title: Acute uncomplicated cystitis: from surveillance data to a rationale for empirical treatment.
abstract: The objectives of this study were to explore the epidemiological features and resistance rates in uropathogens isolated from cases of acute uncomplicated cystitis (AUC) in Greece, and subsequently to guide empirical treatment. Urine samples from outpatients aged >16 years were cultured and for each uropathogen isolated non-susceptibility to orally administered antimicrobial agents was defined. Demographic and clinical data were provided in questionnaire form. From January 2005 to March 2006 a total of 1936 non-duplicate positive urinary cultures were collected and 889 AUC cases were evaluated. Escherichia coli was the main aetiological agent (83%). In the AUC group, non-susceptibility rates for E. coli isolates were as follows: amoxicillin 25.8%; co-trimoxazole 19.2%; cefalothin 14.9%; nitrofurantoin 10.7%; amoxicillin/clavulanic acid 5.2%; nalidixic acid 6%; mecillinam 3.4%; ciprofloxacin 2.2%; cefuroxime 1.7%, and fosfomycin 1.6%. Amoxicillin and/or co-trimoxazole use in the previous 3 months was significantly associated with isolation of a co-trimoxazole-resistant E. coli isolate. The same applied for previous use of a fluoroquinolone agent and isolation of a ciprofloxacin-resistant E. coli isolate. In conclusion, increased co-trimoxazole non-susceptibility rates undermine its use as a first-line agent in empirical treatment, especially in cases of recent use of co-trimoxazole and/or amoxicillin. Fluoroquinolones display potent in vitro activity against community uropathogens, but prudent use is warranted for uncomplicated infections. Mecillinam and nitrofurantoin could serve as effective front-line agents in an effort to design fluoroquinolones-sparing regimens.
authors.affiliation: 4th Department of Internal Medicine, ATTIKON University General Hospital, 1 Rimini Avenue, 12462 Haidari, Athens, Greece. ikatsarolis@gmail.com
authors.forename: Ioannis
authors.initials: I
authors.lastname: Katsarolis
authors.forename: Garyphallia
authors.initials: G
authors.lastname: Poulakou
authors.forename: Sofia
authors.initials: S
authors.lastname: Athanasia
authors.forename: Jenny
authors.initials: J
authors.lastname: Kourea-Kremastinou
authors.forename: Niki
authors.initials: N
authors.lastname: Lambri
authors.forename: Elias
authors.initials: E
authors.lastname: Karaiskos
authors.forename: Periklis
authors.initials: P
authors.lastname: Panagopoulos
authors.forename: Flora V
authors.initials: FV
authors.lastname: Kontopidou
authors.forename: Dionysios
authors.initials: D
authors.lastname: Voutsinas
authors.forename: Georgios
authors.initials: G
authors.lastname: Koratzanis
authors.forename: Maria
authors.initials: M
authors.lastname: Kanellopoulou
authors.forename: Georgios
authors.initials: G
authors.lastname: Adamis
authors.forename: Helen
authors.initials: H
authors.lastname: Vagiakou
authors.forename: Pigi
authors.initials: P
authors.lastname: Perdikaki
authors.forename: Helen
authors.initials: H
authors.lastname: Giamarellou
authors.forename: Kyriaki
authors.initials: K
authors.lastname: Kanellakopoulou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001419:Bacteria / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D003556:Cystitis / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D014556:Urine / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents