title: Increasing resistance in community-acquired urinary tract infections in Latin America, five years after the implementation of national therapeutic guidelines.
abstract: BACKGROUND
  The worldwide increasing resistance to antibiotics has complicated antimicrobial treatment of urinary tract infections (UTIs), especially in Latin America. This study aimed to report the present etiology and antimicrobial susceptibility of UTIs, and the effects of the national guidelines for UTIs introduced in 2003.
  
  
  METHODS
  Urine samples were collected from 304 patients with a clinical suspicion of UTI at the university hospital and primary health centers of León, Nicaragua. When bacterial growth was reported, antimicrobial susceptibility tests for nine frequently used antibiotics were performed.
  
  
  RESULTS
  Ninety-one (29.9%) patients had a positive urine culture. The most frequently isolated microorganisms were Escherichia coli (n=44), Serratia spp (n=11), and Escherichia fergusonii (n=10). High resistance rates were observed in E. coli to ampicillin (61.4%), cefalothin (45.5%), trimethoprim-sulfamethoxazole (38.6%), ciprofloxacin (31.8%), and ceftriaxone (20.5%). Amikacin and nitrofurantoin were the only drugs to which >90% of E. coli were susceptible. E. fergusonii and Serratia spp showed comparable high resistance patterns. Thirteen strains (29.5%) of E. coli were suspected to produce extended-spectrum beta-lactamase (ESBL).
  
  
  CONCLUSIONS
  Resistance rates in community-acquired UTIs in Nicaragua are increasing. The introduction of therapeutic guidelines with ceftriaxone recommended for upper UTIs and nitrofurantoin for lower UTIs, has led to increasing resistance against both antibiotics. The emergence of ESBL-producing E. coli is worrisome, along with the appearance of Serratia spp in the population.
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Center, PO Box 85500, Room F.02.126, 3508 GA Utrecht, The Netherlands. pha.bours@gmail.com
authors.forename: P H A
authors.initials: PH
authors.lastname: Bours
authors.forename: R
authors.initials: R
authors.lastname: Polak
authors.forename: A I M
authors.initials: AI
authors.lastname: Hoepelman
authors.forename: E
authors.initials: E
authors.lastname: Delgado
authors.forename: A
authors.initials: A
authors.lastname: Jarquin
authors.forename: A J
authors.initials: AJ
authors.lastname: Matute
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006291:Health Policy; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009527:Nicaragua / Q000453:epidemiology; D015397:Program Evaluation; D012307:Risk Factors; D012705:Serratia / Q000187:drug effects / Q000302:isolation & purification; D016868:Serratia Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases