Clinical relevance of laboratory-reported antibiotic resistance in acute uncomplicated urinary tract infection in primary care

McNulty, C, Mulligan, AA, Richards, J, Livermore, DM, Little, P, Charlett, A, Freeman, E, Harvey, IM and Thomas, M (2006) Clinical relevance of laboratory-reported antibiotic resistance in acute uncomplicated urinary tract infection in primary care. Journal of Antimicrobial Chemotherapy, 58 (5). pp. 1000-1008. ISSN 0305-7453

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Abstract

Objectives: To determine whether patients with an uncomplicated community-acquired urinary tract infection (UTI) and an isolate resistant to trimethoprim had worse clinical outcomes following empirical treatment with trimethoprim 200 mg twice daily for 3 days than did those with a susceptible isolate. Patients and methods: This was a prospective cohort study of clinical outcome. We enrolled 497 women (=18–70 years) presenting to general practitioner surgeries in Norwich and Gloucester with at least two symptoms of acute (<7 days) uncomplicated UTI. Significant bacteriuria was defined as ≥104 cfu/mL from a mid-stream urine (MSU). Results: Of enrolled patients 75% (334/448) had significant bacteriuria, and trimethoprim resistance was present in 13.9% (44/317) of isolates. Patients with resistant isolates had a longer median time to symptom resolution (7 versus 4 days, P = 0.0002), greater reconsultation to the practice (39% versus 6% in first week, P < 0.0001), more subsequent antibiotics (36% versus 4% in first week, P < 0.0001) and higher rates of significant bacteriuria at 1 month (42% versus 20% with susceptible isolate, P = 0.04). Half of patients reconsulting in the first week had a resistant organism. Conclusions: Patients with uncomplicated UTI caused by trimethoprim-resistant organisms had significantly worse clinical outcomes than those with trimethoprim-susceptible organisms. Nevertheless, trimethoprim resistance was rarer than predicted from routine laboratory submissions and we calculate that 23 women require microbiological investigation to prevent one reconsultation arising from resistance-based treatment failure. We therefore suggest empirical antibiotic treatment in acute, uncomplicated UTIs. If patients reconsult in the first week, we suggest a change of antibiotic treatment with urine culture and susceptibility testing then done. More generally, laboratory resources should concentrate on resistance surveillance to inform empirical antibiotic choice.

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Related URLs:
Depositing User: EPrints Services
Date Deposited: 25 Nov 2010 11:10
Last Modified: 24 Jul 2019 16:01
URI: https://ueaeprints.uea.ac.uk/id/eprint/13243
DOI: 10.1093/jac/dkl368

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