Epidemiology and frequency of resistance among pathogens causing urinary tract infections in 1,510 hospitalized patients: A report from the SENTRY Antimicrobial Surveillance Program (North America)

• Published in: Diagnostic microbiology and infectious disease Vol. 40; no. 3; pp. 129 - 136
• Main Authors: Mathai, D., Jones, R.N., Pfaller, M.A.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2001; Elsevier
• Subjects: Adolescent; Adult; Aged; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacteriology; Biological and medical sciences; Canada - epidemiology; Child; Child, Preschool; Demography; Disease Outbreaks; Drug Resistance, Microbial; Epidemiology; Female; Fundamental and applied biological sciences. Psychology; Gram-Negative Bacteria - drug effects; Gram-Negative Bacteria - isolation & purification; Gram-Negative Bacterial Infections - epidemiology; Gram-Negative Bacterial Infections - microbiology; Gram-Positive Bacteria - drug effects; Gram-Positive Bacteria - isolation & purification; Gram-Positive Bacterial Infections - epidemiology; Gram-Positive Bacterial Infections - microbiology; Hospitalization; Humans; Infant; Male; Medical sciences; Microbial Sensitivity Tests; Microbiology; Middle Aged; Pharmacology. Drug treatments; Population Surveillance; United States - epidemiology; Urinary Tract Infections - epidemiology; Urinary Tract Infections - microbiology; Canada; United States; Enterococcus; Human; Klebsiella; Septicemia; Escherichia coli; Quinupristin; Review; Epidemiology; Antimicrobial agent; Dalfopristin; Infection; Resistance; Streptococcaceae; Sensitivity; Gatifloxacin; Bacteriosis; Bacteria; Micrococcales; Enterobacteriaceae
• ISSN: 0732-8893; 1879-0070
• DOI: 10.1016/S0732-8893(01)00254-1

Bacterial urinary tract infections (UTIs) are an important cause of septicemia resulting in high mortality rates, prolonged hospital stays and increased healthcare costs. Periodic reviews of pathogen frequency and susceptibility patterns impact on appropriate antimicrobial usage, leading to more effective prescribing practices. As part of the SENTRY Antimicrobial Surveillance Program (SENTRY, 1998), participants collected 50 consecutive UTI pathogens from patients hospitalized in 31 medical centers (26 in the United States and five in Canada) and forwarded subcultures to the coordinating center. Thirty-four antimicrobial agents were tested including two investigational compounds (quinupristin/dalfopristin [Q/D], gatifloxacin). The rank order of the 32 species identified during the study was: Escherichia coli (46.9%) > Enterococcus spp. (12.8%) > Klebsiella spp. (11.0%) > Pseudomonas aeruginosa (7.5%) > Proteus mirabilis (5.0%) > coagulase-negative staphylococci (CoNS; 3.4%). This pathogen rank order did not change from 1997 to 1998, but resistance patterns changed. Clonal spread of confirmed extended spectrum β-lactamase-producing strains was not observed, but co-resistance was elevated for aminoglycosides, tetracyclines, sulfonamides, and fluoroquinolones. P. aeruginosa was most susceptible to amikacin (97.3%) > piperacillin ± tazobactam (92.0–95.6%) > cefepime = imipenem (91.2%) > ceftazidime (85.8%). Fluoroquinolone resistance was greater in P. aeruginosa (24.8–39.8%) > P. mirabilis (5.3–13.3%) > Enterobacter spp. (6.7–8.9%) > Klebsiella spp. (4.2–7.8%) > E. coli (3.0–3.8%). Only 5% of enterococci were resistant to vancomycin. These results emphasize the need for continued surveillance studies for common infections which establish baseline resistance patterns by geographic areas, and have the potential to detect epidemics or direct local epidemiologic interventions.