Trends and Risk Factors for Ciprofloxacin Resistance and Extendedspectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients

NARTER, Kamil Fehmi; ÖZVEREN, Bora; ŞAHİN, Ahmet; Türkeri, Levent

Trends and Risk Factors for Ciprofloxacin Resistance and Extendedspectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients

Bora Özveren, (Acıbadem Mehmet Ali Aydınlar Üniversitesi Tıp Fakültesi Üroloji Anabilim Dalı, İstanbul, Türkiye)

Kamil Fehmi Narter, (Acıbadem Mehmet Ali Aydınlar Üniversitesi Sağlık Hizmetleri Meslek Yüksekokulu, İstanbul, Türkiye)

Levent Türkeri, (Acıbadem Mehmet Ali Aydınlar Üniversitesi Tıp Fakültesi Üroloji Anabilim Dalı, İstanbul, Türkiye)

Ahmet Şahin (Acıbadem Mehmet Ali Aydınlar Üniversitesi Tıp Fakültesi Üroloji Anabilim Dalı, İstanbul, Türkiye)

Journal of Urological Surgery

2 1

Yıl: 2021 Cilt: 8 Sayı: 2 Sayfa Aralığı: 135 - 141 Metin Dili: İngilizce İndeks Tarihi: 21-10-2021

Trends and Risk Factors for Ciprofloxacin Resistance and Extendedspectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients

Öz:

Objective: This study aimed to identify the patterns and temporal changes of ciprofloxacin resistance and extended-spectrum beta-lactamase(ESBL) production in uropathogenic isolates obtained from urology and non-urology outpatients.Materials and Methods: In this cross-sectional study, electronic data of urine culture and antimicrobial susceptibility test results of samplescollected in urology and non-urology outpatient departments from 2008 to 2016 were retrospectively analysed to identify correlations betweenbasic demographic features and clinical settings.Results: Escherichia coli (E. coli) was the most prevalent (70%) uropathogenic isolate in a cohort of 7.973 patients consisting of 82.8% women,70.7% adults and 15.7% urology outpatients. Overall, resistance to ciprofloxacin was found in 16.3% of the patients. Ciprofloxacin resistance wasassociated with being male and old, observed more frequently in urology outpatients, detected in 19.2% of E. coli isolates and increased to 54.5%among ESBL-producing bacterial strains (p<0.05). ESBL production was observed in 12% of all isolates. Increased ESBL production was associatedwith old age and isolates of E. coli and Klebsiella spp. (p<0.05). Statistical analysis using multivariate generalised linear mixed models (mGLMMs) toassess the relationship between the outcomes predicted a significantly higher ESBL production in E. coli and Klebsiella spp. isolates and in geriatricpatients. Furthermore, mGLMM analysis predicted a significantly increased likelihood of ciprofloxacin resistance in older adult male patients,especially in E. coli and Enterococcus spp. isolates. Moreover, a high rate of ESBL production was observed, reaching over 15% in 2015 (p<0.05).The rates of ciprofloxacin resistance remained >10% and peaked in 2015 (20.2%, p<0.001). However, in 2016, the rate of ESBL production andciprofloxacin resistance started to decline, displaying significance only regarding the latter (p<0.05).Conclusion: Empirical ciprofloxacin treatment of community-acquired urinary tract infections carries a higher risk of an unsuccessful outcomein male, geriatric and urology outpatients. Empirical antibacterial therapy for urological infections in the outpatient setting should be conductedbased on patient risk profiles and contemporary local resistance data.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Naber KG, Bergman B, Bishop MC, Bjerklund-Johansen TE, Botto H, Lobel B, Jinenez Cruz F, Selvaggi FP; Urinary Tract Infection (UTI) Working Group of the Health Care Office (HCO) of the European Association of Urology (EAU). 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 2001;40:576-588.
2. Morgan DJ, Okeke IN, Laxminarayan R, Perencevich EN, Weisenberg S. Nonprescription antimicrobial use worldwide: a systematic review. Lancet Infect Dis 2011;11:692-701.
3. Mazzariol A, Bazaj A, Cornaglia G. Multi-drug-resistant Gram-negative bacteria causing urinary tract infections: a review. J Chemother 2017;29(Suppl 1):2-9.
4. Dalhoff A. Global fluoroquinolone resistance epidemiology and implictions for clinical use. Interdiscip Perspect Infect Dis 2012;2012:976273.
5. Fasugba O, Gardner A, Mitchell BG, Mnatzaganian G. Ciprofloxacin resistance in community- and hospital-acquired Escherichia coli urinary tract infections: a systematic review and meta-analysis of observational studies. BMC Infect Dis 2015;15:545.
6. Karlowsky JA, Lagacé-Wiens PR, Simner PJ, DeCorby MR, Adam HJ, Walkty A, Hoban DJ, Zhanel GG. Antimicrobial resistance in urinary tract pathogens in Canada from 2007 to 2009: CANWARD surveillance study. Antimicrob Agents Chemother 2011;55:3169-3175.
7. Pitout JD, Nordmann P, Laupland KB, Poirel L. Emergence of Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs) in the community. J Antimicrob Chemother 2005;56:52-59.
8. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial disk susceptibility tests; Approved standard-Ninth edition. CLSI document M2-A9. CLSI, Wayne, PA, USA: 2006.
9. Kahlmeter G, Poulsen HO. Antimicrobial susceptibility of Escherichia coli from community-acquired urinary tract infections in Europe: the ECO·SENS study revisited. Int J Antimicrob Agents 2012;39:45-51.
10. Naber KG, Schito G, Botto H, Palou J, Mazzei T. 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;54:1164-1175.
11. Sanchez GV, Master RN, Karlowsky JA, Bordon JM. In vitro antimicrobial resistance of urinary Escherichia coli isolates among U.S. outpatients from 2000 to 2010. Antimicrob Agents Chemother 2012;56:2181-2183.
12. Cullen IM, Manecksha RP, McCullagh E, Ahmad S, O’Kelly F, Flynn R, McDermott TE, Murphy P, Grainger R, Fennell JP, Thornhill JA. An 11- year analysis of the prevalent uropathogens and the changing pattern of Escherichia coli antibiotic resistance in 38,530 community urinary tract infections, Dublin 1999-2009. Ir J Med Sci 2013;182:81-89.
13. Arslan H, Azap OK, Ergönül O, Timurkaynak F; Urinary Tract Infection Study Group. Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey. J Antimicrob Chemother 2005;56:914-918.
14. Nicolle LE. A practical guide to antimicrobial management of complicated urinary tract infection. Drugs Aging 2001;18:243-254.
15. Zhanel GG, Hisanaga TL, Laing NM, DeCorby MR, Nichol KA, Palatnik LP, Johnson J, Noreddin A, Harding GK, Nicolle LE, Hoban DJ; NAUTICA Group. Antibiotic resistance in outpatient urinary isolates: final results from the North American Urinary Tract Infection Collaborative Alliance (NAUTICA). Int J Antimicrob Agents 2005;26:380-388.
16. Azap OK, Arslan H, Serefhanoğlu K, Colakoğlu S, Erdoğan H, Timurkaynak F, Senger SS. Risk factors for extended-spectrum beta-lactamase positivity in uropathogenic Escherichia coli isolated from community-acquired urinary tract infections. Clin Microbiol Infect 2010;16:147-151.
17. Bonkat G, Müller G, Braissant O, Frei R, Tschudin-Suter S, Rieken M, Wyler S, Gasser TC, Bachmann A, Widmer AF. Increasing prevalence of ciprofloxacin resistance in extended-spectrum-β-lactamase-producing Escherichia coli urinary isolates. World J Urol 2013;31:1427-1432.
18. Oteo J, Pérez-Vázquez M, Campos J. Extended-spectrum [beta]-lactamase producing Escherichia coli: changing epidemiology and clinical impact. Curr Opin Infect Dis 2010;23:320-326.
19. Sahm DF, Thornsberry C, Mayfield DC, Jones ME, Karlowsky JA. Multidrugresistant urinary tract isolates of Escherichia coli: prevalence and patient demographics in the United States in 2000. Antimicrob Agents Chemother 2001;45:1402-1406.
20. Killgore KM, March KL, Guglielmo BJ. Risk factors for community-acquired ciprofloxacin-resistant Escherichia coli urinary tract infection. Ann Pharmacother 2004;38:1148-1152.
21. Koksal E, Tulek N, Sonmezer MC, Temocin F, Bulut C, Hatipoglu C, Erdinc FS, Ertem G. Investigation of risk factors for community-acquired urinary tract infections caused by extended-spectrum beta-lactamase Escherichia coli and Klebsiella species. Investig Clin Urol 2019;60:46-53.
22. Dalhoff A. Resistance surveillance studies: a multifaceted problem--the fluoroquinolone example. Infection 2012;40:239-262.
23. Elias C, Moja L, Mertz D, Loeb M, Forte G, Magrini N. Guideline recommendations and antimicrobial resistance: the need for a change. BMJ Open 2017;7:016264.
24. Gupta K, Hooton TM, Stamm WE. Increasing antimicrobial resistance and the management of uncomplicated community-acquired urinary tract infections. Ann Intern Med 2001;135:41-50.
25. Blaettler L, Mertz D, Frei R, Elzi L, Widmer AF, Battegay M, Flückiger U. Secular trend and risk factors for antimicrobial resistance in Escherichia coli isolates in Switzerland 1997-2007. Infection 2009;37:534-539.
26. Fasugba O, Mitchell BG, Mnatzaganian G, Das A, Collignon P, Gardner A. Five-Year Antimicrobial Resistance Patterns of Urinary Escherichia coli at an Australian Tertiary Hospital: Time Series Analyses of Prevalence Data. PLoS One 2016;11:0164306.

APA	ÖZVEREN B, NARTER K, Türkeri L, ŞAHİN A (2021). Trends and Risk Factors for Ciprofloxacin Resistance and Extendedspectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients. , 135 - 141.
Chicago	ÖZVEREN Bora,NARTER Kamil Fehmi,Türkeri Levent,ŞAHİN Ahmet Trends and Risk Factors for Ciprofloxacin Resistance and Extendedspectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients. (2021): 135 - 141.
MLA	ÖZVEREN Bora,NARTER Kamil Fehmi,Türkeri Levent,ŞAHİN Ahmet Trends and Risk Factors for Ciprofloxacin Resistance and Extendedspectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients. , 2021, ss.135 - 141.
AMA	ÖZVEREN B,NARTER K,Türkeri L,ŞAHİN A Trends and Risk Factors for Ciprofloxacin Resistance and Extendedspectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients. . 2021; 135 - 141.
Vancouver	ÖZVEREN B,NARTER K,Türkeri L,ŞAHİN A Trends and Risk Factors for Ciprofloxacin Resistance and Extendedspectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients. . 2021; 135 - 141.
IEEE	ÖZVEREN B,NARTER K,Türkeri L,ŞAHİN A "Trends and Risk Factors for Ciprofloxacin Resistance and Extendedspectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients." , ss.135 - 141, 2021.
ISNAD	ÖZVEREN, Bora vd. "Trends and Risk Factors for Ciprofloxacin Resistance and Extendedspectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients". (2021), 135-141.

APA	ÖZVEREN B, NARTER K, Türkeri L, ŞAHİN A (2021). Trends and Risk Factors for Ciprofloxacin Resistance and Extendedspectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients. Journal of Urological Surgery, 8(2), 135 - 141.
Chicago	ÖZVEREN Bora,NARTER Kamil Fehmi,Türkeri Levent,ŞAHİN Ahmet Trends and Risk Factors for Ciprofloxacin Resistance and Extendedspectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients. Journal of Urological Surgery 8, no.2 (2021): 135 - 141.
MLA	ÖZVEREN Bora,NARTER Kamil Fehmi,Türkeri Levent,ŞAHİN Ahmet Trends and Risk Factors for Ciprofloxacin Resistance and Extendedspectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients. Journal of Urological Surgery, vol.8, no.2, 2021, ss.135 - 141.
AMA	ÖZVEREN B,NARTER K,Türkeri L,ŞAHİN A Trends and Risk Factors for Ciprofloxacin Resistance and Extendedspectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients. Journal of Urological Surgery. 2021; 8(2): 135 - 141.
Vancouver	ÖZVEREN B,NARTER K,Türkeri L,ŞAHİN A Trends and Risk Factors for Ciprofloxacin Resistance and Extendedspectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients. Journal of Urological Surgery. 2021; 8(2): 135 - 141.
IEEE	ÖZVEREN B,NARTER K,Türkeri L,ŞAHİN A "Trends and Risk Factors for Ciprofloxacin Resistance and Extendedspectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients." Journal of Urological Surgery, 8, ss.135 - 141, 2021.
ISNAD	ÖZVEREN, Bora vd. "Trends and Risk Factors for Ciprofloxacin Resistance and Extendedspectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients". Journal of Urological Surgery 8/2 (2021), 135-141.