Urinary tract infections are one of the most common bacterial infections in 'outpatients' and the prevalence of antibiotic resistance is increasing. This study by a team from Penn Medicine warns of the vicious circle of antibiotic resistance and relapse in this type of infection. Because the inappropriate use of antibiotics indeed promotes recurrent infections. Conclusions presented in the journal Infection Control and Hospital Epidemiology which should once again educate clinicians and patients about the proper use of these drugs.
And in particular, when urine tests will identify resistant organisms, patients should be followed more closely and for a longer period.
A risk of relapse in less than 1 week:these patients with drug-resistant urinary tract infection are more likely to relapse and within a week. They are also more likely to be prescribed the 'wrong' antibiotic, summarizes Dr Judith Anesi, clinical epidemiologist at Penn Medicine and lead author of the study: "Our study adds to the evidence that drug-resistant bacteria are a growing problem, even in the community and even in patients with a seemingly simple infection, such as a urinary tract infection. These drug-resistant infections are difficult to treat, and our study shows that relapses are common. This is'
The study focuses on 151 patients whose infections began “in the community” or outside of a healthcare facility. These patients were seen in the emergency department, in a private practice and the urine cultures were positive for enterobacteriaceae resistant to cephalosporin antibiotics, broad-spectrum antibiotics commonly used to treat bacterial infections. These patients were compared to 151 similar patients whose lab tests showed non-resistant forms of the bacteria. The analysis reveals that:
- patients with the resistant form of the bacteria are more likely than other patients to have much worse clinical outcomes than those in the control group;
- more than half of the 302 patients in the study did not receive an appropriate antibiotic within 48 hours of urinalysis,
- those with a resistant form of the bacteria were even more likely to receive an inappropriate antibiotic;
- patients seen in the emergency department were most likely to receive appropriate treatment early on;
- patients with resistant bacteria usually continue to have the same symptoms for several days and frequently need to be treated again for the same infection within the same week.
These poor results observed in patients positive for the resistant bacterium are related to the very likely increase in virulence of the resistant organisms as well as other patient-specific factors that may predispose the patient to worse results at inclusion. .
The authors conclude that if urine tests identify antibiotic-resistant organisms, patients should be followed more closely and for a longer period because they are at much higher risk of relapse.
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