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

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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.


Percentage of resistant patient-derived E. coli samples over the six-year study period for each antibiotic assessed and Pearson’s correlation of resistant samples over time: (A) ampicillin + sulbactam, (B) cephalothin, (C) ciprofloxacin, (D) norfloxacin, and (E) nitrofurantoin. * p < 0.05; ** p < 0.005.
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ijerph-13-00918-f003: Percentage of resistant patient-derived E. coli samples over the six-year study period for each antibiotic assessed and Pearson’s correlation of resistant samples over time: (A) ampicillin + sulbactam, (B) cephalothin, (C) ciprofloxacin, (D) norfloxacin, and (E) nitrofurantoin. * p < 0.05; ** p < 0.005.

Mentions: In addition to assessing the susceptibility of samples to different antibiotics, we also investigated temporal variation in antibiotic resistance (Figure 3 and Table 3). The percentage of samples resistant to each antibiotic in each of the six years was plotted, and Pearson’s correlation was determined (Figure 3A–E). The data reveal non-linear and non-significant correlations for ampicillin + sulbactam, cephalothin, and nitrofurantoin (Figure 3A,B,E). However, there were consistent linear increases in resistance to ciprofloxacin and norfloxacin, both fluoroquinolones (Figure 3C,D). These increases were in the order of 63.53% for ciprofloxacin and 66.50% for norfloxacin from 2010 to 2015. Both ciprofloxacin and norfloxacin exhibited significant positive correlations between the resistance of samples and the year the samples were collected (p < 0.05).


Antibiotic Resistance of Bacteria Involved in Urinary Infections in Brazil: A Cross-Sectional and Retrospective Study
Percentage of resistant patient-derived E. coli samples over the six-year study period for each antibiotic assessed and Pearson’s correlation of resistant samples over time: (A) ampicillin + sulbactam, (B) cephalothin, (C) ciprofloxacin, (D) norfloxacin, and (E) nitrofurantoin. * p < 0.05; ** p < 0.005.
© Copyright Policy
Related In: Results  -  Collection

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

ijerph-13-00918-f003: Percentage of resistant patient-derived E. coli samples over the six-year study period for each antibiotic assessed and Pearson’s correlation of resistant samples over time: (A) ampicillin + sulbactam, (B) cephalothin, (C) ciprofloxacin, (D) norfloxacin, and (E) nitrofurantoin. * p < 0.05; ** p < 0.005.
Mentions: In addition to assessing the susceptibility of samples to different antibiotics, we also investigated temporal variation in antibiotic resistance (Figure 3 and Table 3). The percentage of samples resistant to each antibiotic in each of the six years was plotted, and Pearson’s correlation was determined (Figure 3A–E). The data reveal non-linear and non-significant correlations for ampicillin + sulbactam, cephalothin, and nitrofurantoin (Figure 3A,B,E). However, there were consistent linear increases in resistance to ciprofloxacin and norfloxacin, both fluoroquinolones (Figure 3C,D). These increases were in the order of 63.53% for ciprofloxacin and 66.50% for norfloxacin from 2010 to 2015. Both ciprofloxacin and norfloxacin exhibited significant positive correlations between the resistance of samples and the year the samples were collected (p < 0.05).

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.