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Vol. 16. Issue 2.
Pages 115-121 (March - April 2012)
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Vol. 16. Issue 2.
Pages 115-121 (March - April 2012)
Open Access
Sex, drugs, bugs, and age: Rational selection of empirical therapy for outpatient urinary tract infection in an era of extensive antimicrobial resistance
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Jaime L. Rochaa, Felipe Francisco Tuonb,
Corresponding author
flptuon@gmail.com

Corresponding author at: Division of Infectious and Parasitic Diseases, Hospital Universitário Evangélico de Curitiba, Alameda Augusto Stellfeld 1908, 3° andar - SCIH - Bigorrilho, Curitiba, RS, 80730-150, Brazil.
, James R. Johnsonc
a Division of Microbiology, Frischmann Aisengart/DASA Medicina Diagnóstica and VITA Curitiba Hospital, Curitiba, PR, Brazil
b Division of Infectious and Parasitic Diseases, Hospital Universitário Evangélico de Curitiba, Curitiba, PR, Brazil
c Veterans Affairs Medical Center and University of Minnesota, Minneapolis, MN, USA
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Abstract
Background

Optimal empirical therapy of urinary tract infection requires accurate knowledge of local susceptibility patterns, which may vary with organism and patient characteristics.

Methods

Among 9,798 consecutive, non-duplicate, community-source urine isolates from ambulatory patients ≥ 13 years old, from clinical laboratory and an academic medical center in Curitiba, Brazil (May 1st to December 1st, 2009), susceptibility data for ampicillin, nitrofurantoin, trimethoprim-sulfamethoxazole, gentamicin, fluoroquinolones, and ceftriaxone/cefotaxime were compared with organism and patient gender and age.

Results

The female-to-male ratio decreased with age, from 28.1 (among 20–29 year-olds) to 3.3 (among > 80 year-olds). Overall, susceptibility prevalence varied widely by drug class, from unacceptably low levels (53.5% and 61.1%: ampicillin and trimethoprimsulfamethoxazole) to acceptable but suboptimal levels (81.2% to 91.7%: fluoroquinolones, ceftriaxone, nitrofurantoin, and gentamicin). E. coli isolates exhibited higher susceptibility rates than other isolates, from 3–4% higher (fluoroquinolones, gentamicin) to ≥ 30% (nitrofurantoin, ceftriaxone). Males exhibited lower susceptibility rates than females. Within each gender, susceptibility declined with increasing age. For females, only nitrofurantoin and gentamicin were suitable for empirical therapy (≥ 80% susceptibility) across all age cohorts; fluoroquinolones were suitable only through age 60, and ceftriaxone only through age 80. For males, only gentamicin yielded ≥ 80% susceptibility in any age cohort.

Conclusion

Few suitable empirical treatment options for community-source urinary tract infection were identified for women aged over 60 years or males of any age. Empirical therapy recommendations must consider the patient's demographic characteristics. Site-specific, age and gender-stratified susceptibility surveillance involving all uropathogens is needed.

Keywords:
Urinary tract infections
Anti-bacterial agents
Drug resistance, bacterial
Fluoroquinolones
Escherichia coli
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Copyright © 2012. Elsevier Editora Ltda.. All rights reserved
The Brazilian Journal of Infectious Diseases

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