TY - JOUR
T1 - Recommendations for the empirical treatment of complicated urinary tract infections using surveillance data on antimicrobial resistance in the Netherlands
AU - Koningstein, Maike
AU - van der Bij, Akke K.
AU - de Kraker, Marlieke E. A.
AU - Monen, Jos C.
AU - Muilwijk, Jan
AU - de Greeff, Sabine C.
AU - Geerlings, Suzanne E.
AU - van Hall, Maurine A. Leverstein-
AU - AUTHOR GROUP
AU - Vlaspolder, F.
AU - Cohen Stuart, J. W. T.
AU - van Hees, B. C.
AU - Wintermans, R. G. F.
AU - Altorf-van der Kuil, W.
AU - Alblas, J.
AU - van der Bij, A. K.
AU - Frentz, D.
AU - Leenstra, T.
AU - Monen, J. C.
AU - Muilwijk, J.
AU - Notermans, D. W.
AU - de Greeff, S. C.
AU - van Keulen, P. H. J.
AU - Kluytmans, J. A. J. W.
AU - Mattsson, E. E.
AU - Sebens, F. W.
AU - Frenay, H. M. E.
AU - Maraha, B.
AU - Heilmann, F. G. C.
AU - Halaby, T.
AU - Versteeg, D.
AU - Hendrix, R.
AU - Schellekens, J. F. P.
AU - Diederen, B. M. W.
AU - de Brauwer, E. I. G. B.
AU - Stals, F. S.
AU - Bakker, L. J.
AU - Dorigo-Zetsma, J. W.
AU - van Zeijl, J. H.
AU - Bernards, A. T.
AU - de Jongh, B. M.
AU - Vlaminckx, B. J. M.
AU - Horrevorts, A.
AU - Kuipers, S.
AU - Moffie, B.
AU - Brimicombe, R. W.
AU - Jansen, C. L.
AU - Renders, N. H. M.
AU - Hendrickx, B. G. A.
AU - Buiting, A. G. M.
AU - Kaan, J. A.
PY - 2014
Y1 - 2014
N2 - Complicated urinary tract infections (c-UTIs) are among the most common nosocomial infections and a substantial part of the antimicrobial agents used in hospitals is for the treatment of c-UTIs. Data from surveillance can be used to guide the empirical treatment choices of clinicians when treating c-UTIs. We therefore used nation-wide surveillance data to evaluate antimicrobial coverage of agents for the treatment of c-UTI in the Netherlands. We included the first isolate per patient of urine samples of hospitalised patients collected by the Infectious Disease Surveillance Information System for Antibiotic Resistance (ISIS-AR) in 2012, and determined the probability of inadequate coverage for antimicrobial agents based on species distribution and susceptibility. Analyses were repeated for various patient groups and hospital settings. The most prevalent bacteria in 27,922 isolates of 23,357 patients were Escherichia coli (47%), Enterococcus spp. (14%), Proteus mirabilis (8%), and Klebsiella pneumoniae (7%). For all species combined, the probability of inadequate coverage was <5% for amoxicillin or amoxicillin-clavulanic acid combined with gentamicin and the carbapenems. When including gram-negative bacteria only, the probability of inadequate coverage was 4.0%, 2.7%, 2.3% and 1.7%, respectively, for amoxicillin, amoxicillin-clavulanic acid, a second or a third generation cephalosporin in combination with gentamicin, and the carbapenems (0.4%). There were only small variations in results among different patient groups and hospital settings. When excluding Enterococcus spp., considered as less virulent, and the carbapenems, considered as last-resort drugs, empirical treatment for c-UTI with the best chance of adequate coverage are one of the studied beta-lactam-gentamicin combinations. This study demonstrates the applicability of routine surveillance data for up-to-date clinical practice guidelines on empirical antimicrobial therapy, essential in patient care given the evolving bacterial susceptibility
AB - Complicated urinary tract infections (c-UTIs) are among the most common nosocomial infections and a substantial part of the antimicrobial agents used in hospitals is for the treatment of c-UTIs. Data from surveillance can be used to guide the empirical treatment choices of clinicians when treating c-UTIs. We therefore used nation-wide surveillance data to evaluate antimicrobial coverage of agents for the treatment of c-UTI in the Netherlands. We included the first isolate per patient of urine samples of hospitalised patients collected by the Infectious Disease Surveillance Information System for Antibiotic Resistance (ISIS-AR) in 2012, and determined the probability of inadequate coverage for antimicrobial agents based on species distribution and susceptibility. Analyses were repeated for various patient groups and hospital settings. The most prevalent bacteria in 27,922 isolates of 23,357 patients were Escherichia coli (47%), Enterococcus spp. (14%), Proteus mirabilis (8%), and Klebsiella pneumoniae (7%). For all species combined, the probability of inadequate coverage was <5% for amoxicillin or amoxicillin-clavulanic acid combined with gentamicin and the carbapenems. When including gram-negative bacteria only, the probability of inadequate coverage was 4.0%, 2.7%, 2.3% and 1.7%, respectively, for amoxicillin, amoxicillin-clavulanic acid, a second or a third generation cephalosporin in combination with gentamicin, and the carbapenems (0.4%). There were only small variations in results among different patient groups and hospital settings. When excluding Enterococcus spp., considered as less virulent, and the carbapenems, considered as last-resort drugs, empirical treatment for c-UTI with the best chance of adequate coverage are one of the studied beta-lactam-gentamicin combinations. This study demonstrates the applicability of routine surveillance data for up-to-date clinical practice guidelines on empirical antimicrobial therapy, essential in patient care given the evolving bacterial susceptibility
U2 - 10.1371/journal.pone.0086634
DO - 10.1371/journal.pone.0086634
M3 - Article
C2 - 24489755
SN - 1932-6203
VL - 9
SP - e86634
JO - PLoS ONE
JF - PLoS ONE
IS - 1
ER -