Universität zu Köln

Stoltidis-Claus, Carolin (2023). Auswirkung des interdisziplinären deutschen Leitlinien-Updates von 2017 zum Management unkomplizierter bakterieller Harnwegsinfektionen auf die Entwicklung antimikrobieller Resistenzen klinischer Enterobacterales-Isolate im Urin gegenüber oralen Antibiotika bei stationären und ambulanten Patienten. PhD thesis, Universität zu Köln.

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Abstract

Introduction: empirical therapy for the treatment of urinary tract infections should be tailored to the current distribution and susceptibility of potential pathogens to ensure optimal treatment. Aim: we aimed to provide an up-to-date overview of the epidemiology and susceptibility of Enterobacterales isolated from urine in Germany. Methods: we 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. Results: resistance 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. Conclusions: resistance 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.

Item Type:	Thesis (PhD thesis)
Translated abstract:	Abstract Language Introduction: empirical therapy for the treatment of urinary tract infections should be tailored to the current distribution and susceptibility of potential pathogens to ensure optimal treatment. Aim: we aimed to provide an up-to-date overview of the epidemiology and susceptibility of Enterobacterales isolated from urine in Germany. Methods: we 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. Results: resistance 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. Conclusions: resistance 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. English
Creators:	Creators Email ORCID ORCID Put Code Stoltidis-Claus, Carolin carolin.claus@gmx.de UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-715680
DOI:	10.2807/1560-7917.ES.2023.28.19.2200568
Date:	11 May 2023
Place of Publication:	Eurosurveillance
Language:	German
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Medizinische Mikrobiologie, Immunologie und Hygiene > Institut für Medizinische Mikrobiologie, Immunologie und Hygiene
Subjects:	Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language Harnwegsinfektionen German antimikrobielle Resistenzen German empirische antimikrobielle Therapie UNSPECIFIED Enterobacterales-Urinisolate UNSPECIFIED
Date of oral exam:	28 September 2023
Referee:	Name Academic Title Jazmati, Nathalie Privatdozentin Dr. med. Pfister, David Professor Dr. med.
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/71568