The ARESC study: an international survey on the antimicrobial resistance of pathogens involved in uncomplicated urinary tract infections
Introduction
Uncomplicated urinary tract infections (UTIs) are among the most prevalent infectious diseases and affect mainly women. Between one-quarter and one-half of all women experience a UTI during their lifetime [1].
The overall aetiology has not changed in recent years and Escherichia coli remains by far the most common uropathogen, accounting for >80% of all positive cultures [2]. However, the management of these infections, generally treated empirically, is becoming complicated due to the emergence of resistance to several first-line antimicrobial agents in this primary pathogen [3].
Because there is a close correlation between resistance to antibiotics and the persistence of E. coli in UTIs as well as wide local variations in the susceptibility of uropathogens to these drugs, recommendation of first-line treatment agents should be supported by updated epidemiological data [4], [5].
The ARESC (Antimicrobial Resistance Epidemiological Survey on Cystitis) study was conducted in nine countries in Europe as well as Brazil from September 2003 to June 2006 to determine the susceptibility of the major uropathogens circulating in the community of these geographic areas.
Part of the ARESC data focusing on E. coli, with emphasis on the clinical implications of the study for empirical antimicrobial therapy, has recently been published [5]. In the present paper we report the complete set of microbiological results involving all bacterial pathogens isolated from uncomplicated cystitis.
Section snippets
Collaborating centres
Seventy centres were enrolled over a 3-year period (2003–2006) in nine European countries and Brazil. Sixty-two centres (3 Austria, 6 Brazil, 10 France, 7 Germany, 4 Hungary, 5 Italy, 6 Poland, 10 Russia, 9 Spain and 2 The Netherlands) provided valuable strains. All participating laboratories adopted the same protocol for classifying urine samples as positive and negative in accordance with the Infectious Diseases Society of America (IDSA) guidelines [6].
Each local site forwarded the strains
Results
Between September 2003 and June 2006, 4264 eligible patients aged 18–65 years with symptoms of acute uncomplicated UTI were enrolled in the survey. Uropathogens with colony counts of >104/mL were cultured from 3181 patients (74.6%). In 3060 patients (96.2%) the infection was monomicrobial and a mixed infection was found in 121 patients (3.8%).
Of the 3181 patients with bacteriuria, causative agents (n = 3018) from 2927 patients were sent to the central laboratory for further evaluation.
Among the
Discussion
Uncomplicated cystitis in females is among the most frequent infections in the community. The ARESC study has assessed the epidemiology and susceptibility patterns of common uropathogens to standard antimicrobials used in the treatment of uncomplicated lower UTI (cystitis). The clinical implications for empirical antimicrobial therapy in nine European countries and Brazil have been published elsewhere [5].
Adoption of the same strict criteria to enrol patients and to classify microbiological
Acknowledgments
This study was performed under the auspices of the European Society for Infection in Urology (ESIU) (Chairman: Truls E. Bjerklund-Johansen) affiliated to the European Association of Urology (EAU). The authors are grateful to Antonio Colantoni for statistical evaluation as well as the investigators of the ARESC Study Group who contributed their findings to the study: Austria: Andreas Sommerhuber (Linz), Daniela Ullisch (Wien), Andreas Szalay (Wien); Brazil: Sergio Cimerman (Sao Paulo), Juvencio
References (26)
- et al.
Surveillance study in Europe and Brazil on clinical aspects and antimicrobial resistance epidemiology in females with cystitis (ARESC): implications for empiric therapy
Eur Urol
(2008) Prevalence and antimicrobial susceptibility of pathogens in uncomplicated cystitis in Europe: The ECO.SENS study
Int J Antimicrob Agents
(2003)- et al.
Outpatient antibiotic use in Europe and association with resistance: a cross-national database study
Lancet
(2005) - et al.
Antimicrobial resistance in Escherichia coli outpatient urinary isolates from women: emerging multidrug resistance phenotypes
Diagn Microbiol Infect Dis
(2007) - Grabe M, Bishop MC, Bjerklund-Johansen TE, Botto H, Çek M, Lobel B, et al. EAU guidelines for the management of urinary...
An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project
J Antimicrob Chemother
(2003)- et al.
Acute uncomplicated cystitis in an era of increasing antibiotic resistance: a proposed approach to empirical therapy
Clin Infect Dis
(2004) - et al.
Empiric use of trimethoprim–sulfamethoxazole (TMP–SMX) in the treatment of women with uncomplicated urinary tract infections, in a geographical area with high prevalence of TMP–SMX-resistant uropathogens
Clin Infect Dis
(2002) - et al.
Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Infectious Diseases Society of America and the Food and Drug Administration
Clin Infect Dis
(1992) - Clinical and Laboratory Standards Institute. Methods for dilution antimicrobial susceptibility tests for bacteria that...
CTX-M-type extended-spectrum β-lactamases in Italy: molecular epidemiology of an emerging countrywide problem
Antimicrob Agents Chemother
EAU guidelines for the management of urinary and male genital tract infections. Urinary Tract Infection (UTI) Working Group of the Health Care Office (HCO) of the European Association of Urology (EAU)
Eur Urol
Who are you—Staphylococcus saprophyticus?
Clin Infect Dis
Cited by (301)
Plasmid-mediated fosfomycin resistance in Escherichia coli isolates of worldwide origin
2023, Journal of Global Antimicrobial ResistanceAntibiotic Resistance Patterns Among Uropathogens in Female Outpatients Affected by Uncomplicated Cystitis: Focus on Fosfomycin Trometamol
2023, International Journal of Antimicrobial AgentsFast identification and susceptibility determination of E. coli isolated directly from patients' urine using infrared-spectroscopy and machine learning
2023, Spectrochimica Acta - Part A: Molecular and Biomolecular Spectroscopy