacterial; Emergency Service, Hospital; Escherichia coli; Escherichia coli Infections; Female; Humans; Levofloxacin; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Escherchia coli isolated, from urine samples were studied for their antibiotic susceptibility patterns, with special reference to the new antimicrobial compound fosfomycin and their correlation with various virulence factors.. The mid stream urine samples received in the department were processed and identification was done by using the standard culture and identification techniques. The antibiotic susceptibility testing was done by modified Kirby-Bauer disk diffusion and the disk diffusion method was used to confirm the ESBL, AmpC, MBL production by the UPEC. Various virulence factors like hemolysin, haemagglutinaton, gelatinase, siderophore production, biofilm formation, serum resistance and hydrophobicity were detected.. Fosfomycin was found to be most effective agent (100%) against uropathogenic E.coli followed by netilmicin (89.5%). The least effective agents were ampiciilin and cotrimoxazole. Twenty nine percent (29%) isolates were found to be multi drug resistant (MDR).. The testing of the newer therapeutic agents like fosfomycin will add on to therapeutics for UTI's.

Topics: Ampicillin; Anti-Bacterial Agents; Biofilms; Drug Resistance, Multiple, Bacterial; Escherichia coli Infections; Fosfomycin; Humans; Microbial Sensitivity Tests; Netilmicin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine; Uropathogenic Escherichia coli; Virulence Factors

Determination of treatment protocols for infections according to antimicrobial susceptibility test (AST) results is are important for controlling the problem of antibiotic resistance. Two standards are widely used in the world. One of them is Clinical Laboratory Standards Institute (CLSI) standards used in Turkey for many years and the other is the European Committee on Antimicrobial Susceptibility Testing (EUCAST) standards which is used in European Union member countries and came into use in 2015 in Turkey. Since the EUCAST standards had higher clinical sensitivity limits particularly for gram-negative bacilli compared to CLSI (2009) standards, there will be some changes in antibiotic resistance profiles of Turkey with the use of EUCAST. CLSI has changed zone diameters after 2009 versions and the differences between the two standards were brought to a minimum level. Knowledge of local epidemiological data is important to determine empirical therapy which will be used in urinary tract infections (UTI). The aim of this study was to determine the differences of antibiotic susceptibility zone diameters based on our local epidemiological data among uropathogenic Escherichia coli isolates according to EUCAST 2014 and CLSI 2014 standards. A total of 298 E.coli strains isolated from urine samples as the cause of uncomplicated acute UTI agents, were included in the study. Isolates were identified by conventional methods and with BBL Crystal E/NF ID System (Becton Dickinson, USA). AST was performed with Kirby Bauer disk diffusion method and results were evaluated and interpreted according to the CLSI 2014 and EUCAST 2014 standards. According to the results, susceptibility rates of isolates against amikacin (100%) and trimethoprim-sulfamethoxazole (63.09%) were identical in both standards. However, statistically significant differences were observed between CLSI and EUCAST standards in terms of susceptibilities against gentamicin (91.95% and 84.56%, respectively; p= 0.004), cefuroxime axetil (20.13% and 77.18%, respectively; p= 0.000) and levofloxacin (73.83% and 67.11%, respectively; p= 0.044). No statistically differences between two standards for ampicillin (32.89% and 36.24%, respectively; p= 0.219), ampicillin-sulbactam (65.77% and 69.13%, respectively; p= 0.216), ciprofloxacin (72.48% and 71.14%, respectively; p= 0.392) and imipenem (94.63% and 95.30%, respectively; p= 0.426) were determined. In this transitional period, continuity of cooperation between the

Topics: Amikacin; Ampicillin; Anti-Bacterial Agents; Bacteriuria; Cefuroxime; Ciprofloxacin; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Escherichia coli Infections; European Union; Gentamicins; Humans; Imipenem; Levofloxacin; Microbial Sensitivity Tests; Reference Standards; Sulbactam; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Tract Infections; Uropathogenic Escherichia coli

The aim of our study was to characterize the phylogenetic groups of Escherichia coli, antibiotic resistance, and containment of class 1 integrons in the first attack of pyelonephritis and in subsequent recurrences in young children. Altogether, 89 urine E. coli isolates from 41 children with urinary tract infection (UTI) were studied for prevalence and persistence of phylogenetic groups by pulsed-field gel electrophoresis (PFGE), antibacterial resistance by minimal inhibitory concentrations (MIC) and class 1 integrons by PCR. Phylogenetic group B2 was most common (57%), followed by D (20%), A (18%) and B1 (5%). Overall resistance to betalactams was 61%, trimethoprim-sulfamethoxazole 28%, and was not associated with phylogenetic groups. According to PFGE, the same clonal strain persisted in 77% of patients. The persistence was detected most often in phylogenetic group B2 (70%). Phylogenetic group B2 more often contained class 1 integrons than group A. Integron positive strains had higher MIC values of cefuroxime, cefotaxime, and gentamicin. In conclusion, phylogenetic group B2 was the most common cause of the first episode of pyelonephritis, as well as in case of the persistence of the same strain and contained frequently class 1 integrons in childhood recurrent UTI. An overall frequent betalactam resistance was equally distributed among phylogenetic groups.

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; Cefotaxime; Cefuroxime; Child; Child, Preschool; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Humans; Integrons; Male; Microbial Sensitivity Tests; Phylogeny; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We report a case of a 55-year-old immunocompromised female who presented to the emergency department with severe diarrhea and vomiting following travel to the Philippines. Stool bacteriology revealed a mixed infection involving an enteropathogenic Escherichia coli and two distinct strains of enteroaggregative Escherichia coli (EAEC). During hospitalization, urine and blood culture tested positive for one of the diarrheagenic EAEC strains, necessitating urinary catheterization, intensive care, and antimicrobial treatment with trimethoprim-sulfamethoxazole, followed by meropenem. Although known to occasionally cause urinary tract infections, EAEC have not been previously associated with sepsis. Our report highlights the potential of EAEC to cause severe extraintestinal infections.

Topics: Anti-Bacterial Agents; Bacteremia; Critical Care; Diarrhea; Enteropathogenic Escherichia coli; Escherichia coli; Escherichia coli Infections; Female; Humans; Middle Aged; Philippines; Sepsis; Travel; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization; Urinary Tract Infections

Topics: Aminoglycosides; Anti-Bacterial Agents; beta-Lactamases; Cephalosporins; Chloramphenicol; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Humans; Male; Methyltransferases; Microbial Sensitivity Tests; Middle Aged; Multilocus Sequence Typing; Pennsylvania; Plasmids; Tetracyclines; Trimethoprim, Sulfamethoxazole Drug Combination

The presence and frequency of multiresistant bacteria in wild birds act as indicators of the environmental contamination of antibiotic resistance. To explore the rate of contamination mediated by Escherichia coli, 150 fecal samples from the brown-headed gull (Chroicocephalus brunnicephalus) and 8 water samples from the Bay of Bengal area were collected, cultured, and tested for antibiotic susceptibility. Special attention was paid to extended-spectrum beta-lactamase (ESBL)-producing isolates, which were further characterized genetically. Antibiotic resistance was found in 42.3% (36/85) of the E. coli isolates and multidrug resistance in 11.8%. Isolates from the area with a higher human activity were more resistant than those from an area with a lower level of activity. Most frequent was resistance to ampicillin (29.4%), followed by trimethoprim-sulfamethoxazole (24.7%) and quinolones (22.4%). Carriage of ESBL-producing E. coli was relatively high (17.3%) in the gulls, whereas no ESBL producers were found in the water. All ESBL-producing E. coli isolates, but one, carried bla(CTX-M-15) or bla(CTX-M-15)-like genes. A bla(CTX-M-14)-like enzyme was found as an exception. Gulls from two different colonies shared E. coli clones and harbored the clinically relevant sequence types ST10, ST48, and ST131. The high frequency of antibiotic resistance and ESBL production among E. coli isolates from gulls indicates that the environmental contamination of antibiotic resistance has already gone far on the coastlines of the Bay of Bengal. Considering the limited control over the antibiotic consumption and waste from human activities in Bangladesh, there is no easy solution in sight.

Topics: Ampicillin; Animals; Anti-Bacterial Agents; Bacterial Typing Techniques; Bangladesh; Bays; beta-Lactamases; Bird Diseases; Charadriiformes; Disease Reservoirs; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Gene Expression; Genotype; Plasmids; Quinolones; Trimethoprim, Sulfamethoxazole Drug Combination; Water Microbiology

Of 20 Klebsiella pneumoniae carbapenemase (KPC)-producing Escherichia coli isolates identified at hospitals in western Pennsylvania, 60% belonged to the epidemic ST131-fimH30 subclone. IncFIIk was the most common replicon type for the blaKPC-carrying plasmids (n = 8). All IncFIIk plasmids possessed a scaffold similar to that of pKpQIL, and seven of them were borne by ST131-fimH30 isolates. IncN plasmids conferred resistance to trimethoprim-sulfamethoxazole, and IncA/C plasmids conferred resistance to gentamicin. Three blaKPC-carrying plasmids (IncA/C and IncN) possessed blaSHV-7/12 and qnrA1 or qnrS1.

Topics: Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Gentamicins; Humans; Microbial Sensitivity Tests; Molecular Epidemiology; Plasmids; Trimethoprim, Sulfamethoxazole Drug Combination

The purpose of this study is to provide resistance data for Escherichia coli isolates causing urinary tract infections in emergency department (ED) patients not requiring admission and explore if differences between this subpopulation and the hospital antibiogram exist. Differences between community-acquired urinary tract infection (CA-UTI) and health care-associated (HA-UTI) subgroups were also investigated.. Patients with a positive urine culture treated and discharged from the ED of a 200-bed community hospital were reviewed. Patients with urinary isolates of more than 100000 colony-forming unit/mL and documented intention to treat were included. Patients who required admission, were pregnant, less than the age of 18 years, or who had a positive culture but without any evidence of intention to treat were excluded. Only the initial visit was included for patients who returned to the ED within 7 days.. Overall, 308 visits were screened, and 217 were included. Of these, 78.3% were CA-UTI, and 21.7% were HA-UTI. Females comprised 88.5% of all patients. E coli was the most common pathogen overall and in both subgroups. E coli resistance to levofloxacin was 13.5% overall, 9.2% for CA-UTI, and 38.5% for HA-UTI compared with 27% on the hospital antibiogram. E coli resistance to sulfamethoxazole/trimethoprim was 26.9% overall, 25.2% for CA-UTI, and 34.6% for HA-UTI vs 26% on the antibiogram.. E coli susceptibility for ED patients not requiring admission may not be accurately represented by hospital antibiograms that contain culture data from various patient types, sites of infection, or patients with varying illness severity. Separation of the ED population into CA-UTI and HA-UTI subgroups may be helpful when selecting empiric antibiotic therapy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Drug Resistance, Bacterial; Emergency Service, Hospital; Escherichia coli Infections; Female; Hospitals, Community; Humans; Levofloxacin; Male; Microbial Sensitivity Tests; Middle Aged; Retrospective Studies; Severity of Illness Index; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

We investigated the impact of the hatchery practice of administering third-generation cephalosporin (3GC) on the selection and persistence of 3GC-resistant Escherichia coli in poultry. We studied 15 3GC-treated (TB) and 15 non-3GC-treated (NTB) broiler flocks and 12 3GC-treated (TL) and 10 non-3GC-treated (NTL) future layer flocks. Fecal samples from each flock were sampled before arrival on the farm (day 0), on day 2, on day 7, and then twice more. E. coli isolates were isolated on MacConkey agar without antibiotics and screened for 3GC resistance, and any 3GC-resistant E. coli isolates were further analyzed. 3GC-resistant E. coli isolates were found in all 3GC-treated flocks on at least one sampling date. The percentages of 3GC-resistant E. coli isolates were significantly higher in TB (41.5%) than in NTB (19.5%) flocks and in TL (49.5%) than in NTL (24.5%) flocks. In the day 2 samples, more than 80% of the E. coli strains isolated were 3GC resistant. 3GC-resistant E. coli strains were still detected at the end of the follow-up period in 6 out of 27 3GC-treated and 5 out of 25 non-3GC-treated flocks. Many 3GC-resistant E. coli strains were resistant to tetracycline, and there were significant differences in the percentages of resistance to sulfamethoxazole-trimethoprim, streptomycin, or gentamicin between treated and nontreated flocks. blaCTX-M and blaCMY-2 were the most frequently detected genes. These results clearly demonstrated that 3GC-resistant strains are introduced early in flocks and that the use of 3GC in hatcheries promotes the selection of 3GC-resistant E. coli. Measures must be implemented to avoid the spread and selection of 3GC-resistant strains.

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents; Cephalosporins; Chickens; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Feces; Microbial Sensitivity Tests; Poultry Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Amoxicillin; Anti-Infective Agents, Urinary; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Fosfomycin; Germany; Humans; Male; Microbial Sensitivity Tests; Nitroquinolines; Outpatients; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A case-case-control study was conducted to identify independent risk factors for recovery of Escherichia coli strains producing CTX-M-type extended-spectrum β-lactamases (CTX-M E. coli) within a large Southeastern Michigan medical center. Unique cases with isolation of ESBL-producing E. coli from February 2010 through July 2011 were analyzed by PCR for blaCTX-M, blaTEM, and blaSHV genes. Patients with CTX-M E. coli were compared to patients with E. coli strains not producing CTX-M-type ESBLs (non-CTX-M E. coli) and uninfected controls. Of 575 patients with ESBL-producing E. coli, 491 (85.4%) isolates contained a CTX-M ESBL gene. A total of 319 (84.6%) patients with CTX-M E. coli (282 [74.8%] CTX-M-15 type) were compared to 58 (15.4%) non-CTX-M E. coli patients and to uninfected controls. Independent risk factors for CTX-M E. coli isolation compared to non-CTX-M E. coli included male gender, impaired consciousness, H2 blocker use, immunosuppression, and exposure to penicillins and/or trimethoprim-sulfamethoxazole. Compared to uninfected controls, independent risk factors for isolation of CTX-M E. coli included presence of a urinary catheter, previous urinary tract infection, exposure to oxyimino-cephalosporins, dependent functional status, non-home residence, and multiple comorbid conditions. Within 48 h of admission, community-acquired CTX-M E. coli (n = 51 [16%]) and non-CTX-M E coli (n = 11 [19%]) strains were isolated from patients with no recent health care contacts. CTX-M E. coli strains were more resistant to multiple antibiotics than non-CTX-M E. coli strains. CTX-M-encoding genes, especially bla(CTX-M-15) type, represented the most common ESBL determinants from ESBL-producing E. coli, the majority of which were present upon admission. Septic patients with risk factors for isolation of CTX-M E. coli should be empirically treated with appropriate agents. Regional infection control efforts and judicious antibiotic use are needed to control the spread of these organisms.

Topics: Aged; Aged, 80 and over; Ambulatory Care; beta-Lactamases; Case-Control Studies; Ciprofloxacin; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Female; Genes, Bacterial; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Catheters; Urinary Tract Infections

Escherichia coli isolates (n=438) from six different broiler chicken flocks (all in, all out) with known consumption of antimicrobials were investigated for their antimicrobial resistance and the prevalence of extended-spectrum β-lactamase (ESBL) phenotypes. E. coli were isolated from chicken at the third and fifth week of age and tested for antimicrobial resistance during the course of fattening. Resistance to sulfamethoxazole+trimethoprim, which was used in four flocks within the first days of life, decreased significantly in all six flocks between the third and fifth week of broiler chicken's life (mean 65.9% vs. 54.3%). By contrast, resistance to spectinomycin increased significantly in all six flocks within the same period (mean 36.1% vs. 57.0%); doxycycline resistance increased significantly in five of six flocks (mean 19.2% vs. 41.7%), although both substances were not used for treatment. Of the sulfonamide resistance genes sul1, sul2, and sul3, sul2 was most frequently found (up to 60%). The prevalence of sul2 increased significantly between weeks 3 and 5, if the chicken were treated with sulfamethoxazole + trimethoprim in the first days of life. If sulfamethoxazole + trimethoprim was not used, then the prevalence of sul2 decreased significantly in the same period. The prevalence of sul1+qacEΔ1 (classical class 1 integrons) was significantly higher in E. coli from sulfamethoxazole + trimethoprim-treated flocks (9.63%), compared to untreated flocks (2.92%). The detection of phenotypes that potentially indicate plasmid-borne AmpC-β-lactamases was inversely associated with sulfamethoxazole + trimethoprim treatment. ESBL phenotypes were found without selective enrichment in four of six flocks. Of all isolated E. coli, 1.8% (n=8) had an ESBL phenotype. ESBL strains differed in their accompanying resistances and/or enterobacterial repetitive intergenic consensus sequences. In conclusion, clonal dissemination seems not to be a major cause of ESBL detection on a chicken farm with all-in all-out production mode.

Topics: Animals; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; beta-Lactams; Chickens; DNA, Intergenic; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Integrons; Plasmids; Poultry Diseases; Protein Isoforms; Spectinomycin; Trimethoprim, Sulfamethoxazole Drug Combination

The rising prevalence of resistance to first-line antimicrobial agents in Escherichia coli, which has paralleled the emergence of E. coli sequence type ST131, has created a need for alternative oral options for use in treating outpatients with infections such as cystitis and chronic prostatitis. Accordingly, we determined susceptibility to six alternative oral agents (azithromycin, chloramphenicol, doxycycline, fosfomycin, minocycline, and rifampin) by Etest or disk diffusion for 120 recently obtained E. coli clinical isolates from Veterans Affairs Medical Centers across the United States. Isolates were randomly selected in three subgroups of 40 isolates each based on coresistance to fluoroquinolones with and without extended-spectrum cephalosporins (ESCs). Results were stratified according to trimethoprim-sulfamethoxazole (TMP-SMZ) phenotype. Overall, the prevalence of susceptible (or susceptible plus intermediate) isolates varied by agent, with rifampin being lowest (0%), fosfomycin highest (98 to 99%), and others in the mid-range (37 to 88%). Substantial proportions of isolates (15 to 27%) yielded intermediate results for azithromycin, chloramphenicol, doxycycline, and minocycline. Among isolates resistant (versus susceptible) to fluoroquinolones with or without ESCs, susceptibility to the above four agents declined significantly among non-ST131 isolates but not ST131 isolates. In contrast, in the presence of resistance to TMP-SMZ, susceptibility to azithromycin, doxycycline, and minocycline was significantly reduced among both ST131 and non-ST131 isolates. These findings identify potential alternative oral agents for use with E. coli isolates resistant to fluoroquinolones, ESCs, and/or TMP-SMZ and suggest that determination of ST131 status could help guide initial antimicrobial selection, pending susceptibility results.

Topics: Anti-Bacterial Agents; Cephalosporins; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Humans; Male; Microbial Sensitivity Tests; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Veterans

A 4-month-old female kitten presented with chronic lower urinary tract signs and Escherichia coli cystitis, and was diagnosed with urinary bladder malakoplakia based upon histopathology. The kitten was treated with a prolonged antibiotic course and the malakoplakia resolved. Malakoplakia is a chronic granulomatous reaction characterized by the formation of Michaelis-Gutman bodies within von Hansemann macrophages. It is well described in humans, but has never been documented in a living veterinary patient. This case report describes the first successful treatment of malakoplakia in veterinary medicine.

Topics: Animals; Anti-Bacterial Agents; Cat Diseases; Cats; Escherichia coli; Escherichia coli Infections; Female; Malacoplakia; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder Diseases; Urinary Tract Infections

Antibiotic use in poultry production is a risk factor for promoting the emergence of resistant Escherichia coli. To ascertain differences in different classes of chickens, the resistance profile, some virulence genes and phylogenetic grouping on 251 E. coli isolates from intensive meat (free range and indoor commercial) and free range egg layer chickens collected between December 2008 and June 2009 in South Australia were performed. Among the 251 strains, 102 (40.6%) and 67 (26.7%) were found to be resistant to tetracycline and ampicillin respectively. Resistance was also observed to trimethoprim-sulfamethoxazole (12.4%), streptomycin (10.8%), spectinomycin (9.6%), neomycin (6.0%) and florfenicol (2.0%) but no resistance was found to ceftiofur, ciprofloxacin or gentamicin. Amplification of DNA of the isolates by polymerase chain reaction revealed the presence of genes that code for resistant determinants: tetracycline (tet(A), tet(B) and tet(C)), ampicillin (bla(TEM) and bla(SHV)), trimethoprim (dhfrV and dhfrXIII), sulphonamide (sulI and sulII), neomycin (aph(3)-Ia(aphA1)), and spectinomycin-streptinomycin (aadA2). In addition, 32.3-39.4% of the isolates were found to belong to commensal groups (A and B1) and 11.2-17.1% belonged to the virulent groups (B2 and D). Among the 251 E. coli isolates, 25 (10.0%) carried two or more virulence genes typical of Extraintestinal pathogenic E. coli (ExPEC). Furthermore, 17 of the isolates with multi-resistance were identified to be groups B2 and D. Although no significant difference was observed between isolates from free range and indoor commercial meat chickens (P>0.05), significant differences was observed between the different classes of meat chickens (free range and indoor commercial) and egg layers (P<0.05). While this study assessed the presence of a limited number of virulence genes, our study re emphasises the zoonotic potential of poultry E. coli isolates.

Topics: Animal Husbandry; Animals; Anti-Bacterial Agents; Base Sequence; Chickens; Drug Resistance, Bacterial; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Feces; Molecular Sequence Data; Phylogeny; Poultry; South Australia; Trimethoprim, Sulfamethoxazole Drug Combination; Virulence; Virulence Factors

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Escherichia coli; Escherichia coli Infections; Female; Humans; Premenopause; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vaccinium macrocarpon

This study examines in vitro antimicrobial resistance data from Escherichia coli isolates obtained from urine samples of U.S. outpatients between 2000 and 2010 using The Surveillance Network (TSN). Antimicrobial susceptibility results (n = 12,253,679) showed the greatest increases in E. coli resistance from 2000 to 2010 for ciprofloxacin (3% to 17.1%) and trimethoprim-sulfamethoxazole (TMP-SMX) (17.9% to 24.2%), whereas nitrofurantoin (0.8% to 1.6%) and ceftriaxone (0.2% to 2.3%) showed minimal change. From 2000 to 2010, the antimicrobial resistance of urinary E. coli isolates to ciprofloxacin and TMP-SMX among outpatients increased substantially.

Topics: Ceftriaxone; Cephalosporin Resistance; Ciprofloxacin; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Nitrofurantoin; Outpatients; Population Surveillance; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Catheter-associated urinary tract infections (CAUTIs) constitute the majority of nosocomial urinary tract infections (UTIs) and pose significant clinical challenges. These infections are polymicrobial in nature and are often associated with multidrug-resistant pathogens, including uropathogenic Escherichia coli (UPEC). Urinary catheterization elicits major histological and immunological alterations in the bladder that can favor microbial colonization and dissemination in the urinary tract. We report that these biological perturbations impact UPEC pathogenesis and that bacterial reservoirs established during a previous UPEC infection, in which bacteriuria had resolved, can serve as a nidus for subsequent urinary catheter colonization. Mannosides, small molecule inhibitors of the type 1 pilus adhesin, FimH, provided significant protection against UPEC CAUTI by preventing bacterial invasion and shifting the UPEC niche primarily to the extracellular milieu and on the foreign body. By doing so, mannosides potentiated the action of trimethoprim-sulfamethoxazole in the prevention and treatment of CAUTI. In this study, we provide novel insights into UPEC pathogenesis in the context of urinary catheterization, and demonstrate the efficacy of novel therapies that target critical mechanisms for this infection. Thus, we establish a proof-of-principle for the development of mannosides to prevent and eventually treat these infections in the face of rising antibiotic-resistant uropathogens.

Topics: Adhesins, Escherichia coli; Animals; Bacterial Adhesion; Biofilms; Catheter-Related Infections; Cross Infection; Drug Therapy, Combination; Escherichia coli Infections; Female; Fimbriae Proteins; Gene Deletion; Mannosides; Mice; Mice, Inbred C57BL; Molecular Weight; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder; Urinary Catheters; Urinary Tract Infections; Uropathogenic Escherichia coli

For women with recurrent urinary tract infections (rUTI), the contribution of antibiotic use versus patient-related factors in determining the presence of antimicrobial resistance in faecal and urinary Escherichia coli, obtained from the same patient population, has not been assessed yet. Within the context of the 'Non-antibiotic prophylaxis for recurrent urinary tract infections' (NAPRUTI) study, the present study assessed determinants of antimicrobial resistance in E. coli isolated from urinary and faecal samples of women with rUTIs collected at baseline. Potential determinants of resistance were retrieved from self-administered questionnaires. From 434 asymptomatic women, 433 urinary and 424 faecal samples were obtained. E. coli was isolated from 146 (34%) urinary samples and from 336 (79%) faecal samples, and subsequently tested for antimicrobial susceptibility. Multivariable analysis showed trimethoprim/sulfamethoxazole (SXT) use three months prior to inclusion to be associated with urine E. coli resistance to amoxicillin (OR 3.6, 95% confidence interval: 1.3-9.9), amoxicillin-clavulanic acid (OR 4.4, 1.5-13.3), trimethoprim (OR 3.9, 1.4-10.5) and SXT (OR 3.2, 1.2-8.5), and with faecal E. coli resistance to trimethoprim (OR 2.0, 1.0-3.7). The number of UTIs in the preceding year was correlated with urine E. coli resistance to amoxicillin-clavulanic acid (OR 1.11, 1.01-1.22), trimethoprim (OR 1.13, 1.03-1.23) and SXT (OR 1.10, 1.01-1.19). Age was predictive for faecal E. coli resistance to amoxicillin (OR 1.02, 1.00-1.03), norfloxacin and ciprofloxacin (both OR 1.03, 1.01-1.06). In conclusion, in women with rUTI different determinants were found for urinary and faecal E. coli resistance. Previous antibiotic use and UTI history were associated with urine E. coli resistance and age was a predictor of faecal E. coli resistance. These associations could best be explained by cumulative antibiotic use.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Feces; Female; Humans; Netherlands; Odds Ratio; Surveys and Questionnaires; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

To investigate the distribution of the genes that encode enterotoxins and the colonization factors (CF) types as well as the antibiotic susceptibility profile of enterotoxigenic Escherichia coli (ETEC) isolated from children from the Brazilian Northeast.. We conducted a 3·5-year prospective study that involved 250 children with and 150 without diarrhoea, aged 1-60 months, from low-income families in Teresina/Brazilian Northeast. All samples were assayed for E. coli, enterotoxin and CF genes and antimicrobial susceptibility by microbiological methods and PCR. ETEC strains were isolated from 9·2% children with and 4·0% without diarrhoea. Infection was more common in children aged 6-24 months in rainy months. elt⁺ /CFA/IV⁺ and elt⁺ /CS14⁺ were the most frequent genotypes. Susceptibility to nalidixic acid, ciprofloxacin and gentamicin and resistance to ampicillin, cephalothin and sulfamethoxazole-trimethoprim were common.. elt ⁺isolates and ETEC strains harbouring genes encoding CFA/IV and CS/14 were the most common ETEC found in Brazilian Northeast.. Our data, the first generated for north-eastern Brazilian children, may be important for the development of an effective vaccine and for facilitation of an empirical choice of antibiotic treatment or prophylaxis for traveller's diarrhoea in the area studied.

Topics: Bacterial Toxins; Brazil; Child, Preschool; Diarrhea; Diarrhea, Infantile; Enterotoxigenic Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Female; Humans; Infant; Male; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Virulence Factors

To evaluate the current prevalence of the three clonal groups O25b:H4-B2-ST131, O15:H1-D-ST393 and CGA-D-ST69 (where ST stands for sequence type) among Escherichia coli isolates causing extraintestinal infections in Spain and to characterize their virulence background, 500 consecutive non-duplicate E. coli isolates causing extraintestinal infections were analysed.. The 500 isolates were collected during February 2009 from five hospitals in different Spanish regions. Phylogenetic groups, STs, serotypes, virulence genes, PFGE profiles, antimicrobial resistance and extended-spectrum β-lactamase (ESBL) enzymes were determined.. The three clonal groups accounted for 19% of the 500 isolates. Furthermore, they accounted for 37% of the isolates exhibiting trimethoprim/sulfamethoxazole plus ciprofloxacin resistance, 34% of aminoglycoside-resistant isolates and 30% of multidrug-resistant isolates. Clonal group ST131 was the most prevalent, and accounted for 12% of isolates overall and for 23% of multidrug-resistant isolates. The ST131 isolates exhibited a significantly higher virulence score (mean of virulence genes 8.1) compared with the ST393 (6.0) and ST69 (5.4) isolates. The prevalence of ESBL-producing isolates was 7%. Six (10%) of the 59 ST131 isolates were positive for CTX-M-15 and one (6%) of the 16 ST393 isolates was positive for CTX-M-14, whereas none of the 22 ST69 isolates produced ESBL enzymes.. The three clonal groups investigated accounted for 30% of the multidrug-resistant isolates, which gives evidence of an important clonal component in the emergence of resistances among extraintestinal pathogenic E. coli. Notably, a single high virulence clonal group (O25b:H4-B2-ST131) causes approximately 1 in every 10 extraintestinal infections in Spain, representing an important public health threat. A new variant of the ST131 clonal group, which is non-ESBL-producing but trimethoprim/sulfamethoxazole resistant and with high virulence content, is reported.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; beta-Lactamases; Ciprofloxacin; Cross-Sectional Studies; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Genes, Bacterial; Hospitals; Humans; Multilocus Sequence Typing; O Antigens; Population Surveillance; Spain; Trimethoprim, Sulfamethoxazole Drug Combination; Virulence; Virulence Factors

Escherichia coli clonal group A (CGA) was first reported in 2001 as an emerging multidrug-resistant extraintestinal pathogen. Because CGA has considerable implications for public health, we examined the trends of its global distribution, clinical associations, and temporal prevalence for the years 1998-2007. We characterized 2,210 E. coli extraintestinal clinical isolates from 32 centers on 6 continents by CGA status for comparison with trimethoprim/sulfamethoxazole (TMP/SMZ) phenotype, specimen type, inpatient/outpatient source, and adult/child host; we adjusted for clustering by center. CGA prevalence varied greatly by center and continent, was strongly associated with TMP/SMZ resistance but not with other epidemiologic variables, and exhibited no temporal prevalence trend. Our findings indicate that CGA is a prominent, primarily TMP/SMZ-resistant extraintestinal pathogen concentrated within the Western world, with considerable pathogenic versatility. The stable prevalence of CGA over time suggests full emergence by the late 1990s, followed by variable endemicity worldwide as an antimicrobial drug-resistant public health threat.

Topics: Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Models, Statistical; Phylogeography; Trimethoprim, Sulfamethoxazole Drug Combination

Urinary tract infection (UTI) is a common complication among kidney transplant patients. UTI caused by multi-resistant extended-spectrum beta-lactamase producing bacteria (ESBL) have largely increased among the hospitalized patient population and especially kidney transplant recipients. We retrospectively studied 83 kidney transplant patients to evaluate the incidence and possible causative conditions of ESBL-related UTI over the last 6 years. ESBL production was determined by the antibiotic susceptibility profile of urine cultures. We compared the incidence in two 3-year periods, 2003-2005 (period 1) and 2006-2008 (period 2). An high incidence of ESBL-related UTI (16.8%) was observed in the posttransplant period performing 31% of the overall UTI incidence, with an increase over the last 3 years from 23.8% to 37.5%. ESBL-related UTI was related to previous episodes of UTI (78.6% vs 29.0%; P < .01) and reoperations (50.0% vs 12.9%; P < .05). We observed a progressively increasing incidence of 13%, 38%, and 45% of ESBL-related UTI among first, second, and third episodes, respectively. Age, gender, HLA mismatches, etiology of chronic kidney disease, diabetes mellitus, acute rejection, induction treatment, and type/level of immunosuppressants were similiar between the groups with or without ESBL-related UTI. We observed a high increased incidence of ESBL-related UTI among kidney transplant recipients, and particularly patients with recurrent UTI.

Topics: Adult; Anti-Bacterial Agents; beta-Lactamases; Cefazolin; Escherichia coli; Escherichia coli Infections; Female; Glomerulonephritis; Graft Rejection; Histocompatibility Testing; Humans; Kidney Transplantation; Male; Microbial Sensitivity Tests; Middle Aged; Postoperative Complications; Recurrence; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The combination of trimethoprim/sulfamethoxazole is often used to treat uncomplicated urinary tract infections in children. The rationale for combining trimethoprim and sulfamethoxazole is that they may act synergistically to increase antibacterial activity. However, approximately 3% of patients show allergic reactions to sulfamethoxazole, of which some are serious (liver failure and Stevens-Johnson syndrome). We determined whether adding sulfamethoxazole is necessary to increase in vitro antibacterial activity for pediatric urinary tract infection compared to that of trimethoprim alone.. We prospectively identified 1,298 children with urinary tract infection (greater than 100,000 cfu/ml Escherichia coli) from a total of 4 American regions. In vitro susceptibility of bacterial isolates to sulfamethoxazole, trimethoprim and trimethoprim/sulfamethoxazole was determined using disk diffusion. Ampicillin susceptibility was tested at 2 sites. At 1 site all uropathogens from consecutive urinary isolates were evaluated.. E. coli susceptibility to trimethoprim was 70%, comparable to the 70% of trimethoprim/sulfamethoxazole (p = 0.9) and higher than the 56.9% of sulfamethoxazole (p <0.05). This susceptibility pattern was without regional differences. At 2 sites susceptibility to trimethoprim was significantly higher than to ampicillin. At 1 site the susceptibility of other uropathogens to trimethoprim and trimethoprim/sulfamethoxazole was similar to that of E. coli.. In children with urinary tract infection in vitro susceptibility to trimethoprim was comparable to that to trimethoprim/sulfamethoxazole and significantly higher than to sulfamethoxazole. This finding was similar at all sites. Adding sulfamethoxazole appears unnecessary and may represent a risk to patients. Trimethoprim can be used as an alternative to trimethoprim/sulfamethoxazole based on in vitro antibacterial susceptibility. Routine trimethoprim/sulfamethoxazole use for urinary tract infection should be carefully reevaluated.

Topics: Ampicillin; Analysis of Variance; Anti-Infective Agents, Urinary; Chi-Square Distribution; Child; Child, Preschool; Drug Combinations; Drug Therapy, Combination; Escherichia coli Infections; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Prospective Studies; Sulfamethoxazole; Treatment Outcome; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Acute generalized exanthematous pustulosis (AGEP) is characterized by sudden onset of non-follicular aseptic pustules with erythema often accompanied by fever and leukocytosis. While the most frequent cause of AGEP is drug reactions, especially antibiotics. Occasional cases have been described as parainfectious. An 82-year-old female presented with recurrent AGEP along with a chronic urinary infection with Escherichia coli. Her cutaneous findings resolved following antibiotic therapy and prophylaxis. To the bets of our knowledge, this is the first case of AGEP associated with an Escherichia coli urinary tract infection.

Topics: Aged, 80 and over; Anti-Infective Agents, Urinary; Biopsy; Diagnosis, Differential; Drug Eruptions; Drug Resistance, Microbial; Escherichia coli Infections; Female; Humans; Long-Term Care; Nitrofurantoin; Recurrence; Skin; Skin Diseases, Papulosquamous; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Incontinence; Urinary Tract Infections

During a 9-year study period from 1997 through 2005, the association between antimicrobial resistance rates in Escherichia coli and outpatient antimicrobial consumption was investigated in 20 hospital districts in Finland. A total of 754,293 E. coli isolates, mainly from urine samples, were tested for antimicrobial resistance in 26 clinical microbiology laboratories. The following antimicrobials were studied: ampicillin, amoxicillin-clavulanate, cephalosporins, fluoroquinolones, trimethoprim, trimethoprim-sulfamethoxazole, pivmecillinam, and nitrofurantoin. We applied a protocol used in earlier studies in which the level of antimicrobial consumption over 1 year was compared with the level of resistance in the next year. Statistically significant associations were found for nitrofurantoin use versus nitrofurantoin resistance (P < 0.0001), cephalosporin use versus nitrofurantoin resistance (P = 0.0293), amoxicillin use versus fluoroquinolone resistance (P = 0.0031), and fluoroquinolone use versus ampicillin resistance (P = 0.0046). Interestingly, we found only a few associations between resistance and antimicrobial consumption. The majority of the associations studied were not significant, including the association between fluoroquinolone use and fluoroquinolone resistance.

Topics: Ambulatory Care Facilities; Amdinocillin Pivoxil; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Infective Agents; Cephalosporins; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Finland; Fluoroquinolones; Hospitals, Community; Humans; Microbial Sensitivity Tests; Nitrofurantoin; Retrospective Studies; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The epidemiology of acute pyelonephritis (APN) has changed with time. Therefore we investigated the current clinical characteristics of APN and the significance of proper surgical management for treatment of 1,026 APN patients in South Korea for the past 5 yr. The male-to-female ratio was about 1:8. The peak ages of female patients were 20s (21.3%) and over 60s (23.7%), while that of male was over 60s (38.1%). The occurrence of sepsis was 10.1%. Complicated APN patients were 35.4%. Ninety-four patients (9.2%) needed urological procedures. The duration of the flank pain and of the costovertebral angle tenderness in complicated APN patients was statistically significantly longer than that with simple APN patients (4.3 vs. 3.4 days, 4.4 vs. 4.0 days). If flank pain and costovertebral angle tenderness sustain over 4 days, proper radiologic studies should be performed immediately with the consideration of surgical procedure. Also the resistance to antibiotics was increasing. As the sensitivities to ampicillin (27.2%) and trimethoprim/sulfamethoxazole (44.7%) of Escherichia coli and Klebsiella pneumoniae were very low, it is necessary to take the careful choice of antibiotics into consideration.

Topics: Acute Disease; Adult; Aged; Ampicillin; Drug Resistance; Escherichia coli Infections; Female; Humans; Klebsiella Infections; Male; Microbial Sensitivity Tests; Middle Aged; Pyelonephritis; Retrospective Studies; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination

In our study of nursing home residents with clinically suspected urinary tract infection who did not require the use of an indwelling catheter, we identified bacteria isolated from urine samples, the resistance patterns of these isolated bacteria, and the antibiotic therapy prescribed to the residents. Escherichia coli, the predominant organism isolated, frequently was resistant to commonly prescribed oral antibiotics. Trimethoprim-sulfamethoxazole remains the best empiric antimicrobial therapy for a urinary tract infection, but nitrofurantoin should be considered if E. coli is identified.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Drug Resistance, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Female; Homes for the Aged; Humans; Male; Microbial Sensitivity Tests; Nitrofurantoin; Nursing Homes; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

Recent studies from North America and Europe have demonstrated community-wide clonal spread of uropathogenic Escherichia coli (UPEC). To investigate if a similar pattern of spread occurs in Brazil, we characterized UPEC from women with community-acquired urinary tract infection (UTI) in Rio de Janeiro. E. coli isolates from women with UTI in one public outpatient clinic were evaluated for antibiotic susceptibility, E. coli phylogenetic grouping, enterobacterial repetitive intergenic consensus (ERIC) 2 PCR and pulsed-field gel electrophoresis fingerprinting, and multilocus sequence typing. From March 2005 to November 2006, 344 patients were studied. Of these, 186 (54%) had confirmed UTI, 118 (63.4%) of which were caused by E. coli. More than 50% of these isolates were resistant to ampicillin and trimethoprim/sulfamethoxazole. Of these, 96 (81%) belonged to 19 ERIC2 clonal groups. The largest group included 15 isolates, all belonging to multilocus sequence typing group ST69 and phylogenetic group D; they had pulsed-field gel electrophoresis patterns sharing at least 89% similarity compared with the CgA reference strain ATCC BAA-457. CgA strains have been found to be widespread in the United States in the early 2000s. Clonal group E. coli strains accounted for a large proportion (52%) of all UTIs and 82% of the trimethoprim/sulfamethoxazole-resistant E. coli UTIs. Thus, as in North America and Europe, UPECs that cause UTI in Rio de Janeiro also show clonal distribution, and a substantial proportion of drug-resistant UTI is caused by a small set of genetically related E. coli strains.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Bacterial Typing Techniques; Brazil; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli Infections; Female; Humans; Middle Aged; Molecular Sequence Data; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Uropathogenic Escherichia coli; Young Adult

Between 2000 and 2006 the sum of ciprofloxacin and folic acid antagonists prescriptions to Bavarian (South-eastern Gemany) outpatients stayed constant. However, prescription numbers of ciprofloxacin increased while those of folic acid antagonists decreased suggesting an apparent shift in the treatment of urinary infections toward ciprofloxacin. During the observation period the proportion of E. coli resistant against ciprofloxacin increased from 5% to 10% while that against co-trimoxazole increased from 21% to 27%. The proportion of E. coli simultaneously exhibiting resistance to ciprofloxacin and co-trimoxazole increased from 3.9% to 8.5%. A leading influence of ciprofloxacin application for these developments is discussed.

Topics: Anti-Bacterial Agents; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Escherichia coli Infections; Germany; Humans; Practice Patterns, Physicians'; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Uropathogenic Escherichia coli

Urinary tract infections (UTI) are among the most prevalent infectious diseases, and their financial burden on society is substantial. Management of UTIs has been complicated by the emergence of resistance to most commonly used antibiotics. Increasing prevalence of resistance has led to a gradual evolution in the antibiotics used to treat UTIs. The aims of this study were to determine the TMP/SMX (trimethoprim/sulfamethoxazole) resistance rate in patients with uncomplicated UTIs and to determine which empiric antibiotics are prescribed in the emergency department for the outpatient management of UTI. Between June 2004 and May 2005, archives of the emergency department were searched retrospectively and the files of patients diagnosed with UTI were reviewed. Patients' demographical data, urine culture results, pathogen microorganisms, and TMP/SMX and fluoroquinolone (FQ) resistance rates were recorded. We obtained information from 274 files of patients who had been diagnosed with UTI. The most frequently isolated pathogen was Escherichia coli (54%). Of the 274 patients diagnosed with UTI, 251 had been started on empiric antibiotics. The most frequently prescribed antibiotics were FQs (85%), and the first choice in this group was ofloxacin (58%). The resistance rate for TMP/SMX was 34% and all of the resistant microorganisms were E. coli. The resistance rate for the FQ group was 16.4% and resistant microorganisms were E. coli. In the treatment of UTIs in our patient population, the most prescribed antibiotics were FQs. At the same time it was found that resistance rates against FQ antibiotics are as high as 16.4%. Unfortunately, in our population, in the near future, empiric FQ use may result in bacterial resistance.

Topics: Adolescent; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Aza Compounds; Ceftriaxone; Drug Resistance, Microbial; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Male; Middle Aged; Moxifloxacin; Quinolines; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

Topics: Aged, 80 and over; Ampicillin; Anti-Infective Agents; Aspirations, Psychological; Drug Resistance, Bacterial; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Fatal Outcome; Female; Humans; Knee Joint; Radiography; Trimethoprim, Sulfamethoxazole Drug Combination

While the spectrum of opportunistic infections due to HIV infection has been widely discussed, there are very limited data available in south India on certain incident infections especially urinary tract infections (UTI) in HIV-infected subjects.. Bacterial aetiology of 350 symptomatic UTI in HIV-infected subjects and the drug resistance pattern of the Escherichia coli isolates tested between June 2005 and July 2007 at the YRG Centre for AIDS Research and Education, a tertiary HIV Referral Centre in Chennai has been described here.. E. coli was the most common etiological agent of UTI in HIV patients, followed by Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus faecalis, Pseudomonas aeruginosa, Proteus spp. and Staphylococcus epidermidis. Twenty-nine E. coli isolates were multi-drug-resistant and 83.3% of the isolates were resistant to sulfamethoxazole-trimethoprim.. Urinary pathogens in HIV-infected patients demonstrate high antimicrobial resistance and with majority of therapy for UTIs being empiric, constant updates of the aetiological agents and their drug susceptibility pattern would largely be beneficial to clinicians in choosing the right drug.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; HIV Infections; Humans; India; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Male; Pyelonephritis; Trimethoprim, Sulfamethoxazole Drug Combination

High rates of resistance to trimethoprim-sulfamethoxazole (TMP-SMX) among uropathogenic Escherichia coli are recognized, and concerns exist about emerging fluoroquinolone resistance.. Adults presenting to 11 US emergency departments with (1) flank pain and/or costovertebral tenderness, (2) temperature >38 degrees C, and (3) a presumptive diagnosis of pyelonephritis were enrolled; patients for whom 1 uropathogen grew on culture were analyzed. Epidemiologic and clinical data were collected at the time of care. The prevalence of E. coli in vitro antibiotic resistance and risk factors associated with TMP-SMX-resistant E. coli infection were determined.. Among 403 women with uncomplicated pyelonephritis caused by E. coli, the mean site rate of E. coli resistance to TMP-SMX was 24% (range, 13%-45%). Mean site rates of E. coli resistance to ciprofloxacin and levofloxacin were 1% and 3%, respectively. Only TMP-SMX exposure within 2 days before presentation and Hispanic ethnicity were associated with E. coli resistance to TMP-SMX (compared with resistance rates of approximately 20% among women lacking these risk factors); antibiotic exposure within 3-60 days before presentation, health care setting exposure within 30 days before presentation, history of urinary tract infections, and age >55 years were not associated with E. coli resistance to TMP-SMX. Among 207 patients with complicated pyelonephritis, mean site rates of E. coli resistance to ciprofloxacin and levofloxacin were 5% and 6%, respectively.. These results suggest that the prevalence of TMP-SMX-resistant infection among patients with uncomplicated pyelonephritis is > or =20% in many areas of the United States, and risk stratification cannot identify patients at low risk of infection. Rates of fluoroquinolone-resistant E. coli infection appear to be low among patients with uncomplicated pyelonephritis but higher among those with complicated infections. Fluoroquinolones should remain to be the preferred empirical treatment for women with uncomplicated pyelonephritis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ciprofloxacin; Cross-Sectional Studies; Drug Resistance, Bacterial; Emergencies; Escherichia coli; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Levofloxacin; Middle Aged; Ofloxacin; Pyelonephritis; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; United States

The prevalence of antimicrobial resistance among uropathogenic E. coli varies widely worldwide; to guide empirical therapy is necessary to have local, up-to-date susceptibility data.. We tested 907 isolates from patients in Mexico City by disk diffusion and further characterized ciprofloxacin, cephalosporin and nitrofurantoin resistant strains.. Isolates were mostly resistant to ampicillin (74%), trimethoprim-sulfamethoxazole (60.1%) and ciprofloxacin (32.6%). The most effective drug was netilmicin (5.1% resistant) and the most effective of oral drugs was nitrofurantoin (7.4% resistant). Sixty-percent of ciprofloxacin-resistant strains had minimal inhibitory concentrations of 125 microg/ml or higher, well beyond urinary concentrations at the end of the 12-hour inter-dose period for standard oral regimes. Extended-spectrum beta-lactamases were detected in 6% of strains, most of them from community-acquired infections. All strains resistant to nitrofurantoin carried a 20 Kb plasmid, which when transformed into a susceptible recipient, conferred resistance to nitrofurantoin, ampicillin, sulfonamides, streptomycin, and partially protected against ciprofloxacin.. Drugs considered of choice against uncomplicated urinary tract infections are facing high resistance prevalences and resistance determinants formerly seen only at hospitals are now among community strains. Treatment guidelines from developed countries might not reflect these local trends.

Topics: Ampicillin; Anti-Bacterial Agents; Ciprofloxacin; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Escherichia coli Infections; Female; Humans; Mexico; Microbial Sensitivity Tests; Netilmicin; Nitrofurantoin; Pregnancy; Prevalence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Uropathogenic Escherichia coli

Emerging antimicrobial resistance among uropathogens makes the management of acute uncomplicated cystitis increasingly challenging. Few prospective data are available on the risk factors for resistance to trimethoprim-sulfamethoxazole (TMP-SMX), the drug of choice in most settings. In order to evaluate this, we prospectively enrolled women 18 to 50 years of age presenting to an urban primary care practice with symptoms of cystitis. Potentially eligible women provided a urine sample for culture and completed a questionnaire regarding putative risk factors for TMP-SMX resistance. Escherichia coli isolates were tested for clonal group A (CGA) membership by a fumC-specific PCR. Of 165 women with cystitis symptoms, 103 had a positive urine culture and were eligible for participation. E. coli was the predominant uropathogen (86%). Fifteen (14.6%) women had a TMP-SMX-resistant (TMP-SMX r) organism (all of which were E. coli). Compared with the women who had a TMP-SMX-susceptible organism, women in the TMP-SMX r group were more likely to have traveled (odds ratio [OR], 15.4; 95% confidence interval [CI], 4.4 to 54.3; P < 0.001) and to be Asian (OR, 6.1; 95% CI, 1.0 to 36.4; P = 0.048). CGA was also independently associated with TMP-SMX resistance (OR, 105; 95% CI, 6.3 to 1,777.6; P = 0.001). No association with TMP-SMX resistance was demonstrated for the use of either TMP-SMX or another antibiotic in the past 3 months or with having a child in day care. Among these women with acute uncomplicated cystitis, Asian race and recent travel were independently associated with TMP-SMX resistance. TMP-SMX r isolates were more likely to belong to CGA. Knowledge of these risk factors for TMP-SMX resistance could facilitate the accurate selection of empirical therapy.

Topics: Acute Disease; Adolescent; Adult; Anti-Infective Agents, Urinary; Cystitis; Drug Resistance, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urine

Isolates of Escherichia coli belonging to clonal group A (CGA), a recently described disseminated cause of drug-resistant urinary tract infections in humans, were present in four of seven sewage effluents collected from geographically dispersed areas of the United States. All 15 CGA isolates (1% of the 1,484 isolates analyzed) exhibited resistance to trimethoprim-sulfamethoxazole (TMP-SMZ), accounting for 19.5% of the 77 TMP-SMZ-resistant isolates. Antimicrobial resistance patterns, virulence traits, O:H serotypes, and phylogenetic groupings were compared for CGA and selected non-CGA isolates. The CGA isolates exhibited a wider diversity of resistance profiles and somatic antigens than that found in most previous characterizations of this clonal group. This is the first report of recovery from outside a human host of E. coli CGA isolates with virulence factor and antibiotic resistance profiles typical of CGA isolates from a human source. The occurrence of "human-type" CGA in wastewater effluents demonstrates a potential mode for the dissemination of this clonal group in the environment, with possible secondary transmission to new human or animal hosts.

Topics: Bacterial Typing Techniques; Base Sequence; DNA, Bacterial; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Fimbriae Proteins; Genes, Bacterial; Humans; Phylogeny; Random Amplified Polymorphic DNA Technique; Sewage; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Virulence

Strongyloidiasis is caused by a small intestinal nematode with a complex life cycle. In Italy the infection is endemic in rural areas of the Po Valley. The clinical syndrome of S. stercoralis encompasses a broad spectrum of symptoms and signs and, in the immunocompromised host, larvae can migrate to different organs and tissues. Also immune response seems to play a role in the pathogenesis of the disease. We report a case of strongyloidiasis complicated by Gram-negative sepsis and nephrotic syndrome in an immigrant from South America with a normal immune response. Whereas sepsis cleared up quickly, parasitic clearance was obtained only after treatment with ivermectin and nephrotic syndrome was still present three months after the end of treatment.

Topics: Adult; Albendazole; Animals; Anthelmintics; Anti-Bacterial Agents; Bacteremia; Ecuador; Endemic Diseases; Escherichia coli Infections; Humans; Immunocompetence; Italy; Ivermectin; Larva; Male; Nephrosis, Lipoid; Nephrotic Syndrome; Prednisone; Strongyloides stercoralis; Strongyloidiasis; Trimethoprim, Sulfamethoxazole Drug Combination

During a 1-year period, from November 2003 to October 2004, urinary Escherichia coli isolates were collected from 20 clinical microbiology laboratories across Spain. The main objective was to assess the resistance of E. coli to the antimicrobials most commonly prescribed for community-acquired urinary tract infections depending on the patient's age. A total of 2,230 valid E. coli strains from female outpatients were isolated and sent to a single central reference laboratory for confirmation and susceptibility testing using an agar dilution method. A two-sided chi-squared test was used to assess the differences in resistance between age groups (< or =65 and >65 years). E. coli resistance was found to be more common to ampicillin (52.1%), cotrimoxazole (26%) and quinolones (18%), whereas resistance to amoxicillin-clavulanic acid, cefuroxime axetil and fosfomycin were below 3%. In women older than 65 years, resistance to ciprofloxacin reached up to 29% compared with 13% of those in the under 65 age group (p <0.001). For cotrimozaxole, rates were 32% vs. 23% (p <0.001) and for ampicillin 56% vs. 50% (p=0.02), respectively. It was concluded that fosfomycin, amoxicillin-clavulanic acid and cefuroxime axetil are the most suitable antimicrobials for empirical treatment in Spain given the high 18% and 26% resistance rates to quinolones and cotrimoxazole, respectively. Being older than 65 years of age was associated with higher resistance rates to ciprofloxacin (29%). These results should be considered when recommending empirical therapy for acute cystitis in women.

Topics: Adult; Age Factors; Aged; Ampicillin Resistance; Anti-Bacterial Agents; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Middle Aged; Spain; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In young children infections with resistant Escherichia coli (E. coli) can lead to life-threatening situations. Epidemiological data on the prevalence and major determinants of carriage of antibiotic resistant E. coli among children in the community setting are sparse.. In a population-based study from Germany, stool samples were obtained from children aged 6 months to 4 years attending a pediatrician for a regular health screening (N=568) or an acute infection (N=316), as well as from their parents (N=1,594) and siblings (N=624). E. coli was cultured, and minimal inhibitory concentrations to various antibiotics were tested. We determined prevalences of E. coli resistance to commonly prescribed antibiotics and their association with potential risk factors.. Prevalence of E. coli resistance was 16.6%, 8.7%, and 11.6% for ampicillin, cotrimoxazole, and doxycycline, respectively. Strong associations were found with antibiotic resistance among siblings (odds ratios [95% confidence intervals] for ampicillin, doxycycline, and cotrimoxazole resistance: 4.4 [1.8-10.8], 8.0 [3.0-21.2], and 10.8 [3.5-32.7], respectively).. Resistance prevalences in this community-based study were much lower than those reported from the clinical sector. Household contacts seem to be the key factor for children;s colonization with resistant E. coli in the community setting.

Topics: Age Distribution; Ampicillin Resistance; Anti-Bacterial Agents; Anti-Infective Agents; Child, Preschool; Community-Acquired Infections; Doxycycline; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Escherichia coli Infections; Feces; Female; Germany; Humans; Infant; Male; Parents; Patient Acceptance of Health Care; Prevalence; Risk Factors; Siblings; Socioeconomic Factors; Trimethoprim, Sulfamethoxazole Drug Combination

In an era of increasing antimicrobial resistance, knowledge of local antimicrobial susceptibility patterns of common uropathogens is essential for prudent empiric therapy of community-acquired urinary tract infections.. To define antimicrobial susceptibility of Gram-negative uropathogens in northern Israel over a 10 year period and to compare it with patterns of antibiotic use in the same community.. We tested the susceptibility of all Gram-negative urinary isolates from outpatients at HaEmek Medical Center over the years 1995, 1999, 2002 and 2005 to common antimicrobial agents. MIC90 of Escherichia coli to some of these agents was determined and antibiotic consumption data over the years 2000-2005 (DDD/1000/day) were obtained.. We observed a rise in susceptibility rates of E. coli to amoxicillin-clavulanate, trimethoprim-sulfamethoxazole and nitrofurantoin and of other Gram-negative isolates to amoxicillin-clavulanate, ceftriaxone and cephalothin. Susceptibility rates of all Gram-negative uropathogens to ciprofloxacin decreased significantly. MIC90 of E. coli for all drugs tested remained stable. There was a significant decrease in the use of nitrofurantoin and TMP-SMX and a significant increase in the use of ampicillin, cephalothin and ceftriaxone.. Antibiotic resistance patterns mostly remained unchanged or improved slightly. There was, however, a constant decrease in susceptibility of all Gram-negative uropathogens to ciprofloxacin. Antibiotic use patterns could not explain the changes seen in antibiotic susceptibility patterns.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents, Urinary; Ciprofloxacin; Community-Acquired Infections; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Gram-Negative Bacteria; Humans; Israel; Microbial Sensitivity Tests; Nitrofurantoin; Population Surveillance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Escherichia coli Infections; Female; Humans; Secondary Prevention; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Trimethoprim-sulfamethoxazole (TMP-SMX) is a combination chemotherapeutic agent, a commonly used antibiotic. Adverse drug reactions occur in 6-8% of patients. Although, the most common adverse reactions include mild gastrointestinal distress and cutaneous events, also a wide range of hematological abnormalities have been ascribed to TMP-SMX. We report a 40-year-old male patient who developed an early onset neutropenia, thrombocytopenia, generalised rash and oral candidiasis after 5 days long TMP-SMX therapy. Although generalised rash may seen more and improves with discontinuation of the therapy; severe neutropenia, thrombocytopenia and oral candidiasis are seen very rare and rarely leads to fatality as it was in our case. Despite thrombocyte transfusions, whole blood transfusions, red cell concentrates and filgrastim therapy we lost our patient. We want to underline that although the TMP-SMX combination is usually well tolerated it can also lead to fatal complications.

Topics: Adult; Anti-Infective Agents; Anti-Inflammatory Agents; Candidiasis, Oral; Cefepime; Cephalosporins; Chlorhexidine; Drug Eruptions; Escherichia coli; Escherichia coli Infections; Exanthema; Fatal Outcome; Filgrastim; Granulocyte Colony-Stimulating Factor; Humans; Male; Meropenem; Neutropenia; Nystatin; Platelet Transfusion; Prednisolone; Recombinant Proteins; Thienamycins; Thrombocytopenia; Trimethoprim, Sulfamethoxazole Drug Combination

A multidrug-resistant Escherichia coli clonal group (designated CgA) has been isolated from women with cystitis and pyelonephritis in several communities. This study was designed to determine if CgA can cause community-acquired bloodstream infections.. All community-acquired bloodstream infections caused by E. coli identified at the San Francisco General Hospital between May 2001 and May 2003 were included. The diagnosis of septicemia was based on admission diagnosis. E. coli isolates were characterized by antibiotic susceptibility profile, enterobacterial repetitive intergenic consensus (ERIC2) PCR, serogrouping, and pulsed field gel electrophoresis (PFGE).. A total of 127 individuals with a community-acquired bloodstream infection were identified; 48 (39%) were trimethoprim-sulfamethoxazole (SXT)-resistant. CgA, as defined by ERIC2 PCR, was responsible for 19 (15%) of these infections. Infection with a CgA isolate was associated with an admission diagnosis of cystitis or pyelonephritis (p=0.01). By PFGE, none of the CgA isolates were indistinguishable to the prototype cystitis strain; however, nine bloodstream isolates differed by fewer than six bands.. CgA can cause community-acquired bloodstream infections, but does not appear to cause a disproportionate number of severe extraintestinal infections. This study provides evidence that UTI-causing clonal groups can cause a wide spectrum of disease and are an important clinical and public health concern.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Child; Child, Preschool; Community-Acquired Infections; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Female; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Middle Aged; Polymerase Chain Reaction; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The goal of this study was to assess how resistance to quinolones, fluoroquinolones and trimethoprim/sulfamethoxazole relates to the virulence potential and phylogenetic background of clinical Escherichia coli isolates.. Among 150 uropathogens (21% resistant to quinolones, 12% resistant to fluoroquinolones and 29.3% resistant to trimethoprim/sulfamethoxazole), E. coli phylogenetic group, 15 virulence-associated genes and 7 O antigens were analysed. Clonal group A (CGA) and genomic PCR profiles were studied among trimethoprim/sulfamethoxazole-resistant isolates.. Isolates susceptible to the three antimicrobial agents were significantly associated with phylogenetic group B2, whereas resistant isolates exhibited shifts to non-B2 groups (quinolone and fluoroquinolone-resistant isolates to group A; trimethoprim/sulfamethoxazole-resistant isolates to group D). Diverse virulence traits, including UTI-associated O antigens, were significantly less frequent among resistant isolates, particularly those resistant to fluoroquinolones (median score, 3.9 virulence factors/strain) and also to quinolones (5.2) or trimethoprim/sulfamethoxazole (6.4), as compared with the corresponding drug-susceptible isolates (median scores of 7.9, 8.6 and 7.9, respectively). Among 44 trimethoprim/sulfamethoxazole-resistant isolates, 3 (6.8%) belonged to CGA. All these 3 CGA strains caused pyelonephritis (P=0.02) and exhibited the consensus virulence profile of previously described CGA strains from abroad.. E. coli isolates resistant to quinolones, trimethoprim/sulfamethoxazole and especially fluoroquinolones were associated with reductions in virulence traits and shifts to non-B2 phylogenetic groups. Moreover, fluoroquinolone resistance usually occurred in low-virulence E. coli group A isolates rather than in isolates from groups B2 and D which had lost virulence traits. CGA accounted for 23% of trimethoprim/sulfamethoxazole-resistant E. coli producing pyelonephritis.

Topics: Adult; Anti-Bacterial Agents; Data Interpretation, Statistical; Escherichia coli; Escherichia coli Infections; Female; Fluoroquinolones; Genotype; Humans; O Antigens; Quinolones; Reverse Transcriptase Polymerase Chain Reaction; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Virulence Factors

To describe the distribution of trimethoprim-sulfamethoxazole resistance genes and the role of horizontal gene transfer and clonal expansion in recent increases of antibiotic resistance rates among uropathogenic Escherichia coli in Europe and Canada.. We identified antibiotic resistance alleles sul1, sul2, sul3 and dfr along with type 1 and type 2 integrons among 350 uropathogenic E. coli isolates from a cross-sectional study of acute, uncomplicated, community-acquired urinary tract infections in 16 western European countries and Canada (ECOSENS).. Trimethoprim resistance gene distributions showed no regional dependency (P = 0.84). The most common trimethoprim resistance gene was dfrA1, which occurred in 37.9% of dfr containing isolates. Similarly, the sulfamethoxazole resistance gene distributions did not vary significantly by region (P = 0.20). sul2, the most common sulfamethoxazole resistance gene, was found in 77.9% of sulfamethoxazole-resistant isolates. The distribution of type 1 and type 2 integrons varied slightly by region (P = 0.04) with type 1 integrons being the more common (85.9%). We observed 34 combinations of the sul genes, dfr genes and integron types; the most common combinations were broadly disseminated across every region examined.. Horizontal gene transfer plays a larger role than clonal expansion in the increase of trimethoprim-sulfamethoxazole resistance levels in Europe and Canada.

Topics: Anti-Bacterial Agents; Canada; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Europe; Gene Transfer, Horizontal; Humans; Integrons; Microbial Sensitivity Tests; Sulfamethoxazole; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Ciprofloxacin-resistant Escherichia coli isolates (n = 1,858) from outpatient midstream urine specimens at 40 North American clinical laboratories in 2004 to 2005 were frequently resistant to ampicillin (79.8% of isolates) and trimethoprim-sulfamethoxazole (66.5%); concurrent resistance to cefdinir (9.0%) or nitrofurantoin (4.0%) was less common. Only 10.8% of isolates were resistant to ciprofloxacin alone. Fluoroquinolone-resistant isolates of E. coli from urine were frequently multidrug resistant.

Topics: Adolescent; Adult; Ampicillin; Anti-Infective Agents, Urinary; Cefdinir; Cephalosporins; Ciprofloxacin; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Fluoroquinolones; Humans; In Vitro Techniques; Male; Microbial Sensitivity Tests; Middle Aged; Nitrofurantoin; North America; Outpatients; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We studied 100 well-characterized E. coli blood isolates from patients with urosepsis for their susceptibility to nalidixic acid, ampicillin and trimethoprim-sulfamethoxazole, according to prevalence of virulence factors, phylogenetic groups and subgroups, PAI II(J96)-like domains (determined by physical linkage of cnf1, hly and hra) and PAI I(CFT073)-like domains (determined by physical linkage of papGII to the hly locus). Nalidixic acid resistance was associated with a lower prevalence of sfa/foc, K1 antigen, pathogenicity island II(J96)-like domains, subgroup B2/I and a shift towards group A.

Topics: Ampicillin; Anti-Infective Agents; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Genomic Islands; Humans; Microbial Sensitivity Tests; Nalidixic Acid; Phylogeny; Polymerase Chain Reaction; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Virulence Factors

Infection due to extended-spectrum beta-lactamase (ESBL)-producing microorganisms is an emerging problem in the community; a high proportion of these microorganisms have been isolated from urine samples of women with uncomplicated urinary tract infections (UTI). The options for oral treatment of uncomplicated UTI are limited because of the multiple drug resistance typical of ESBL-producing strains.. The in vitro activity of fosfomycin (FOS) was determined against 428 ESBL-producing strains, including 290 (68%) E. coli and 138 (32%) K. pneumoniae. Activity of fosfomycin was compared with that of amoxicillin-clavulanate (AMC), ciprofloxacin (CIP) and cotrimoxazole (SxT). MICs of AMC, CIP, and SxT, and detection of ESBL production were tested by the broth microdilution method, whereas FOS MICs were determined by the agar dilution method. ESBLs were characterized by isoelectric focusing, polymerase chain reaction (PCR) and direct sequencing of encoding genes. The genetic relationship among the isolates was determined by REP-PCR.. Among the 428 ESBL-producing isolates studied, 417 (97.4%) were susceptible to FOS (MIC < or = 64 microg/mL). The resistance rate of E. coli to FOS was 0.3%, and was lower than resistance to AMC (11.7%), whereas the resistance rate of K. pneumoniae was 7.2% and was equal to resistance to AMC. SxT and CIP were the least active antibiotic agents against ESBL-producing isolates (sensitivity < 50%). There were no differences in fosfomycin activity against strains expressing different types of ESBLs.. Fosfomycin showed maintained activity against ESBL-producing strains and did not present co-resistance with other antimicrobial groups.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; Ciprofloxacin; Cross Infection; Escherichia coli; Escherichia coli Infections; Fosfomycin; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Multicenter Studies as Topic; Substrate Specificity; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The multistate occurrence of cases of urinary tract infection (UTI) caused by trimethoprim-sulfamethoxazole (TMP-SMZ)-resistant Escherichia coli strains belonging to a single clonal group (designated as clonal group A [CgA]) in the United States has raised an intriguing hypothesis that these infections may have been spread by contaminated food products. The present study attempted to determine if CgA strains could be traced to food animals.. A total of 495 animal and environmental E. coli isolates, which belonged to serogroups O11, O17, O73, and O77 and were collected between 1965 and 2002 by the Gastroenteric Disease Center at Pennsylvania State University (University Park, PA), were further subtyped by antimicrobial drug susceptibility, enterobacterial repetitive intergenic consensus (ERIC2) PCR, random amplified polymorphic DNA analysis, pulsed-field gel electrophoresis (PFGE), and virulence profile pattern.. Of 495 isolates, 128 (26%) had an ERIC2 PCR electrophoretic pattern indistinguishable from that of the human prototype CgA strain, and 14 CgA isolates were resistant to TMP-SMZ. Cluster analysis of PFGE patterns showed that 1 of these 14 isolates, obtained from a cow in 1988, was 94% similar to a CgA uropathogenic human-associated E. coli strain. The pattern for this isolate was included among a cluster of PFGE patterns for 5 human-associated UTI isolates that were >80% similar to each other.. These observations suggest that drug-resistant, uropathogenic human-associated E. coli strains potentially have an animal origin. The possibility that human drug-resistant UTI could be a foodborne illness has serious public health implications.

Topics: Animals; Anti-Bacterial Agents; Bacterial Typing Techniques; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Genotype; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Virulence Factors; Zoonoses

Topics: Acute Disease; Animals; Anti-Bacterial Agents; Bacterial Typing Techniques; Escherichia coli; Escherichia coli Infections; Female; Food Microbiology; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Zoonoses

The MICs for 162 diarrheagenic Escherichia coli strains and 28 Shigella strains were determined on the basis of NCCLS guidelines. More than 75% of the strains were resistant to ampicillin, chloramphenicol (53.6% of Shigella strains), and trimethoprim-sulfamethoxazole. Multiresistance was detected in 89.5% of E. coli strains and 78.6% of Shigella strains.

Topics: Ampicillin Resistance; Anti-Bacterial Agents; Child; Chloramphenicol Resistance; Diarrhea; Drug Resistance; Drug Resistance, Bacterial; Dysentery, Bacillary; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Shigella; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Vietnam

Among 1,102 recent Escherichia coli clinical isolates, clonal group A was identified in 17 of 20 (U.S. and non-U.S.) geographic locales, mainly among U.S. isolates (9% vs. 3%; p < 0.001) and those resistant to trimethoprim-sulfamethoxazole (10% vs. 1.7%; p < 0.001). The extensive antimicrobial resistance and virulence profiles of clonal group A may underlie its recent widespread emergence.

Topics: Anti-Infective Agents; Child; Communicable Diseases, Emerging; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Microbial Sensitivity Tests; Phylogeny; Prevalence; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections; Virulence

Over the last 10 years the treatment of choice for urinary tract infections (UTIs) in Turkey has changed from co-trimoxazole to quinolones owing to the rate of resistance to co-trimoxazole and its high level of therapeutic failure. The resistance ratio of 1939 UTI Escherichia coli from outpatients (1994-2003) was evaluated by Kirby-Bauer disc diffusion method for the aforementioned antibiotics to determine the change in resistance. The co-trimoxazole resistance ratio decreased during this period, with the highest ratio in 1996 (69.3%) and the lowest ratio in 2003 (38.5%) (P < 0.001). The lowest resistance ratios occurred in 1995 (4.1%) for ofloxacin and in 1996 (5.2%) for ciprofloxacin, and the highest resistance ratios occurred in 2002 (25.3% and 27.6%) for ofloxacin and ciprofloxacin, respectively (P < 0.001, P < 0.001). These findings emphasise that antibiotic usage policies, especially empirical therapies, should be based on antimicrobial resistance surveillance studies.

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Escherichia coli Infections; Fluoroquinolones; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Tract Infections

The aim of this study was to describe epidemiological, clinical, and bacteriological aspects of Escherichia coli bacteremia and meningitis in the Ibrahima-Diop-Mar infectious diseases clinic, Dakar Fann National Hospital Center (Senegal).. Data was collected from the bacteriology laboratory and hospitalization files.. 57 cases of E. coli bacteremia were reported. Among them, 10 were associated with meningitis. AIDS was diagnosed in 74% of the cases. The global lethality rate was 47% but this rate was higher in cases of associated meningitis (80 vs 37%) and in AIDS patients (50 vs 27%). Ceftriaxone, aztreonam, gentamicin, and ciprofloxacin were active on more than 95% of strains but cotrimoxazole was active on only 49% of the strains. Resistance to cotrimoxazole was higher among E. coli strains isolated from AIDS patients (62 vs 13%).. The low susceptibility to cotrimoxazole might increase the incidence of E. coli infections among patients with AIDS. It is therefore important to find an alternative to cotrimoxazole chemoprophylaxis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; AIDS-Related Opportunistic Infections; Antibiotic Prophylaxis; Bacteremia; Child; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Female; Hospitals, Public; Humans; Male; Meningitis, Bacterial; Middle Aged; Retrospective Studies; Senegal; Systemic Inflammatory Response Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

Fifty faecal samples from healthy adults were grown on MacConkey agar and three pink colonies were subcultured, identified to species level and their antimicrobial susceptibility determined. Forty-seven samples yielded 141 isolates of Escherichia coli that were susceptible to most antimicrobials. Resistance was noted for ampicillin (30.5%), chloramphenicol (12.1%), tetracycline (23.4%), trimethoprim (24.8%) and co-trimoxazole (22.7%). A direct faecal plating method was used for extended resistance screening with E. coli as the indicator organism. Zone breakpoints were determined using normalised resistance interpretation and gave similar susceptibility results. Eighty-eight isolates of E. coli from within the zones of inhibition revealed four times more antimicrobial resistance. Extended antimicrobial resistance screening both provides the susceptibility profile of the dominant E. coli isolate and detects greater resistance in rare isolates.

Topics: Ampicillin; Anti-Bacterial Agents; Carrier State; Chloramphenicol; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Feces; Folic Acid Antagonists; Humans; Microbial Sensitivity Tests; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Stool carriage of drug-resistant Escherichia coli in home-living residents of a rural community was examined. Carriage of nalidixic acid-resistant E. coli was associated with recent use of antimicrobial agents in the household. Household clustering of drug-resistant E. coli was observed. Most carriers of drug-resistant E. coli lacked conventional risk factors.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Carrier State; Cephalosporins; Child; Child, Preschool; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Family Characteristics; Feces; Female; Humans; Idaho; Male; Microbial Sensitivity Tests; Middle Aged; Nalidixic Acid; Rural Population; Trimethoprim, Sulfamethoxazole Drug Combination

From October 1999 through January 2000, an Escherichia coli clonal group (designated "CgA") was isolated from the urine of nearly one-half of all women with urinary tract infections (UTIs) caused by trimethoprim-sulfamethoxazole (TMP-SMZ)-resistant E. coli in a California community. This study describes the prevalence of pyelonephritis caused by CgA in the same community. E. coli isolates were characterized by enterobacterial repetitive intergenic consensus (ERIC2) polymerase chain reaction (PCR), serogrouping, and pulsed-field gel electrophoresis. Fourteen (11%) of 130 women with UTIs received a diagnosis of pyelonephritis. CgA was associated with 4 (57%) of the 7 pyelonephritis cases caused by TMP-SMZ-resistant E. coli and was associated with none of the cases caused by TMP-SMZ-susceptible E. coli (P<.02). Six (86%) of these TMP-SMZ-resistant E. coli isolates belonged to 2 distinct ERIC2 PCR-defined clonal groups, whereas all of the TMP-SMZ-susceptible E. coli strains had unique fingerprints (P<.001). The prevalence of antimicrobial-resistant pyelonephritis in a community may be affected by a limited number of E. coli clonal groups.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Polymerase Chain Reaction; Pyelonephritis; Serotyping; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

The antifolate drugs sulphadoxine and pyrimethamine are used for treatment of chloroquine-resistant Plasmodium falciparum in Africa. Resistance to pyrimethamine has been associated with point mutations in the dhfr-gene and resistance to sulphadoxine with mutations in the dhps-gene. There is concern that the use of the antifolates trimethoprim and sulphamethoxazole for treatment of other infectious diseases will result in the selection of malaria parasites with mutations in these genes. In Guinea-Bissau, where sulfonamide and trimethoprim-containing drugs have been used extensively, we decided to assess the prevalence of mutations in the dhfr-and dhps-gene in P. falciparum isolated from children suffering from acute malaria and to assess the resistance patterns to trimethoprim/sulphamethoxazole in Escherichia coli isolated from the same patients. A thick film and a blood sample for polymerase chain reaction (PCR) were obtained from 100 children attending the Bandim Health Centre in Bissau with symptoms compatible with malaria. Furthermore, a stool sample was collected from the same children and cultured for E. coli. Of the cultured E. coli, 67% were resistant both to sulfonamides and trimethoprim, 4% to sulfonamides alone, 3% to trimethoprim alone while 26% were fully sensitive to both drugs. PCR was successfully performed in 97 blood samples. Of these, 41% had triple mutations at the dhfr-gene (at codons 51, 59 and 108), and 15% had triple mutations plus mutation at codon 437 in the dhps-gene. Only 45% harboured the wild-type dhfr-gene. Thus both bacterial resistance and mutations in the parasitic genes were common, but not linked in the individual child. As sulphadoxine-pyrimethamine has only been used as a second line treatment for chloroquine resistant malaria in Guinea-Bissau for a few years, it is worrying to find a high prevalence of mutations in the parasitic genes coding for resistance to these drugs. Therefore, restricting the use of sulphadoxine-pyrimethamine for the treatment of chloroquine resistant malaria might not be sufficient to prevent the development of resistance in the parasites as long as antifolate drugs are used extensively.

Topics: Adolescent; Animals; Antimalarials; Child; Child, Preschool; Drug Combinations; Drug Resistance; Escherichia coli; Escherichia coli Infections; Female; Genetic Markers; Guinea-Bissau; Humans; Infant; Malaria, Falciparum; Male; Mutation; Plasmodium falciparum; Pyrimethamine; Sulfadoxine; Trimethoprim, Sulfamethoxazole Drug Combination

To investigate whether diabetes mellitus is a risk factor for resistance in Escherichia coli isolated from patients with bacteriuria.. Data were obtained from a multicentre study. A clean-voided midstream urine culture was collected from 636 women with diabetes, who were between 18 and 75-years-old, attended an out-patient department and had no symptoms of a urinary tract infection. The resistance of E. coli was determined for different antimicrobials. The results were compared with resistance data from routine isolates of E. coli, obtained from women in the same age category, time period and location.. A total of 135 E. coli were isolated from women with diabetes mellitus (mean age 57 +/- 14 years) and compared with 5907 routine isolates of E. coli obtained from female patients visiting an out-patient department (mean age 52 +/- 17 years). The resistance rates of E. coli isolated from diabetic patients and the routine isolates of E. coli to trimethoprim-sulfamethoxazole were 19% and 23%, respectively, to amoxicillin 16% and 32%, to nitrofurantoin 1% and 3%, to ciprofloxacin 0% and 4%, to ofloxacin 0% and 5%, and to norfloxacin 1% and 4%.. The resistance of uropathogenic E. coli in non-hospitalized women with diabetes mellitus is not higher than that seen in routine isolates of E. coli. This suggests that diabetes in itself is not a risk factor for resistance.

Topics: Adolescent; Adult; Aged; Amoxicillin; Anti-Infective Agents; Bacteriuria; Ciprofloxacin; Diabetes Complications; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Middle Aged; Nitrofurantoin; Norfloxacin; Ofloxacin; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

A rapid, continuous method for noninvasively monitoring the effectiveness of several antibacterial agents in real time by using a model of wound infection was developed. This study was divided into three steps: (i) construction of a plasmid to transform Escherichia coli into a bioluminescent variant, (ii) study of the bioluminescent E. coli in vitro as a function of temperature and pH, and (iii) determination of the MIC and the minimal bactericidal concentration of sulfamethoxazole-trimethoprim (SMX-TMP). Finally, the efficacy of SMX-TMP was monitored in vivo in a cutaneous wound model (hairless rat) infected with this bioluminescent bacterium by using a bioluminescence imaging system. E. coli was transformed by electroporation with a shuttle vector (pRB474) containing the firefly (Photinus pyralis) luciferase gene, resulting in a bioluminescent phenotype. It was found that pH 5.0 was optimal for incorporation of the susbstrate D-luciferin for the luciferase reaction. In vitro, when the agar dilution method, standard turbidity assays, and the bioluminescence imaging system were used, E. coli(pRB474) proved to be susceptible to SMX-TMP. In vivo, at 4 h, SMX-TMP treatment was already efficient compared to no treatment (P = 0.034). At 48 h, no bioluminescence was detected in the wound, demonstrating the susceptibility of E. coli to SMX-TMP. In conclusion, this study points out the advantage of using bioluminescence imaging to evaluate the effects of antibiotics for the treatment of acute infections in vivo in a nondestructive and noninvasive manner.

Topics: Animals; Anti-Bacterial Agents; Colony Count, Microbial; Disease Models, Animal; DNA Primers; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Hydrogen-Ion Concentration; Luminescent Measurements; Male; Microbial Sensitivity Tests; Plasmids; Rats; Reverse Transcriptase Polymerase Chain Reaction; Temperature; Transformation, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection

Edema disease (ED) of pigs is an enterotoxaemic disease caused by enterotoxaemic Escherichia coli (ETEEC) infection. Antimicrobial therapy for pigs with ED is controversial because it may induce death of sickish piglets. In this study, we investigated the effects in vitro of 7 antimicrobial agents, ampicillin, gentamicin, colistin, bicozamycin, fosfomycin, sulfamethoxazole-trimethoprim and enrofloxacin, on the release and production of shiga toxin (Stx) 2e by ETEEC strains. We found that more Stx 2e accumulated in the bacterial cells than was released into supernatant. Associated with inhibition of cell wall synthesis, the exposure to ampicillin or fosfomycin increased the release of Stx 2e. The production levels of Stx 2e in all antimicrobial-treated cultures were equal to the level in the control or less than in the control. These results suggest that cell wall synthesis inhibitors, such as ampicillin and fosfomycin, may change for the worse in the signs in ETEEC infectious pigs. On the other hand, gentamicin, colistin, bicozamycin and enrofloxacin may be useful for the treatment of pigs with ED.

Topics: Ampicillin; Animals; Anti-Bacterial Agents; Bridged Bicyclo Compounds, Heterocyclic; Cell Wall; Colistin; Edema Disease of Swine; Enrofloxacin; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Fosfomycin; Gentamicins; Quinolones; Shiga Toxin 2; Sus scrofa; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Costa Rica; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In vitro surveillance data from across the United States indicate that approximately 10%-20% of urinary Escherichia coli isolates from female outpatients are resistant to trimethoprim-sulfamethoxazole (TMP-SMX). Alternative therapies for uncomplicated urinary tract infections in women include fluoroquinolones and nitrofurantoin, but the activities of these agents against TMP-SMX-resistant isolates are rarely reported. Among TMP-SMX-resistant urinary E. coli isolates tested in US laboratories from 1998 through 2001, 9.5% (5767 of 60,414) were resistant to ciprofloxacin and 1.9% (1214 of 63,817) were resistant to nitrofurantoin; 10.4% of ciprofloxacin-resistant isolates (683 of 6560) were resistant to nitrofurantoin. An association between resistance to fluoroquinolones and nitrofurantoin in E. coli has not been previously reported and warrants further study.

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Nitrofurantoin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Bacterial Agents; beta-Lactamases; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The antimicrobial resistance profiles, comprising 12 antibiotics, of 2478 isolates of Escherichia coli from the ECO.SENS Project involving women with acute uncomplicated urinary tract infection at 252 community health care centres in 17 countries were determined. Resistance to ampicillin alone (6.3%) and sulfamethoxazole alone (5.4%) were the most common 'single resistances'. Multiple resistance was most common in Spain and least common in Finland. The main associated-resistance profiles involved ampicillin/sulfamethoxazole (8.7%) and ampicillin/sulfamethoxazole/trimethoprim/trimethoprim-sulfamethoxazole (6.4%). The most common profile of multiple resistance was ampicillin/sulfamethoxazole/trimethoprim/trimethoprim-sulfamethoxazole/nalidixic acid/ciprofloxacin. Twenty-one isolates, half of which came from Spain, were resistant to seven antibiotics or more. Three isolates, one from Spain and two from Portugal, were resistant to nine of the 12 antibiotics investigated.

Topics: Ampicillin Resistance; Anti-Bacterial Agents; Canada; Drug Resistance, Microbial; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Europe; Female; Humans; Microbial Sensitivity Tests; Population Surveillance; Sulfamethoxazole; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The aim is to evaluate the effectiveness of AM3 (Inmunoferon) in the treatment of the recurrent cystitis in women in order to know the rate of good results, previously to design a clinical trial.. Twenty-four women who had been diagnosed of two cystitis episodes in the previous 6 months without cure by antibiotic treatment were admitted to the study. Standard antibiotic treatment and 3 daily grammes of AM3 was given for 9 months. Infection and irritative symptoms during micturition rate were evaluated at the inclusion date and afterwards, at the first, third, sixth and nineth month.. Nineteen patients finished the study. The infection rate decreased from 100% at the inclusion date to 26% in the first month and then it became stable about 50%. Irritative symptoms during micturition decreased from 46% at the inclusion date to a rate lower than 10% in the 4 controls running.. AM3 reduced evident urinary infection in a 50% and irritative symptoms during micturition in a 90%. Control clinical trials are needed to confirm the AM3 effects on this pathology.

Topics: Adjuvants, Immunologic; Amoxicillin; Calcium Phosphates; Ciprofloxacin; Clavulanic Acid; Cystitis; Drug Evaluation; Drug Therapy, Combination; Escherichia coli Infections; Female; Follow-Up Studies; Fosfomycin; Glycopeptides; Humans; Pilot Projects; Recurrence; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vaginosis, Bacterial

One of my patients presented with bacteriuria early in her pregnancy. Urine culture was positive for Escherichia coli. I would like to prescribe a trimethoprim-sulfamethoxazole combination because it worked well for her in the past. What is known about the safety of this medication during early pregnancy?. Evidence-based studies report an association between trimethoprim-sulfonamide combinations in early pregnancy and several major malformations, such as neural tube defects and cardiovascular defects. If clinically possible, physicians are advised to use alternative antimicrobial medications for treatment of urinary tract infections during early pregnancy.

Topics: Abnormalities, Drug-Induced; Adult; Anti-Infective Agents; Contraindications; Escherichia coli Infections; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, First; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Antibiotic resistance is increasing in Escherichia coli, the most common cause of urinary tract infections, but its epidemiology has not been well described. We evaluated the epidemiology of trimethoprim-sulfamethoxazole-resistant E. coli in a large, public health care system in Denver, Colorado.. Outpatients with E. coli urinary tract infections during the first 6 months of 1998 were evaluated retrospectively. A prospective study was then performed to confirm the rate of trimethoprim-sulfamethoxazole resistance. We used several strain-typing methods (pulsed-field gel electrophoresis, ribotyping, serotyping) to evaluate the molecular epidemiology of the resistance.. The rate of trimethoprim-sulfamethoxazole resistance was similar in the retrospective (24% [161/681]) and prospective (23% [30/130]) phases of the study (P = 0.89). Almost all trimethoprim-sulfamethoxazole-resistant strains (98%) were resistant to at least one other antibiotic. Risk factors for infection with a resistant strain included age < or =3 years, Hispanic ethnicity, recent travel outside the United States, and a prior urinary tract infection. However, rates of resistance were >15% among nearly all of the subgroups. Most strains had high-level resistance (>1000 microg/mL) to trimethoprim-sulfamethoxazole. Of the 23 resistant isolates evaluated, 10 (43%) belonged to the clone A group. There was no correlation between conventional epidemiologic characteristics and the molecular mechanism of resistance or strain type.. Resistance to trimethoprim-sulfamethoxazole among E. coli isolates among patients in a Denver public health care system is common, with high rates of resistance even among patients without risk factors.

Topics: Adolescent; Adult; Anti-Infective Agents, Urinary; Child; Child, Preschool; Colorado; Community-Acquired Infections; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Molecular Epidemiology; Prospective Studies; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The aim of this study was to investigate the molecular basis of an observed increasing resistance to trimethoprim and sulphonamides despite a simultaneous decline in co-trimoxazole consumption. The distribution of sulphonamide resistance genes sul1, sul2 and the recently discovered sul3 was studied in a collection of clinical isolates of Enterobacteriaceae.. PCR with primers specific for sul1, sul2 and sul3 was used to detect the three known sulphonamide resistance genes in the isolate collection. Sequence analysis was used for confirmation of results. Restriction endonuclease digestion and conjugational transfer assays were used for plasmid analysis.. In 64 sulphonamide-resistant isolates, 39 sul1 genes and 48 sul2 genes were detected. Twenty-five isolates carried both sul1 and sul2 and two were negative for both genes. With PCR and sequence analysis these two were shown to harbour the new sulphonamide resistance gene sul3, which was carried by different plasmids.. Sulphonamide resistance gene sul3, which is widespread among pigs in Switzerland, has now also been identified in two different clinical isolates of Escherichia coli, located in urinary tract infections in patients in Sweden.

Topics: Anti-Infective Agents; Conjugation, Genetic; Dihydropteroate Synthase; DNA, Bacterial; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Humans; Plasmids; Reverse Transcriptase Polymerase Chain Reaction; Sulfonamides; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The Infectious Diseases Society of America advocates trimethoprim-sulfamethoxazole (SXT) as initial therapy for females with acute uncomplicated bacterial cystitis in settings where the prevalence of SXT resistance does not exceed 10 to 20%. To determine trends in the activities of SXT, ampicillin, ciprofloxacin, and nitrofurantoin among urine isolates of Escherichia coli from female outpatients, susceptibility testing data from The Surveillance Network (TSN) Database-USA (n = 286,187) from 1995 to 2001 were analyzed. Resistance rates among E. coli isolates to ampicillin (range, 36.0 to 37.4% per year), SXT (range, 14.8 to 17.0%), ciprofloxacin (range, 0.7 to 2.5%), and nitrofurantoin (range, 0.4 to 0.8%) varied only slightly over this 7-year period. Ciprofloxacin was the only agent studied that demonstrated a consistent stepwise increase in resistance from 1995 (0.7%) to 2001 (2.5%). In 2001, SXT resistance among E. coli isolates was >10% in all nine U.S. Bureau of the Census regions. At institutions testing > or =100 urinary isolates of E. coli (n = 126) in 2001, ampicillin (range, 27.3 to 98.8%) and SXT (range, 7.5 to 47.1%) resistance rates varied widely while ciprofloxacin (range, 0 to 12.9%) and nitrofurantoin (range, 0 to 2.8%) resistance rates were more consistent. In 2001, the most frequent coresistant phenotypes were resistance to ampicillin and SXT (12.0% of all isolates; 82.3% of coresistant isolates) and resistance to ampicillin, ciprofloxacin, and SXT (1.4% of all isolates; 9.9% of coresistant isolates). Coresistance less frequently included resistance to nitrofurantoin (3.5% of coresistant isolates) than resistance to ciprofloxacin (15.8%), SXT (95.7%), and ampicillin (98.1%). In conclusion, among urinary isolates of E. coli from female outpatients in the United States, national resistance rates to SXT were relatively consistent (14.8 to 17.0%) from 1995 to 2001 but demonstrated considerable regional and institutional variation in 2001. Therapies other than SXT may need to be considered in some locations.

Topics: Ampicillin; Anti-Infective Agents; Anti-Infective Agents, Urinary; Ciprofloxacin; Databases, Factual; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Female; Geography; Humans; Microbial Sensitivity Tests; Nitrofurantoin; Outpatients; Penicillins; Phenotype; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Topics: Adult; Anti-Infective Agents, Urinary; Cystitis; Drug Resistance, Bacterial; Escherichia coli Infections; Female; Humans; Trimethoprim, Sulfamethoxazole Drug Combination

One of the more perplexing aspects of urinary tract infections (UTIs) is their high propensity to recur. It has been proposed that recurrent infections are a result of the reintroduction of bacteria from the gastrointestinal tract (GIT) to the urinary tract (UT); however, since a significant subset of recurrent UTIs are caused by an identical bacterial strain, it has been challenging to formally prove this hypothesis for same-strain recurrences by using epidemiologic approaches. We present data here obtained by using a mouse model of UTIs in which it was shown that 36% (5 of 14) of mice infected with uropathogenic Escherichia coli (UPEC) will have at least one bacteriuric recurrence, with 21% (3 of 14) having more than one recurrence during a 6-week period after an acute UTI. Intraurethrally infected mice develop UPEC reservoirs in both their feces and their bladders. Ten days of trimethoprim-sulfamethoxazole (SXT) therapy reduces urinary recurrences and eradicates fecal colonization, whereas 3 days of SXT treatment has no effect over a twenty-eight-day observation period despite clearing fecal colonization acutely. Interestingly, SXT is unable to eradicate bacteria from the bladder reservoir even after a 10-day treatment regimen, thus demonstrating that the bladder reservoir can persist even in the face of long-term antibiotic therapy.

Topics: Animals; Anti-Infective Agents, Urinary; Bacteriuria; Disease Models, Animal; Escherichia coli; Escherichia coli Infections; Feces; Female; Mice; Mice, Inbred C57BL; Recurrence; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Ciprofloxacin; Drug Resistance, Multiple; Emigration and Immigration; Escherichia coli; Escherichia coli Infections; Humans; New York City; Trimethoprim, Sulfamethoxazole Drug Combination; Urban Population; Urinary Tract Infections

Topics: Drug Resistance, Multiple; Escherichia coli; Escherichia coli Infections; Female; Hispanic or Latino; Humans; Prevalence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Escherichia coli is typically the causative organism in uncomplicated urinary tract infection (UTI). Resistance rates of E. coli to trimethoprim/sulfamethoxazole (TMP/SMX) are increasing, exceeding 10% in many communities. Guidelines recommend using alternative treatments in these areas. Providers must reevaluate policies to include considerations for E. coli resistance. A model was developed, with cases for illustration, to help organizations determine the resistance rate threshold, where TMP/SMX is no longer first-line therapy. Using published data, a 19% to 21% threshold was derived, supporting a previous report of 22%. The model can aid decision makers updating internal policies to conform with guidelines for the treatment of uncomplicated UTI and to improve care.

Topics: Anti-Bacterial Agents; Cost of Illness; Drug Utilization; Escherichia coli; Escherichia coli Infections; Humans; Practice Patterns, Physicians'; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Uro-Vaxom was used in the treatment of recurrent urinary tract infections in 35 girls. Most of them (34/35) tolerated the drug very well, no side effect were observed. We stopped administration of the Uro-Vaxom in one girl, during the first month of treatment because of vomiting. This way efficiency of Uro-Vaxom was evaluated in the treatment of recurrent urinary tract infections in 34 girls. Uro-Vaxom was found to be a valuable drug, supporting antibiotic therapy in recurrent urinary tract infections caused by E. coli.

Topics: Adjuvants, Immunologic; Adolescent; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Child; Child, Preschool; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Female; Furagin; Gentamicins; Humans; Recurrence; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Risk Factors; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Decision Making; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Nitrofurantoin; Risk Factors; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Practice Guidelines as Topic; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Drug Resistance, Multiple, Bacterial; Economics, Pharmaceutical; Escherichia coli; Escherichia coli Infections; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Infectious Diseases Society of America guidelines state that uncomplicated urinary tract infections (UTIs) should be treated empirically with trimethoprim-sulfamethoxazole (TMP-SMZ), unless the community resistance among uropathogens exceeds 10%-20%, in which case a fluoroquinolone (FQ) should be used. However, the data to support this threshold are limited. We performed a cost-minimization and sensitivity analysis to determine what level of TMP-SMZ resistance in a community should trigger FQ use. The mean cost of empirical treatment with TMP-SMZ was US$92 when the proportion of resistant Escherichia coli was 0%, $106 when it was 20%, and $120 when it was 40%. The mean cost of empirical FQ treatment was $107 at current levels of FQ resistance. When >22% of E. coli in a community are TMP-SMZ-resistant, empirical FQ therapy becomes less costly than TMP-SMZ therapy. Treatment guidelines for empirical treatment of UTIs may need modification, and the threshold trigger for empirical FQ use should be raised to >20% TMP-SMZ resistance.

Topics: Anti-Infective Agents; Anti-Infective Agents, Urinary; Computer Simulation; Cost Savings; Cost-Benefit Analysis; Costs and Cost Analysis; Decision Support Techniques; Decision Trees; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Practice Guidelines as Topic; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The management of urinary tract infections is complicated by the increasing prevalence of antibiotic-resistant strains of Escherichia coli. We studied the clonal composition of E. coli isolates that were resistant to trimethoprim-sulfamethoxazole from women with community-acquired urinary tract infections.. Prospectively collected E. coli isolates from women with urinary tract infections in a university community in California were evaluated for antibiotic susceptibility, O:H serotype, DNA fingerprinting, pulsed-field gel electrophoretic pattern, and virulence factors. The prevalence and characteristics of an antibiotic-resistant clone were evaluated in this group of isolates and in those from comparison cohorts in Michigan and Minnesota.. Fifty-five of the 255 E. coli isolates (22 percent) from the California cohort were resistant to trimethoprim-sulfamethoxazole as well as other antibiotics. There was a common pattern of DNA fingerprinting, suggesting that the isolates belonged to the same clonal group (clonal group A), in 28 of 55 isolates with trimethoprim-sulfamethoxazole resistance (51 percent) and in 2 of 50 randomly selected isolates that were susceptible to trimethoprim-sulfamethoxazole (4 percent, P<0.001). In addition, 11 of 29 resistant isolates (38 percent) from the Michigan cohort and 7 of 18 (39 percent) from the Minnesota cohort belonged to clonal group A. Most of the clonal group A isolates were serotype O11:H(nt) or O77:H(nt), with similar patterns of virulence factors, antibiotic susceptibility, and electrophoretic features.. In three geographically diverse communities, a single clonal group accounted for nearly half of community-acquired urinary tract infections in women that were caused by E. coli strains with resistance to trimethoprim-sulfamethoxazole. The widespread distribution and high prevalence of E. coli clonal group A has major public health implications.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; California; Cohort Studies; Community-Acquired Infections; DNA Fingerprinting; Drug Resistance, Multiple; Escherichia coli; Escherichia coli Infections; Female; Humans; Michigan; Middle Aged; Minnesota; Prevalence; Serotyping; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Virulence

Topics: Anti-Infective Agents, Urinary; Community-Acquired Infections; Disease Outbreaks; Escherichia coli; Escherichia coli Infections; Humans; Prevalence; Serotyping; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections; Virulence

Topics: Aged; Biofilms; Combined Modality Therapy; Enterococcus faecalis; Escherichia coli Infections; Gram-Positive Bacterial Infections; Humans; Kidney Calculi; Male; Microbial Sensitivity Tests; Nephrostomy, Percutaneous; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Children with gastrointestinal infections caused by Escherichia coli O157:H7 are at risk for the hemolytic-uremic syndrome. Whether antibiotics alter this risk is unknown.. We conducted a prospective cohort study of 71 children younger than 10 years of age who had diarrhea caused by E. coli O157:H7 to assess whether antibiotic treatment in these children affects the risk of the hemolytic-uremic syndrome and to assess the influence of confounding factors on this outcome. Estimates of relative risks were adjusted for possible confounding effects with the use of logistic-regression analysis.. Among the 71 children, 9 (13 percent) received antibiotics and the hemolytic-uremic syndrome developed in 10 (14 percent). Five of these 10 children had received antibiotics. Factors significantly associated with the hemolytic-uremic syndrome were a higher initial white-cell count (relative risk, 1.3; 95 percent confidence interval, 1.1 to 1.5), evaluation with stool culture soon after the onset of illness (relative risk, 0.3; 95 percent confidence interval, 0.2 to 0.8), and treatment with antibiotics (relative risk, 14.3; 95 percent confidence interval, 2.9 to 70.7). The clinical and laboratory characteristics of the 9 children who received antibiotics and the 62 who did not receive antibiotics were similar. In a multivariate analysis that was adjusted for the initial white-cell count and the day of illness on which stool was obtained for culture, antibiotic administration remained a risk factor for the development of the hemolytic uremic syndrome (relative risk, 17.3; 95 percent confidence interval, 2.2 to 137).. Antibiotic treatment of children with E. coli O157:H7 infection increases the risk of the hemolytic-uremic syndrome.

Topics: Anti-Bacterial Agents; Cephalosporins; Child; Child, Preschool; Diarrhea; Escherichia coli Infections; Escherichia coli O157; Feces; Female; Hemolytic-Uremic Syndrome; Humans; Infant; Logistic Models; Male; Prospective Studies; Risk; Trimethoprim, Sulfamethoxazole Drug Combination

In continuous surveillance of routine samples from five Dutch laboratories, we studied resistance to the antibiotics most commonly prescribed for urinary tract infections (UTI) in The Netherlands, namely norfloxacin, amoxycillin, trimethoprim and nitrofurantoin, from 1989 to 1998 in >90000 Escherichia coli isolates. Resistance to norfloxacin increased from 1.3% in 1989 to 5.8% in 1998. Multiresistance, defined as resistance to norfloxacin and at least two of the other three antibiotics, increased from 0.5% in 1989 to 4. 0% in 1998. Multivariate analysis of the norfloxacin resistance demonstrated that this yearly increase (the odds ratio was 1.0 in 1989, 1.6 in 1992, 2.9 in 1995 and 6.1 in 1998) was independent of other determinants of resistance to norfloxacin, such as age, gender and origin of the isolate. Analysis of strata, classified by year, age and gender, demonstrated an association between prescription of fluoroquinolones (defined daily doses per case of UTI) and resistance to norfloxacin in E. coli (P < 0.001). There was no significant association with the prescription of nitrofuran derivatives (nitrofurantoin) and trimethoprim with or without sulphamethoxazole. The yearly increase of resistance to fluoroquinolones in E. coli from UTI may stem from increased prescription of fluoroquinolones for UTI. Resistance of E. coli to these agents is likely to increase further as fluoroquinolone use increases in future.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents; Anti-Infective Agents, Urinary; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Multivariate Analysis; Netherlands; Nitrofurantoin; Norfloxacin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The antibacterial pattern of tetracycline and bactrim was compared with that of the chloroform extract of two Pseudomonas strains using ten hospital strains each of Staphylococcus aureus and Escherichia coli. There was no perfect correlation between isolate source, antibiotic type and sensitivity. Both the synthetic and natural antibiotic agent exhibited antibacterial activities against resistant hospital isolates at high concentrations.

Topics: Anti-Bacterial Agents; Chloroform; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Hospitals; Humans; Microbial Sensitivity Tests; Pseudomonas; Staphylococcal Infections; Staphylococcus aureus; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents, Urinary; Child, Preschool; Escherichia coli Infections; Humans; Male; Nail Diseases; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

There are increasing concerns regarding antimicrobial resistance in Canada. Data are limited on the prevalence, patterns of resistance and risk factors associated with resistant organisms, including coliforms, in children. This study was done to address these issues as they relate to urinary tract isolates of Escherichia coli in a tertiary care pediatric centre in Ottawa.. A surveillance study was conducted from December 1992 to December 1994. Susceptibility testing of urinary tract isolates of E. coli was performed using a panel of antimicrobial agents. A case-control study was also conducted for subjects with isolates resistant to trimethoprim-sulfamethoxazole (T-S), this drug being used a representative "first-line" agent.. A total of 1636 consecutive isolates were obtained from 967 subjects. Of the 1636 isolates, 736 (45.0%) were resistant to ampicillin, 514 (31.4%) were resistant to T-S, 363 (22.2%) were resistant to both ampicillin and T-S, and 27 (1.7%) were resistant to both ampicillin and gentamicin. In the case-control study 274 children with isolates resistant to T-S were matched with 274 children who had T-S-sensitive isolates obtained during the study period or the preceding or subsequent 6 months. Multivariate analyses indicated that subjects who had received antimicrobials for more than 4 weeks in the previous 6 months were about 23 times more likely to have isolates resistant to T-S than were subjects without this risk factor (odds ratio [OR] 23.4, 95% confidence interval [CI] 12.0-47.6). Children with genitourinary tract abnormalities were 2.4 times more likely to have resistant isolates than those without such abnormalities (95% CI 1.2-4.5). Compared with children who had no hospital admissions in the previous year, those with 1 admission in that period were more likely to have resistant isolates (OR 2.3, 95% CI 1.4-7.5), as were those with 2 or more admissions in that period (OR 3.2, 95% CI 1.1-4.8). Compared with children aged 2-6 years, children under 2 years of age were less likely to have resistant isolates (OR 0.3, 95% CI 0.2-0.8).. Selective antimicrobial pressure and multiple admissions to hospital were among the risk factors associated with antimicrobial resistance. The finding of a low but definite level of resistance to both ampicillin and gentamicin is important for the selection of empiric therapy for sepsis in neonates. The role of inexpensive first-line agents in the outpatient treatment and prevention of urinary tract infections requires re-examination, particularly in children who have recently received antimicrobial therapy.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Case-Control Studies; Child; Child, Preschool; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Female; Humans; Infant; Logistic Models; Male; Microbial Sensitivity Tests; Ontario; Population Surveillance; Risk Factors; Statistics, Nonparametric; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Antibiotic therapy for infection with Shiga-toxin-producing Escherichia coli O157:H7 is controversial because of the possibility of its inducing hemolytic uremic syndrome and acute encephalopathy. In a previous study, mice with protein-calorie malnutrition were found to be highly susceptible to this pathogen. The efficacy of oral antibiotic therapy in malnourished mice infected with O157 organisms was assessed. Mice fed a low-protein calorie diet were infected intragastrically with 2 x 10(6) colony-forming units of a Shiga-toxin-producing strain of Escherichia coli O157:H7. Infected mice were orally given a therapeutic dose of an antibiotic, including norfloxacin, fosfomycin, kanamycin, ampicillin, clarithromycin or trimethoprim-sulfamethoxazole for 3 days: mice on protocol A received the antibiotic on days 1-3, starting on the day after infection, and mice on protocol B received the antibiotic on days 3-5. The duration of fecal pathogen excretion was shorter and the toxin level in the stool and blood lower in the mice that received protocol A than in untreated mice; all of the mice treated on protocol A survived the lethal infection. All antibiotics except trimethoprim-sulfamethoxazole, administered on protocol B, exhibited the same effect as that exhibited by the respective antibiotic administered on protocol A. Only the mice treated with protocol B of trimethoprim-sulfamethoxazole had a higher toxin level in the blood than untreated controls, resulting in 95% mortality. These results suggest that the antibiotics used in this study, except for trimethoprim-sulfamethoxazole, could reduce the risk of hemolytic uremic syndrome and acute encephalopathy following Escherichia coli O157:H7 infection in humans, and that fosfomycin, in particular, may be relevant for testing in humans.

Topics: Ampicillin; Animals; Anti-Bacterial Agents; Bacterial Toxins; Brain Chemistry; Disease Models, Animal; Disease Progression; Escherichia coli Infections; Escherichia coli O157; Feces; Fosfomycin; Kanamycin; Mice; Mice, Inbred C57BL; Norfloxacin; Protein-Energy Malnutrition; Reference Values; Sensitivity and Specificity; Shiga Toxins; Statistics, Nonparametric; Survival Rate; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To describe the clinical findings, treatment and results of long-term follow-up of a case of malacoplakia of the bladder.. After diagnostic endoscopic evaluation, transurethral resection of the lesion was performed and antibiotic therapy was administered. The same treatment was repeated 4 years later. During the following 10 years, the patient had a yearly endoscopic evaluation that showed no recurrence of the lesion.. Transurethral resection combined with antibiotic therapy is effective in the treatment of malacoplakia of the bladder. The importance of long-term follow-up of the patient is emphasized.

Topics: Anti-Bacterial Agents; Chronic Disease; Cystoscopy; Electrocoagulation; Escherichia coli Infections; Female; Follow-Up Studies; Hematuria; Histiocytes; Humans; Malacoplakia; Middle Aged; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder Diseases; Urinary Tract Infections

This study assessed changing patterns of antibiotic resistance in Escherichia coli urinary tract infections at a university student health center during three periods: the first 6 months each of 1991, 1994, and 1997. Urine culture and sensitivity results were taken from available medical records of female patients having urine cultures during the three periods (1991, n = 739; 1994, n = 938; 1997, n = 863); age and ethnicity were also noted. In E. coli isolates (the majority of positive cultures), resistance to four antibiotics changed significantly: ampicillin (30% to 45% to 39%), carbenicillin (29% to 42% to 39%), tetracycline (29% to 40% to 23%), and trimethoprim/sulfamethoxazole (15% to 32% to 15%). The results raise questions regarding the future clinical reliability of several commonly used antibiotics in the treatment of urinary tract infection.

Topics: Adolescent; Adult; Age Factors; Ampicillin Resistance; Anti-Bacterial Agents; Carbenicillin; Cephalosporin Resistance; Cephalothin; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Ethnicity; Female; Humans; Los Angeles; Penicillin Resistance; Reproducibility of Results; Retrospective Studies; Student Health Services; Tetracycline Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

The aim of this study was to describe antibiotic resistance rates of enterotoxigenic Escherichia coli in Israel in order to facilitate the empirical choice of antibiotic treatment or prophylaxis for traveler's diarrhea and infantile diarrhea in our region. A total of 281 enterotoxigenic Escherichia coli isolates were tested: 144 from Bedouin infants and 137 from Israeli soldiers. Antibiotic-resistant isolates were prevalent in both groups, but higher resistance rates were found in the pediatric group. Strains producing heat-labile toxin showed higher resistance rates than strains producing heat-stable toxin. The results obtained in Israel preclude the use of many commonly used antibiotics for the treatment of traveler's diarrhea. Quinolones, however, are still effective.

Topics: Adolescent; Adult; Bacterial Toxins; Diarrhea; Diarrhea, Infantile; Drug Resistance, Microbial; Enterotoxins; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Ethnicity; Humans; Infant; Israel; Military Personnel; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

Traveller's Diarrhea (TD, turista) is the most common health disturbance in travellers, affecting 20-50% of two-week travellers depending on their origin, destination and eating habits. The etiological agents most frequently isolated from the stools are enterotoxinogenic Escherichia coli (ETEC), Salmonella spp., Shigella spp., but the rate of isolation of Campylobacter spp. and non cholera vibrios is also high in Asia. Preventive measures in eating habits should in principle be able to curb the incidence of TD but compliance of travellers is usually poor. Antibiotic chemoprophylaxis has proved effective, but economic, safety and microbiological (drug resistance) considerations discourage its widespread use. Any treatment strategy should consider that TD is usually a self-limiting, benign illness in most travellers, even though infants, elderly people or persons with severe baseline diseases (heart diseases, diabetes, immunocompromised hosts, etc...) may sometimes suffer severe consequences. Adequate rehydration is the cornerstone of treatment and intestinal motility inhibitors may be used in adults (not in children) with severe diarrhea during the first 24 hours if the suspicion of invasive pathogen has been ruled out. Routine antibiotic treatment of TD is controversial, due to the benign nature of the syndrome and to the impossibility to ascertain its causative agent. It should be limited to severe and disabling cases. Among the many antibiotics tested, quinolones are now considered first-choice treatment worldwide, even though disturbing reports of the increasing prevalence of quinolone-resistant Campylobacter spp. from Asia have been recently published. Cotrimoxazole is efficient in Central America. The role of non absorbed antibiotics and probiotics is still to be fully elucidated.

Topics: 4-Quinolones; Adult; Aged; Ambulatory Care; Anti-Infective Agents; Antibiotic Prophylaxis; Child; Diarrhea; Disease; Dysentery, Bacillary; Escherichia coli Infections; Feeding Behavior; Fluid Therapy; Humans; Immunocompromised Host; Infant; Patient Compliance; Salmonella Infections; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acidosis, Renal Tubular; Anti-Infective Agents, Urinary; Electrochemistry; Escherichia coli Infections; Humans; Hydrogen-Ion Concentration; Hyperkalemia; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Trimethoprim-sulphamethoxazole (TMP-SMZ) is considered a safe drug for treatment of infectious bacterial diseases in children. Side-effects are rare and generally take the form of a hypersensitivity reaction to the sulphamethoxazole component of the drug. Hepatic injury usually presents as a transient elevation of liver enzymes, which is of little clinical relevance. Fulminant liver failure due to TMP-SMZ has been reported in only six adults and never in children. We here report a 5-year-old girl who developed fulminant liver failure 3 weeks after her third exposure to TMP-SMZ. After a biphasic clinical course she underwent successful liver transplantation.. Trimethoprim-Sulphamethoxazole may cause fulminant liver failure in children. The disease can run a biphasic clinical course and liver transplantation must be considered as the therapeutic option for these patients.

Topics: Biopsy; Child, Preschool; Escherichia coli Infections; Female; Hepatic Encephalopathy; Humans; Liver; Liver Function Tests; Liver Transplantation; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Empiric treatment with ciprofloxacin and norfloxacin has been recommended recently for patients with acute diarrhoeal disease. In a retrospective 6-month study period the results of stool cultures from 209 patients with acute diarrhoea admitted to the emergency room were analysed. Seventy-eight cultures (37%) were positive for one or more bacteria. Shigella was the most commonly isolated pathogen (68%). Shigella sonnei comprised 72% and Shigella flexneri 19% of all the bacterial isolates. While no antimicrobial resistance to ciprofloxacin was found for both Shigella species, only 36 and 26% of the Shigella isolates were sensitive to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMZ), respectively. These findings point out to the emergence of drug resistance to commonly used antimicrobial drugs. Shigella's high sensitivity to the newer quinolones should make this the treatment of choice for the very sick patient, although physicians should be cautioned to the fact that indiscriminate use of this drug could result in the emergence of resistance similar to that noted with ampicillin and TMP-SMZ.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Ampicillin; Bacterial Infections; Bacteriological Techniques; Child; Child, Preschool; Ciprofloxacin; Diarrhea; Drug Resistance, Microbial; Dysentery, Bacillary; Emergency Service, Hospital; Escherichia coli Infections; Feces; Humans; Infant; Microbial Sensitivity Tests; Middle Aged; Salmonella Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Thirty-seven strains of E. coli recovered from cases of septicaemia in chicken were tested for sensitivity to 6 antibiotics. Minimum inhibitory concentration (MIC) determinations done on the strains showed resistance to trimethoprim-sulfamethoxazole (septrin) (100%), ampicillin (62.2%), tetracycline (51.4%), kanamycin (13.5%) and gentamicin (2.7%). All were sensitive to chloramphenicol. Conjugation studies showed easy transfer of the resistance factor for septrin to the recipient sensitive strain, K12F-, a 60 megadalton plasmid was transferred in most of the cases (a number of plasmids moved across to K12F- strains). Septrin was chosen as a referral antibiotic because it is used extensively for treating diarrhoeal cases in children in Kenya. The results expressed the possibility of the chicken being the possible source of the septrin resistance gene (plasmid) for humans, and vice versa.

Topics: Ampicillin Resistance; Animals; Chickens; Child; Chloramphenicol; Conjugation, Genetic; Diarrhea; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Gentamicins; Humans; Kanamycin Resistance; Kenya; Plasmids; Poultry Diseases; R Factors; Sepsis; Tetracycline Resistance; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Clavulanic Acids; Drug Resistance, Microbial; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Nalidixic Acid; Ofloxacin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Age Factors; Aged; Bacteriuria; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Prostatitis; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A 74 year old woman became progressively confused and developed visual hallucinations and delusions over a six day period, after the institution of routine oral trimethoprim-sulfamethoxazole therapy for a urinary tract infection. The medication was discontinued, and a marked improvement was noted 36 hours later. There was a complete return to normal mental functioning 60 hours after therapy was discontinued. The relationship between the patient's symptoms with the initiation and discontinuation of the medication suggests that the drug had a causal effect.

Topics: Aged; Delusions; Dose-Response Relationship, Drug; Escherichia coli Infections; Female; Hallucinations; Hip Prosthesis; Humans; Mental Status Schedule; Postoperative Complications; Psychoses, Substance-Induced; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The effects of a beta 2-receptor agonist, terbutaline, on haematocrit and survival were studied in rats in which septic shock had been induced by intraperitoneal injection of a mean (SD) dose of 6.0 (4.5) x 10(8) live E. coli. Untreated septic animals developed haemoconcentration, the mean (SD) haematocrit increasing from 47.5 (1.4) to 53.1 (2.2). Mean (SD) survival time was 8.9 (0.6) hours, and no animal survived for 24 hours. Terbutaline given as the only treatment in doses of 0.1, 0.5, and 2.5 mg/kg before injection of E. coli significantly reduced the haemoconcentration, with haematocrit of 51.9, 46.6 and 47.9, respectively, at 4 hours. Survival was not significantly prolonged. When terbutaline was started 5.5 hours after injection of E. coli and given in addition to a chemotherapeutic drug (trimethoprim + sulphamethoxazole) and dexamethasone, haematocrit were reduced, 24 hour survival improved from 44% to 68%, and 7 day survival improved from 20% to 48%. We conclude that terbutaline given alone counteracts the loss of plasma volume during septicaemia and, when combined with a chemotherapeutic and dexamethasone, significantly improves long term survival.

Topics: Albumins; Animals; Dexamethasone; Drug Therapy, Combination; Escherichia coli Infections; Hematocrit; Male; Plasma Volume; Rats; Rats, Inbred Strains; Shock, Septic; Survival Rate; Terbutaline; Trimethoprim, Sulfamethoxazole Drug Combination

An 8-year-old Arabian gelding with septic cholangitis and peritonitis was successfully treated with trimethoprim/sulfadiazine. The gelding was referred for evaluation of signs of abdominal pain, icterus, fever, and weight loss. Peritoneal fluid analysis revealed septic and suppurative peritonitis. Culture of the peritoneal fluid yielded Escherichia coli and Klebsiella pneumoniae, which were sensitive to trimethoprim/sulfadiazine. On the basis of results of hepatic ultrasonography, a diagnosis of septic cholangitis also was made. The horse was treated with 30 mg of trimethoprim/sulfadiazine/kg, PO, q 12 h for approximately 6 weeks. The horse improved steadily, and telephone follow-up with the owner 1 year later disclosed that the horse had complete return to normal condition, appetite, and attitude. On the basis of our findings, aggressive, long-term anti-inflammatory and antibiotic treatment may result in complete return to health and normal athletic function in horses with septic cholangitis and concurrent septic peritonitis.

Topics: Animals; Cholangitis; Escherichia coli; Escherichia coli Infections; Horse Diseases; Horses; Klebsiella Infections; Klebsiella pneumoniae; Liver; Male; Peritonitis; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography

Under combat conditions infectious disease can become a major threat to military forces. During Operation Desert Shield, there were numerous outbreaks of diarrhea among the U.S. forces. To evaluate the causes of and risk factors for diarrheal disease, we collected clinical and epidemiologic data from U.S. troops stationed in northeastern Saudi Arabia.. Between September and December 1990, stool cultures for enteric pathogens were obtained from 432 military personnel who presented with diarrhea, cramps, vomiting, or hematochezia. In addition, a questionnaire was administered to 2022 soldiers in U.S. military units located in various regions of Saudi Arabia.. A bacterial enteric pathogen was identified in 49.5 percent of the troops with gastroenteritis. Enterotoxigenic Escherichia coli and Shigella sonnei were the most common bacterial pathogens. Of 125 E. coli infections, 39 percent were resistant to trimethoprim-sulfamethoxazole, 63 percent to tetracycline, and 48 percent to ampicillin. Of 113 shigella infections, 85 percent were resistant to trimethoprim-sulfamethoxazole, 68 percent to tetracycline, and 21 percent to ampicillin. All bacterial isolates were sensitive to norfloxacin and ciprofloxacin. After an average of two months in Saudi Arabia, 57 percent of the surveyed troops had at least one episode of diarrhea, and 20 percent reported that they were temporarily unable to carry out their duties because of diarrheal symptoms. Vomiting was infrequently reported as a primary symptom, but of 11 military personnel in whom vomiting was a major symptom, 9 (82 percent) had serologic evidence of infection with the Norwalk virus.. Gastroenteritis caused by enterotoxigenic E. coli and shigella resistant to a number of drugs was a major problem that frequently interfered with the duties of U.S. troops during Operation Desert Shield.

Topics: Adolescent; Adult; Ampicillin; Diarrhea; Drug Resistance, Microbial; Dysentery, Bacillary; Escherichia coli; Escherichia coli Infections; Feces; Gastroenteritis; Humans; Male; Middle Aged; Military Personnel; Norwalk virus; Saudi Arabia; Shigella sonnei; Surveys and Questionnaires; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Vomiting; Warfare

The majority of the 78 enteropathogenic (EPEC) and the 151 non-EPEC Escherichia coli strains isolated from preterm neonates during an outbreak of gastroenteritis in a hospital in Nairobi, Kenya, were resistant to trimethoprim-sulfamethoxaxole, chloramphenicol, oxytetracycline and ampicillin, but only a few strains were resistant to cefazolin, cefamandole, cefotaxime, amikacin and nalidixic acid. Fourteen different antimicrobial resistance patterns were observed in the 229 strains of E. coli analysed. Eighty-two percent of the EPEC strains belonged to two resistance pattern compared with 79% of non-EPEC strains which exhibited three resistance patterns. There was no consistent relationship between plasmid profile group and antimicrobial resistance pattern, although one resistance pattern was more frequently observed in EAF-positive strains belonging to the dominant plasmid profile group. Nine percent of the EPEC strains were resistant to gentamicin compared to 37% in the non-EPEC group. No correlation was observed between administration of gentamicin and percentage of resistant strains isolated. None of the nine neonates receiving gentamicin died during the outbreak. Gentamicin resistance was observed in E. coli strains from six out of these nine neonates. Five out of fourteen neonates who received other antimicrobials, or no antibiotic treatment at all, died.

Topics: Ampicillin; Chloramphenicol; Cross Infection; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Gentamicins; Humans; Infant, Newborn; Kenya; Oxytetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Child; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Humans; Pyelonephritis; Sulfonamides; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anemia, Sickle Cell; Cefazolin; Child, Preschool; Drug Therapy, Combination; Escherichia coli Infections; Female; Gentamicins; Humans; Metacarpus; Osteomyelitis; Trimethoprim, Sulfamethoxazole Drug Combination

We treated 15 men who had chronic bacterial prostatitis refractory to trimethoprim-sulfamethoxazole and/or carbenicillin with 400 mg. norfloxacin twice daily for 28 days. All pathogens were susceptible to norfloxacin and absent in prostatic fluid cultures obtained during therapy. One patient had negative post-therapy prostatic fluid cultures but was lost to followup at 1 month. Of the 14 patients followed for at least 6 months 9 (64%) were cured of the original infection, including 6 who have remained uninfected and have had negative prostatic secretion and urine cultures for at least 2 years (1), 1 year (2) or 6 months (3). In 3 patients urinary tract infections recurred with new pathogens at 6, 560 and 820 days after post-therapy negative prostatic fluid cultures. Bacterial prostatitis with the original pathogen recurred in 5 patients within 2 months of completing therapy. The bacteria remained susceptible to norfloxacin but could not be eradicated with 30 to 90 days of additional norfloxacin therapy. Cures were achieved in 9 of 12 patients with Escherichia coli, none of 2 with Pseudomonas prostatitis and 3 of 5 with prostatic calculi. No patient experienced significant adverse effects. The data suggest that norfloxacin is effective and safe for the treatment of refractory chronic bacterial prostatitis.

Topics: Carbenicillin; Chronic Disease; Escherichia coli Infections; Follow-Up Studies; Humans; Male; Middle Aged; Norfloxacin; Prostatitis; Pseudomonas Infections; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Coliform myositis was diagnosed in a young calf with signs of pain, swelling, and edema of the right hind limb. Diagnostic methods included bacteriologic culture and antimicrobial susceptibility testing. The organism isolated was a gas-producing Escherichia coli. The infection responded to administration of trimethoprim/sulfadiazine, to which the organism was susceptible in vitro.

Topics: Animals; Cattle; Cattle Diseases; Escherichia coli; Escherichia coli Infections; Male; Microbial Sensitivity Tests; Myositis; Trimethoprim, Sulfamethoxazole Drug Combination

We searched the susceptibility of E. coli strains isolated from urine cultures of sick children with urinary tract infections to Nitrofurantoin, Co-trimoxazole, Gentamicin, Ampicillin and Amoxillin-Clavulonic acid. In our study, we compared the results of Farabi Hospital of Black Sea Technical University Medical Faculty, Hacettepe University Medical Faculty Children Hospital and Glasgow Royal Hospital for sick children and tried to show their regional and national differences for antibiotic susceptibility.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Bacteriuria; Child; Clavulanic Acids; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Gentamicins; Humans; Multicenter Studies as Topic; Nitrofurantoin; Scotland; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Tract Infections

A 73 year old male was hospitalised with fever of unknown origin and episodes with septic shock. During the in-hospital stay the clinical situation deteriorated rapidly, and E. coli was isolated from bloodcultures. All routine investigations revealed no specific abnormalities except for the electrocardiogram, which showed an old anterior-apical infarction although no history of cardiac disease was present. A CT-scan of the thorax and a scintigraphy using labelled autologous leucocytes made the diagnosis of a myocardial abscess, located in an apical aneurysm, probable. No other site of infection could be found and so it was decided to perform an aneurysmectomy with abscess evacuation in combination with extensive antibiotic treatment. After two years the patient is doing well. Only one case of survival has been reported before, also after surgical intervention. This underlines the importance of early diagnosis and aggressive therapy especially with regard to the reported high incidence of cardiac rupture.

Topics: Abscess; Aged; Combined Modality Therapy; Drug Combinations; Endocarditis, Bacterial; Escherichia coli Infections; Heart Aneurysm; Humans; Male; Myocardial Infarction; Sulfamethoxazole; Thrombosis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Several radiological studies have suggested that pyelonephritis in infancy and childhood may result in kidney growth retardation without renal scarring. In the present study, we induced ascending pyelonephritis in 20-day-old rats with intravesical infusion of E. coli. Four days after infusion, E. coli was cultured from all renal cortex. The rats were either left untreated (PNu) or were treated with trimethoprim-sulfa (PNt). The rats were investigated one month after infection and compared with an age-matched control group (C). Seventy-nine percent of the PNu rats had recovered spontaneously from infection. Body weight was the same in all groups. In PNu rats, kidney weight (KW), kidney area (KA) and glomerular filtration rate (GFR) were significantly decreased. KW, KA and GFR were similar in PNt and C rats. The numbers of filtering nephrons were not reduced by the infection. The total cortical DNA content (index of cell number) was significantly lower in PNu (5.30 +/- 0.32 mg) and PNt (6.62 +/- 0.44 mg) than in C rats (8.48 +/- 0.49 mg). The cortical DNA content was significantly lower in PNu than in PNt rats. The cortical protein/DNA ratio was significantly higher in PNu rats than in C rats. The protein/DNA ratio was similar in PNt and PNu rats. The increase in protein/DNA ratio was interpreted as a sign of cell hypertrophy. The inflammatory process as such did not increase the protein/DNA ratio. The kidneys were also examined for structural lesions. Signs of scarring, inflammation and cell necrosis were almost absent in all groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aging; Animals; Body Weight; DNA; Drug Combinations; Escherichia coli Infections; Female; Glomerular Filtration Rate; Kidney; Organ Size; Proteins; Pyelonephritis; Rats; Rats, Inbred Strains; Reference Values; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder

The effect of a single day treatment with 600 mg norfloxacin 600 mg ofloxacin or 1,920 mg trimethoprim-sulfamethoxazol was determined on 114 patients with acute cystitis. The overall clinical efficacy was excellent in 101 patients (89%), moderate in 9 patients (8%) and poor in 4 patients (3%). Recurrence was observed in 8 cases (8%) within 6 weeks after the treatment. The effectiveness rate and the recurrence rate were inferior in those caused by S. epidermidis compared with those caused by E. coli.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Urinary; Cystitis; Drug Administration Schedule; Drug Combinations; Escherichia coli Infections; Female; Humans; Middle Aged; Norfloxacin; Ofloxacin; Recurrence; Staphylococcal Infections; Staphylococcus epidermidis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Ampicillin; Ampicillin Resistance; Anti-Infective Agents, Urinary; Drug Combinations; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The percentage of Shigella and enterotoxigenic Escherichia coli (ETEC) strains resistant to trimethoprim (TMP)-sulfamethoxazole isolated from children with diarrhea at the outpatient department of the Children's Hospital in Bangkok increased from 3 and 0%, respectively, in 1982 to 29% and 25% in 1986. One hundred thirty-nine Shigella and 22 ETEC strains resistant to greater than 1024 micrograms/ml of trimethoprim (TMPr) isolated from children with diarrhea in Bangkok in 1984 and 1985 were analyzed for the presence of type I, II and III plasmid-specific dihydrofolate reductase (DHFR) genes. Thirty-two percent (45 of 139) of TMPR Shigella had genes encoding type II and 9% (13 of 139) had genes encoding type I DHFR genes. Fifty percent (11 of 22) of TMPR ETEC had type II and 14% (3 of 22) had type I DHFR genes. Plasmids encoding DHFR were identified by the Southern technique in 24% (14 of 58) of Shigella and 1 of 14 ETEC that contained genes encoding DHFR. Plasmids coding for type II DHFR were transferred to E. coli K12 by conjugation from 13 of 14 Shigella and a plasmid coding for type I DHFR was transferred from the single ETEC containing a plasmid coding for type I DHFR. Genes coding for DHFR were presumably situated on the chromosome in 76% (44 of 58) of Shigella and 93% (13 of 14) of ETEC that contained genes encoding DHFR. Since 58% (81 of 139) of TMPR Shigella and 36% (8 of 22) of TMPR ETEC strains examined did not contain genes encoding type I, II or III DHFR, high level TMP resistance was presumably caused by other types of DHFR genes.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Anti-Bacterial Agents; Child; Conjugation, Genetic; Diarrhea; DNA, Bacterial; Drug Combinations; Dysentery, Bacillary; Enterotoxins; Escherichia coli; Escherichia coli Infections; Genes, Bacterial; Humans; Nucleic Acid Hybridization; R Factors; Shigella; Sulfamethoxazole; Tetrahydrofolate Dehydrogenase; Thailand; Trimethoprim; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Animals; Cystitis; Drug Combinations; Drug Evaluation, Preclinical; Escherichia coli Infections; Fosfomycin; Klebsiella Infections; Norfloxacin; Pipemidic Acid; Proteus Infections; Rats; Rats, Inbred Strains; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

This study examines the causes for the therapeutic failure of trimethoprim-sulfamethoxazole in a patient with infected cysts caused by a sensitive strain of Escherichia coli. We determined the concentration of trimethoprim and sulfamethoxazole in eight cysts (four proximal, four distal) following therapeutic nephrectomy in a patient treated eight days with trimethoprim-sulfamethoxazole in appropriate doses. In four proximal cysts, mean trimethoprim level was 16.1 +/- 0.8 micrograms/mL with mean sulfamethoxazole level of 94.7 +/- 13.0 micrograms/mL. In distal cysts, mean trimethoprim level was 227.8 +/- 16.8 micrograms/mL with mean sulfamethoxazole level of 9.7 +/- 3.6 micrograms/mL. Serum peak and trough trimethoprim concentrations were 9.8 micrograms/mL and 5.4 micrograms/mL with peak and trough sulfamethoxazole concentrations of 136.0 micrograms/mL and 65.0 micrograms/mL. Significant WBC counts were present in seven cysts, three proximal and four distal. All three proximal cysts were sterile; in contrast, the four distal cysts grew the same strain of E coli isolated from the blood and urine of this patient. The infection resolved following nephrectomy. We conclude that the failure of trimethoprim-sulfamethoxazole to eradicate the infection was caused by the inability of sulfamethoxazole to enter distal cysts in sufficient concentration for the synergistic effect commonly seen with trimethoprim and sulfamethoxazole in combination. Treatment of cyst infections with trimethoprim-sulfamethoxazole should probably be avoided in instances when the organism is resistant to trimethoprim alone.

Topics: Cysts; Drug Combinations; Drug Evaluation; Drug Synergism; Escherichia coli; Escherichia coli Infections; Female; Humans; Hydrogen-Ion Concentration; Middle Aged; Polycystic Kidney Diseases; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

In the course of a study to determine the nature and type of secondary bacterial infection in dracunculiasis. The most common organisms cultured from lesions were Escherichia coli, Enterobacter and Staphylococcus aureus. E. coli and Enterobacter which were found to carry high morbidity were sensitive to Gentamycin, Claforan and Septrin.

Topics: Cefotaxime; Dracunculiasis; Drug Combinations; Enterobacter; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Humans; Skin Diseases, Infectious; Skin Ulcer; Staphylococcal Skin Infections; Staphylococcus aureus; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

During the last two years eight children aged 3 months to 7 years were treated successfully for contaminated small bowel syndrome (CSBS). All patients had a history of a laparotomy in the neonatal period and showed bile stained vomiting and diarrhoea. On examination, a painful distended abdomen with hyperactive bowel sounds was found. Plain abdominal x-rays showed signs of mechanical intestinal obstruction. The diagnosis of CSBS was made by positive gram stain and cultures of samples taken via a nasogastric tube. After antibiotic treatment the symptoms disappeared within a few days. We therefore believe that CSBS should always be considered in the differential diagnosis of abdominal emergencies. Our views agree with those of other authors in so far as we feel that antibiotic therapy may help to avoid unnecessary laparotomies in such cases.

Topics: Child; Child, Preschool; Clostridium; Clostridium Infections; Drug Combinations; Escherichia coli; Escherichia coli Infections; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Infant; Infant, Newborn; Intestinal Obstruction; Intestine, Small; Laparotomy; Ornidazole; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A model of ascending urinary tract infection due to an isolate of Escherichia coli was developed in normal and streptozotocin-induced mice to compare the efficacy of norfloxacin and trimethoprim-sulphamethoxazole. Norfloxacin and trimethoprim-sulphamethoxazole both were effective in reducing the number of colony forming units of E. coli from the kidneys of normal experimentally-infected mice, although norfloxacin yielded a greater quantitative reduction of colony forming units. Norfloxacin was substantially more effective than trimethoprim-sulphamethoxazole in reducing the number of colony forming units from kidney homogenates when the test animals were diabetic. This study supports the initiation of clinical trials to evaluate norfloxacin in diabetic patients.

Topics: Animals; Anti-Infective Agents; Diabetes Mellitus, Experimental; Disease Models, Animal; Drug Combinations; Escherichia coli Infections; Female; Mice; Mice, Inbred Strains; Norfloxacin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

40 uninephrectomized male Wistar rats with an experimental E.-coli-022-pyelonephritis (PN) were treated twice daily for 9 days with 30 mg trimethoprim and 150 mg sulfamethoxazole (TMP-SMO) i.p. Bacteriologically most of the kidneys became sterile. Histologically a significant reduction of the frequency of severe PN was found in the treated group. The biologic half-life of 131I-hippuran indicated a decrease of excretory function which was reversible. Urine osmolality and osmotic clearance were increased after oral water loading in 10 untreated control animals with PN but not in the treated group. The 9 day treatment had a favourable effect bacteriologically, histologically and also on renal function.

Topics: Animals; Drug Combinations; Drug Evaluation, Preclinical; Escherichia coli Infections; Half-Life; Iodohippuric Acid; Kidney; Male; Nephrectomy; Pyelonephritis; Rats; Rats, Inbred Strains; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

In this study; E. coli strains isolated from 100 patients with urinary tract infections were investigated for their antibiotic susceptibility and metabolic deficiencies. The strains were found to be highly susceptible to gentamicin (%97), Bactrim (R) (%77) and resistant to the other antibiotics in changing but important degrees. Study of metabolic deficiencies revealed that 9 of the strains were in accord with the deficiency criteria and only one of them was thymin-dependent.

Topics: Adult; Aged; Anti-Bacterial Agents; Drug Combinations; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Humans; Male; Middle Aged; Sulfamethoxazole; Thymine; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary malakoplakia may pursue an aggressive clinical course with persistent infection, despite seemingly appropriate antibiotic therapy. The authors studied seven adult females with urinary malakoplakia. Specific immunocytochemical staining demonstrated intracellular Escherichia coli in malakoplakia tissue in four patients. In two of the four patients, the bacteria were present despite antibiotic-induced sterile urines at time of biopsy. Cessation of therapy consistently lead to recurrent bacteriuria in these patients. In one such patient, the intracellular bacilli were confirmed as E. coli by culture of crushed malakoplakia tissue and electron microscopic study; the organisms were a routine E. coli strain susceptible to multiple previously administered antibiotics. Only sequential treatment with bethanechol chloride and trimethoprim-sulfamethoxazole, however, eliminated the infection; all three drugs are thought to be capable of enhancing intracellular killing of bacteria. Conventional antibiotic therapy failed to halt progression of disease in other malakoplakia patients. The data indicate that intracellular bacteria may serve as a reservoir of persistent/recurrent infection in urinary malakoplakia. Optimal therapy should include therapeutic agents that may control intracellular organisms.

Topics: Adult; Aged; Bacteriological Techniques; Bacteriuria; Bethanechol; Bethanechol Compounds; Drug Combinations; Escherichia coli; Escherichia coli Infections; Female; Humans; Immunoenzyme Techniques; Malacoplakia; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urologic Diseases

This study evaluates the relative effects of 2 combined antibiotics, a crystalloid solution, 4 3% colloid solutions, and a pharmacologic dose of corticosteroids, given alone and in combination for the treatment of Escherichia coli-induced septic shock. All treatments began 5.5 h after bacterial injection. Untreated septic rats had a mean survival time of 9.9 h. Antibiotics (trimethophrim and sulfamethoxazole) alone did not significantly increase mean survival time (11.0 h). No rats in either of these two groups survived 24 h. When antibiotics and dexamethasone were combined, 40% (4/10) rats lived longer than 24 h (p less than .05). With Ringer's solution infusion, the mean survival time was 8.7 h and 30% (3/10) lived longer than 24 h. When a 3% colloid solution was given, 50% (20/40) lived more than 24 h and 20% (8/40) lived more than 7 days. There was no significant difference between the 4 colloid solutions (albumin, dextran-40, dextran-70, hydroxyethyl starch). When Ringer's solution was combined with dexamethasone and antibiotics, 80% (8/10) lived more than 24 h and 20% (2/10) were long-term survivors. When the antibiotic drug was combined with a colloid solution and dexamethasone, all animals lived more than 24 h and 90% (9/10) lived more than 7 days. This study demonstrates the therapeutic value of an effective antibiotic drug for control of the infective organism, a colloid solution infusion to maintain blood volume and circulation, and corticosteroids for still largely unknown reasons.

Topics: Animals; Colloids; Combined Modality Therapy; Dexamethasone; Drug Combinations; Escherichia coli Infections; Female; Fluid Therapy; Hematocrit; Male; Rats; Rats, Inbred Strains; Shock, Septic; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

All urinary pathogens from general practice and from hospital have been tested for sensitivity to a range of antimicrobial drugs for the last 12 years. During that period there have been marked changes. In general practice there has been a marked increase in the proportion of staphylococcal infections, from 5.1% to 14.8%, and a noticeable decrease in the proportion caused by Proteus mirabilis, from 9.2% to 4.1%. Similar, but smaller, changes have been seen in the proportions of hospital UTI caused by those organisms, while the proportion of hospital infections due to Klebsiella-Enterobacter spp. has fallen from 16.8% to 8.3%. These, and other, changes have been reflected in changing antibiotic sensitivity patterns. In particular, sensitivity of urinary pathogens to ampicillin/amoxycillin and to cephaloridine has continued to fall both in general practice and in hospital. In general practice UTI nalidixic acid-resistance is becoming more important as the proportion of Gram-positive urinary pathogens increases. There has been little change in sensitivity to trimethoprim or co-trimoxazole over the last 12 years.

Topics: Amoxicillin; Ampicillin; Anti-Bacterial Agents; Cephaloridine; Drug Combinations; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Penicillin Resistance; Proteus mirabilis; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Of 114 recipients of pancreatic, renal, and bone marrow transplants who were given trimethoprim-sulfamethoxazole (TMP-SMZ) for antimicrobial prophylaxis, 44 (39%) had a total of 52 fecal isolates of TMP-SMZ-resistant gram-negative bacilli. In most of these 44 patients, the resistant isolate was found at a concentration of greater than or equal to 10(6) organisms/ml of feces. Escherichia coli was the most frequent of the isolates, and Citrobacter freundii was the next most frequent. Eight of the 114 transplant recipients had gram-negative bacteremia; in six of these eight patients, a TMP-SMZ-resistant gram-negative bacillus was the etiologic agent of bacteremia. Four of the latter six patients had stool cultures analyzed prior to the detection of bacteremia; all four had high concentrations (greater than or equal to 10(8)/ml) of fecal TMP-SMZ-resistant E. coli one to 20 days before they were found to have E. coli bacteremia. In each of these instances, the E. coli isolates from the stool and the blood had similar antibiograms. These findings indicated that resistance to TMP-SMZ is becoming more prevalent and that the screening of patients for the presence of fecal TMP-SMZ-resistant Enterobacteriaceae prior to initiation of long-term therapy with this antimicrobial agent may be worthwhile.

Topics: Bone Marrow Transplantation; Citrobacter; Drug Combinations; Drug Resistance, Microbial; Enterobacteriaceae; Escherichia coli; Escherichia coli Infections; Feces; Humans; Kidney Transplantation; Pancreas Transplantation; Sepsis; Sulfamethoxazole; Thymidine; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Anti-Infective Agents, Urinary; Drug Combinations; Escherichia coli Infections; Female; Hematuria; Humans; Melena; Sulfamethoxazole; Thrombocytopenia; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Child, Preschool; Drug Combinations; Drug Resistance, Microbial; Escherichia coli Infections; Humans; Leukemia, Lymphoid; Male; Meningitis; Sepsis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Each year, more than one million American travelers develop diarrhea, usually due to toxin-producing Escherichia coli. Traveler's diarrhea can be prevented with bismuth subsalicylate or doxycycline, but neither is suitable for pediatric patients. Trimethoprim-sulfamethoxazole is effective for prophylaxis and treatment in adults. It is also safe for children and may prove to be efficacious. It may be possible to avoid widespread prophylaxis and to give medication only if diarrhea develops.

Topics: Bismuth; Child; Diarrhea; Doxycycline; Drug Combinations; Escherichia coli Infections; Humans; Organometallic Compounds; Premedication; Salicylates; Sulfamethoxazole; Travel; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Bismuth; Diarrhea; Doxycycline; Drug Combinations; Escherichia coli Infections; Humans; Organometallic Compounds; Salicylates; Sulfamethoxazole; Travel; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

We evaluated the activity of trimethoprim/sulfamethoxazole (TMP/SMZ) against a K1 Escherichia coli strain. Minimal inhibitory and bactericidal concentrations were 0.06/1.14 and 0.25/4.75 micrograms/ml, respectively. In vivo studies using an infant rat model of bacteremia and meningitis revealed that TMP/SMZ penetrated well into the cerebrospinal fluid (CSF) and that 37% of serum levels were achieved. The efficacy of TMP/SMZ was compared with that of ampicillin, chloramphenicol, cefotaxime and lamoxactam. Bacterial clearance from blood and CSF was significantly greater with TMP/SMZ than with ampicillin or chloramphenicol and mortality was significantly less than with chloramphenicol (p less than 0.01). However, 3 of 21 (14%) and 2 of 8 animals (25%) still had positive blood and CSF cultures after 3 days of treatment with TMP/SMZ. None of the survivors in the cefotaxime and lamoxactam groups were bacteremic after 1 day of therapy. Furthermore, 5 of 13 animals (38%) treated with TMP/SMZ developed meningitis during therapy, in contrast with none in the cefotaxime and lamoxactam groups. These findings indicate that although the activity of TMP/SMZ is bactericidal in vitro and in vivo against E. coli, TMP/SMZ may not provide optimal therapy for gram-negative bacillary meningitis in this model.

Topics: Animals; Colony-Forming Units Assay; Drug Combinations; Escherichia coli Infections; Meningitis; Rats; Sepsis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination