title: Increased resistance to first-line agents among bacterial pathogens isolated from urinary tract infections in Latin America: time for local guidelines?
abstract: Emerging resistance phenotypes and antimicrobial resistance rates among pathogens recovered from community-acquired urinary tract infections (CA-UTI) is an increasing problem in specific regions, limiting therapeutic options. As part of the SENTRY Antimicrobial Surveillance Program, a total of 611 isolates were collected in 2003 from patients with CA-UTI presenting at Latin American medical centers. Each strain was tested in a central laboratory using Clinical Laboratory Standard Institute (CLSI) broth microdilution methods with appropriate controls. Escherichia coli was the leading pathogen (66%), followed by Klebsiella spp. (7%), Proteus mirabilis (6.4%), Enterococcus spp. (5.6%), and Pseudomonas aeruginosa (4.6%). Surprisingly high resistance rates were recorded for E. coli against first-line orally administered agents for CA-UTI, such as ampicillin (53.6%), TMP/SMX (40.4%), ciprofloxacin (21.6%), and gatifloxacin (17.1%). Decreased susceptibility rates to TMP/SMX and ciprofloxacin were also documented for Klebsiella spp. (79.1 and 81.4%, respectively), and P. mirabilis (71.8 and 84.6%, respectively). For Enterococcus spp., susceptibility rates to ampicillin, chloramphenicol, ciprofloxacin, and vancomycin were 88.2, 85.3, 55.9, and 97.1%, respectively. High-level resistance to gentamicin was detected in 24% of Enterococcus spp. Bacteria isolated from patients with CA-UTI in Latin America showed limited susceptibility to orally administered antimicrobials, especially for TMP/SMX and fluoroquinolones. Our results highlight the need for developing specific CA-UTI guidelines in geographic regions where elevated resistance to new and old compounds may influence prescribing decisions.
authors.affiliation: Laboratório Especial de Microbiologia Clínica, Universidade Federal de São Paulo, 04025-010 São Paulo, SP, Brazil. soraya_andrade@lemc.com.br
authors.forename: Soraya S
authors.initials: SS
authors.lastname: Andrade
authors.forename: Helio S
authors.initials: HS
authors.lastname: Sader
authors.forename: Ronald N
authors.initials: RN
authors.lastname: Jones
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Pereira
authors.forename: Antônio C C
authors.initials: AC
authors.lastname: Pignatari
authors.forename: Ana C
authors.initials: AC
authors.lastname: Gales
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D011159:Population Surveillance; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents