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Asymptomatic bacteriuria treatment leads to greater drug resistance
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Researchers from Italy found a higher rate of antibiotic resistance in women with recurrent urinary tract infections who received asymptomatic bacteriuria treatment.
“We showed that [asymptomatic bacteriuria (AB)] treatment is associated with a higher prevalence of antibiotic resistant bacteria,” Tommaso Cai, MD, from the department of urology at Santa Chiara Hospital in Trento, Italy, and colleagues wrote in Clinical Infectious Diseases. “This is the first study to address this issue in women affected by [recurrent urinary tract infections (rUTIs)].”
Cai and colleagues followed 550 patients who were enrolled in a previous randomized clinical trial using AB treatments to reduce the recurrence of UTIs. The patients were divided into two groups — group A (n = 257) received no treatment and group B (n = 293) received AB treatment.
At each follow-up visit of 6 months or less, patients were evaluated using a baseline questionnaire and urological examination, and each patient with a UTI was treated with antibiotics according to European Association of Urology guidelines. Women were followed up (mean, 38.8 months) to evaluate antibiograms and urine cultures.
The researchers found a recurrence of UTIs in 37.7% of group A and 69.6% of group B, with Enterococcus faecalis in group A (58.8%) and Escherichia coli in group B (45.5%) identified as the most common pathogens. There were no statistically significant differences in the rate of upper UTIs in either group. Of 301 symptomatic patients treated in groups A and B, the most common antibiotics used were fosfomycin trometamol (28.2%), nitrofurantoin (19.6%), amoxicillin-clavulanic acid (12.2%), co-trimoxazole (11.6%) and ciprofloxacin (9.9%). There was a higher rate of antibiotic resistance in group B for patients being treated for E. coli, and Cai and colleagues noted resistance for amoxicillin/clavulanic acid (P = .03), trimethoprim/sulfamethoxazole (P = .01) and ciprofloxacin (P = .03).
“We also demonstrated that the higher rates of symptomatic UTIs in the treated group depended on AB treatment during the previous study, highlighting that the incorrect use of antibiotics in AB patients is potentially dangerous with long-lasting negative effects,” they wrote.
In a related editorial, Florian M.E. Wagenlehner, MD, PhD, of the Clinic for Urology, Pediatric Urology and Andrology at Justus-Liebig University in Giessen, Germany, and Kurt G. Naber, MD, PhD, of the Technical University of Munich, said the findings support the guidelines in incorporating nonantibiotic strategies for the prevention of UTIs in women, provided those strategies are proven effective in clinical studies.
“Such strategies may also be important to decrease the general antibiotic consumption in the population and thus to slow down emergence of antibiotic resistance, because as shown in an interventional comparative study, antibiotic resistance once established has a low probability to be reversed, at least for trimethoprim and co-trimoxazole,” they wrote. – by Jeff Craven
Disclosure: The researchers report no relevant financial disclosures. Please see the full editorial for a list of Wagenlehner and Naber’s relevant financial disclosures.
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