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Antibiotic Resistance of Bacteria Involved in Urinary Infections in Brazil: A Cross-Sectional and Retrospective Study

View Article: PubMed Central - PubMed

ABSTRACT

Empirical and prolonged antimicrobial treatment of urinary tract infections caused by Escherichia coli is associated with the emergence of bacterial resistance, and not all countries have strict policies against the indiscriminate use of drugs in order to prevent resistance. This cross-sectional and retrospective study (2010–2015) aimed to evaluate the sensitivity and resistance of patient-derived E. coli to different drugs broadly used to treat urinary infections in Brazil: ampicillin + sulbactam, cephalothin, ciprofloxacin, norfloxacin, and nitrofurantoin. We obtained 1654 E. coli samples from ambulatory patients with disease symptoms of the urinary tract from a Brazilian public hospital. While all antibiotics were effective in killing E. coli to a large degree, nitrofurantoin was the most effective, with fewer samples exhibiting antibiotic resistance. We assessed the costs of generic and brand name versions of each antibiotic. Nitrofurantoin, the most effective antibiotic, was the cheapest, followed by the fluoroquinolones (ciprofloxacin and norfloxacin), ampicillin + sulbactam and, lastly, cephalothin. Finally, assessment of antibiotic resistance to fluoroquinolones over the study period and extrapolation of the data led to the conclusion that these antibiotics could no longer be effective against E. coli-based urinary infections in approximately 20 years if their indiscriminate use in empirical treatment continues.

No MeSH data available.


Phenotypic profile for susceptibility testing (antibiogram) of urine cultures positive for E. coli from outpatients. Antibiotics including ampicillin + sulbactam (Amp + Sulb), cephalothin (CF), ciprofloxacin (CP), norfloxacin (NF), and nitrofurantoin (NT) were tested by the disc diffusion method. Percentages of sensitive (S) and resistant (R) strains are presented. * p < 0.05.
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ijerph-13-00918-f002: Phenotypic profile for susceptibility testing (antibiogram) of urine cultures positive for E. coli from outpatients. Antibiotics including ampicillin + sulbactam (Amp + Sulb), cephalothin (CF), ciprofloxacin (CP), norfloxacin (NF), and nitrofurantoin (NT) were tested by the disc diffusion method. Percentages of sensitive (S) and resistant (R) strains are presented. * p < 0.05.

Mentions: For each E. coli-positive urine sample, we evaluated the phenotypic profile of sensitivity and resistance to five antibiotics (Table 1 and Figure 2). Although there was variation in the distribution between the sensitivity and resistance samples (ampicillin + sulbactam = 77.32/22.68; cephalothin = 68.17/31.83; ciprofloxacin = 71.10/28.90; norfloxacin = 69.25/30.75; nitrofurantoin = 94.04/5.95), all antibiotics tested exhibited significant efficacy (p < 0.05) (Figure 2).


Antibiotic Resistance of Bacteria Involved in Urinary Infections in Brazil: A Cross-Sectional and Retrospective Study
Phenotypic profile for susceptibility testing (antibiogram) of urine cultures positive for E. coli from outpatients. Antibiotics including ampicillin + sulbactam (Amp + Sulb), cephalothin (CF), ciprofloxacin (CP), norfloxacin (NF), and nitrofurantoin (NT) were tested by the disc diffusion method. Percentages of sensitive (S) and resistant (R) strains are presented. * p < 0.05.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036751&req=5

ijerph-13-00918-f002: Phenotypic profile for susceptibility testing (antibiogram) of urine cultures positive for E. coli from outpatients. Antibiotics including ampicillin + sulbactam (Amp + Sulb), cephalothin (CF), ciprofloxacin (CP), norfloxacin (NF), and nitrofurantoin (NT) were tested by the disc diffusion method. Percentages of sensitive (S) and resistant (R) strains are presented. * p < 0.05.
Mentions: For each E. coli-positive urine sample, we evaluated the phenotypic profile of sensitivity and resistance to five antibiotics (Table 1 and Figure 2). Although there was variation in the distribution between the sensitivity and resistance samples (ampicillin + sulbactam = 77.32/22.68; cephalothin = 68.17/31.83; ciprofloxacin = 71.10/28.90; norfloxacin = 69.25/30.75; nitrofurantoin = 94.04/5.95), all antibiotics tested exhibited significant efficacy (p < 0.05) (Figure 2).

View Article: PubMed Central - PubMed

ABSTRACT

Empirical and prolonged antimicrobial treatment of urinary tract infections caused by Escherichia coli is associated with the emergence of bacterial resistance, and not all countries have strict policies against the indiscriminate use of drugs in order to prevent resistance. This cross-sectional and retrospective study (2010&ndash;2015) aimed to evaluate the sensitivity and resistance of patient-derived E. coli to different drugs broadly used to treat urinary infections in Brazil: ampicillin + sulbactam, cephalothin, ciprofloxacin, norfloxacin, and nitrofurantoin. We obtained 1654 E. coli samples from ambulatory patients with disease symptoms of the urinary tract from a Brazilian public hospital. While all antibiotics were effective in killing E. coli to a large degree, nitrofurantoin was the most effective, with fewer samples exhibiting antibiotic resistance. We assessed the costs of generic and brand name versions of each antibiotic. Nitrofurantoin, the most effective antibiotic, was the cheapest, followed by the fluoroquinolones (ciprofloxacin and norfloxacin), ampicillin + sulbactam and, lastly, cephalothin. Finally, assessment of antibiotic resistance to fluoroquinolones over the study period and extrapolation of the data led to the conclusion that these antibiotics could no longer be effective against E. coli-based urinary infections in approximately 20 years if their indiscriminate use in empirical treatment continues.

No MeSH data available.