title: The importance of gender-stratified antibiotic resistance surveillance of unselected uropathogens: a Dutch Nationwide Extramural Surveillance study.
abstract: Few studies have been performed on urinary tract infections (UTIs) in men. In the present study, general practitioners (n = 42) from the Dutch Sentinel General Practice Network collected urinary samples from 560 male patients (≥ 18 years) suspected of UTI and recorded prescribed antibiotic treatment. In this way, the antibiotic susceptibility of Gram-negative uropathogens, including extended-spectrum beta-lactamase (ESBL-) producing Escherichia coli could be determined. In addition, E. coli susceptibility and antibiotic prescriptions were compared with data from a similar UTI study among women and with data collected 7 years earlier. Of 367 uropathogens (66%) identified (≥ 10(3) cfu/mL), most were Gram-negative (83%) and E. coli being isolated most frequently (51%). Antibiotic susceptibility to ciprofloxacin, norfloxacin and nitrofurantoin was 94%, 92% and 88%, respectively, whereas co-amoxiclav (76%) and co-trimoxazole (80%) showed lower susceptibilities. One ESBL (0.5%) was found. A significantly higher proportion of female UTIs was caused by E. coli compared with men (72% versus 51%, P<0.05). E. coli susceptibility tended to be lower in men compared with women, although not reaching statistical significance. No changes in E. coli susceptibility were observed over time (all P>0.05). Co-amoxiclav and nitrofurantoin prescriptions increased over time (11% versus 28% and 16% versus 23% respectively, both P<0.05), whereas co-trimoxazole prescriptions decreased (24% versus 14%, P<0.05). In conclusion, given the observed gender differences in uropathogen distribution and (tendency in) E. coli antibiotic susceptibility, empirical male UTI treatment options should be based on surveillance studies including men only. When awaiting the culture result is clinically not possible, fluoroquinolones are advised as first-choice antibiotics for male UTIs in Dutch general practices based on current antibiotic susceptibility data. The prevalence of ESBL-producers was low and no differences were observed in antibiotic susceptibility over a 7-year period. In addition, antibiotic prescriptions changed in accordance with national guidelines during this time period.
authors.affiliation: Department of Medical Microbiology, Maastricht University Medical Centre/Care and Public Health Research Institute, Maastricht, The Netherlands.
authors.forename: Casper D J
authors.initials: CD
authors.lastname: den Heijer
authors.forename: John
authors.initials: J
authors.lastname: Penders
authors.forename: Gé A
authors.initials: GA
authors.lastname: Donker
authors.forename: Cathrien A
authors.initials: CA
authors.lastname: Bruggeman
authors.forename: Ellen E
authors.initials: EE
authors.lastname: Stobberingh
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D004352:Drug Resistance, Microbial; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000652:urine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000652:urine; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
references.citation: Am J Med. 1999 Mar;106(3):327-34
references.pmid: 10190383
references.citation: J Antimicrob Chemother. 2010 Sep;65(9):1862-77
references.pmid: 20587612
references.citation: Clin Microbiol Infect. 2004 Jun;10(6):502-11
references.pmid: 15191377
references.citation: Med Sci Monit. 2009 Nov;15(11):PI61-5
references.pmid: 19865064
references.citation: Ann Clin Microbiol Antimicrob. 2008 Jun 18;7:13
references.pmid: 18564430
references.citation: Clin Microbiol Infect. 2000 Sep;6(9):509-15
references.pmid: 11168187
references.citation: Scand J Clin Lab Invest Suppl. 2000;231:1-86
references.pmid: 12647764
references.citation: Braz J Infect Dis. 2012 Mar-Apr;16(2):115-21
references.pmid: 22552451
references.citation: Clin Microbiol Infect. 2006 May;12 Suppl 3:67-80
references.pmid: 16669930
references.citation: Ann Intern Med. 2001 Jul 3;135(1):41-50
references.pmid: 11434731
references.citation: Int J Clin Pharmacol Ther. 2004 Jul;42(7):360-6
references.pmid: 15605687
references.citation: Expert Opin Pharmacother. 2007 Aug;8(11):1667-74
references.pmid: 17685884
references.citation: Ned Tijdschr Geneeskd. 2006 Apr 1;150(13):718-22
references.pmid: 16623344
references.citation: J Infect Dis. 1987 May;155(5):847-54
references.pmid: 3559288
references.citation: Int J Antimicrob Agents. 2005 Nov;26(5):380-8
references.pmid: 16243229
references.citation: J Antimicrob Chemother. 2010 Oct;65(10):2128-33
references.pmid: 20682565
references.citation: Urology. 2010 Aug;76(2):336-40
references.pmid: 20494416
references.citation: Clin Infect Dis. 2009 Sep 1;49(5):682-90
references.pmid: 19622043
references.citation: Drugs. 2001;61(3):353-64
references.pmid: 11293646
references.citation: Chemotherapy. 2003 Dec;49(6):269-79
references.pmid: 14671426
references.citation: Clin Infect Dis. 2011 Mar 1;52(5):e103-20
references.pmid: 21292654
references.citation: BMC Infect Dis. 2008 Jan 30;8:12
references.pmid: 18234108
references.citation: Clin Infect Dis. 2007 Oct 1;45(7):894-6
references.pmid: 17806056