title: Predictive value of Escherichia coli susceptibility in strains causing asymptomatic bacteriuria for women with recurrent symptomatic urinary tract infections receiving prophylaxis.
abstract: A significant proportion of women develop a recurrence following an initial urinary tract infection (UTI). In women with recurrent UTI, the predictive value of asymptomatic bacteriuria (ASB) for the development of a subsequent UTI has not yet been established and it is not known whether information from an asymptomatic sample is useful in guiding antimicrobial therapy. To address these questions, we used data that originated from the 'Non-antibiotic prophylaxis for recurrent urinary tract infections' (NAPRUTI) study: two randomized controlled trials on the prevention of recurrent UTI in non-hospitalized premenopausal and postmenopausal women (n=445). During 15months of follow-up, no difference was observed in the time to a subsequent UTI between women with and without ASB at baseline (hazard ratio: 1.07, 95% CI 0.80-1.42). The antimicrobial susceptibility and pulsed-field gel-electrophoresis (PFGE) pattern of 50 Escherichia coli strains causing a UTI were compared with those of the ASB strain isolated 1month previously. The predictive values of the susceptibility pattern of the ASB strain, based on resistance prevalence at baseline, were ≥76%, except in the case of nitrofurantoin- and amoxicillin-clavulanic acid-resistance. Asymptomatic and symptomatic isolates had similar PFGE patterns in 70% (35/50) of the patients. In the present study among women with recurrent UTI receiving prophylaxis, ASB was not predictive for the development of a UTI. However, the susceptibility pattern of E. coli strains isolated in the month before a symptomatic E. coli UTI can be used to make informed choices for empirical antibiotic treatment in this patient population.
authors.affiliation: Division of Infectious Diseases, Tropical Medicine and AIDS, Department of Internal Medicine, Centre for Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: M A J
authors.initials: MA
authors.lastname: Beerepoot
authors.forename: C D J
authors.initials: CD
authors.lastname: den Heijer
authors.forename: J
authors.initials: J
authors.lastname: Penders
authors.forename: J M
authors.initials: JM
authors.lastname: Prins
authors.forename: E E
authors.initials: EE
authors.lastname: Stobberingh
authors.forename: S E
authors.initials: SE
authors.lastname: Geerlings
mesh_terms: D019980:Amoxicillin-Potassium Clavulanate Combination / Q000494:pharmacology; D019072:Antibiotic Prophylaxis; D001437:Bacteriuria / Q000188:drug therapy* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008826:Microbial Sensitivity Tests; D009582:Nitrofurantoin / Q000494:pharmacology; D011237:Predictive Value of Tests; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D019980:Amoxicillin-Potassium Clavulanate Combination; D009582:Nitrofurantoin