Etiología de la infección urinaria de adquisición comunitaria y perfil de susceptibilidad de Escherichia coli a los principales agentes antimicrobianos
Palabras clave:
INFECCIONES URINARIAS, INFECCIONES COMUNITARIAS ADQUIRIDAS, INFECCIONES POR ESCHERICHIA COLI, AGENTES ANTIBACTERIANOSResumen
Introducción: la infección urinaria (IU) constituye la segunda infección más frecuente en el ámbito de la asistencia primaria en salud. Las quinolonas fluoradas son la terapéutica empírica más utilizada en nuestro medio. Para establecerla en forma adecuada, es necesario conocer la sensibilidad antimicrobiana de los agentes etiológicos más frecuentes.
Objetivos: los objetivos del presente trabajo fueron: determinar las características de los pacientes que consultaron por IU de origen comunitario en la emergencia del Hospital Pasteur, conocer la etiología de las mismas así como el perfil de sensibilidad de las cepas de E.coli aisladas en este tipo de infección.
Material y método: se realizó un estudio descriptivo transversal en el que se analizaron 313 pacientes con diagnóstico de IU: 61 de sexo masculino (19,5%) y 252 de sexo femenino (80,5%); 177 (56,5%) presentaron IU alta y 159 (50,8%) IU complicada.
Resultados: el agente más frecuentemente aislado fue E.coli (80%) seguido de: S.saprophyticus (6%) y Klebsiella spp (6%). La sensibilidad de E.coli a ampicilina y trimetropin/sulfametozaxol estuvo por debajo de 80%, lo cual impide su uso como terapia empírica. La sensibilidad global de E.coli a fluoroquinolonas fue 85% aunque se comprobó mayor tasa de resistencia en pacientes con IU complicada o mayores de 60 años. La sensibilidad a nitrofurantoína estuvo por encima de 97% en todas las poblaciones analizadas.
Conclusiones: la creciente resistencia a fluoroquinolonas representa un grave problema de salud pública. Por ello, es necesario buscar opciones terapéuticas diferentes, especialmente en pacientes con IU complicada y/o mayores de 60 años, además de hacer un uso más racional de la antibioticoterapia en los episodios de IU no complicada.
Citas
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(17) Andreu A, Planells I, Grupo Cooperativo Español para el Estudio de la Sensibilidad Antimicrobiana de los Patógenos Urinarios. Etiología de la infección urinaria adquirida en la comunidad y resistencia de Eschericia coli a los antimicrobianos de primera línea: estudio multicéntrico nacional. Med Clin (Barc) 2008; 130(13): 481-6.
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(19) Tabibian JH, Gornbein J, Heidari A, Dien SL, Lau VH, Chahal P, et al. Uropathogens and host characteristics. J Clin Microbiol 2008; 46(12): 3980-6.
(20) Raz R, Colodner R, Kunin CM. Who are you-Staphylococcus saprophyticus? Clin Infect Dis 2005; 40(6): 896-8.
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(23) Organización Panamericana de la Salud. Informe anual de la red de monitoreo/Vigilancia de la resistencia a los antibióticos, 2004. Brasilia: OPS, 2005: 75.
(24) Pedreira W, Anzalone L, Álvez M, Cafferatta A. Fosfomicina trometamol: una opción terapéutica válida en infecciones urinarias bajas. Rev Med Urug 2003; 19(2): 107-16.
(25) Andrade SS, Sader HS, Jones RN, Pereira AS, Pignatari AC, Gales AC. Increased resistance to first-line agents among bacterial pathogens isolated from urinary tract infections in Latin America: time for local guidelines? Mem Inst Oswaldo Cruz 2006; 101(7): 741-8.
(26) Pitout JD, Gregson DB, Church DL, Elsayed S, Laupland KB. Community- wide outbreaks of clonally related CTX-M-14 beta-lactamase-producing Escherichia coli strains in the Calgary Health Region. J Clin Microbiol 2005; 43(6): 2844-9.
(27) Arslan H, Azap OK, Ergönül O, Timurkaynak F; Urinary Tract Infection Study Group. Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey. J Antimicrob Chemother 2005; 56(5): 914-8.
(28) Killgore KM, March KL, Guglielmo BJ. Risk factors for community-acquired ciprofloxacin-resistant Escherichia coli urinary tract infection. Ann Pharmacother 2004; 38(7-8): 1148-52.
(29) Pintos M, Frantchez V, Seija V, Echizarto D, Bravo N. Risk factors for community-acquired urinary tract infection due to quinolone-resistant enterobacteria. World Congress of Internal Medicine, 29. Buenos Aires, 2008.
(30) Gobernado M, Valdés L, Alós JI, García-Rey C, Dal-Ré R, García-de-Lomas J; Spanish Surveillance Group for E. coli Urinary Pathogens. Quinolone resistance in female outpatient urinary tract isolates of Escherichia coli: age-related differences. Rev Esp Quimioter 2007; 20(2): 206-10.
(31) Smith SP, Manges AR, Riley LW. Temporal changes in the prevalence of community-acquired antimicrobial-resistant urinary tract infection affected by Escherichia coli clonal group composition. Clin Infect Dis 2008; 46(5): 689-95.
(32) Cagnacci S, Gualco L, Debbia E, Schito GC, Marchese A. European emergence of ciprofloxacin-resistant Escherichia coli clonal groups O25:H4-ST 131 and O15:K52:H1 causing community-acquired uncomplicated cystitis. J Clin Microbiol 2008; 46(8): 2605-12.
(33) Manges AR, Smith SP, Lau BJ, Nuval CJ, Eisenberg JN, Dietrich PS, et al. Retail meat consumption and the acquisition of antimicrobial resistant Escherichia coli causing urinary tract infections: a case-control study. Foodborne Pathog Dis 2007; 4(4): 419-31.
(34) Kashanian J, Hakimian P, Blute M Jr, Wong J, Khanna H, Wise G, et al. Nitrofurantoin: the return of an old friend in the wake of growing resistance. BJU Int 2008; 102(11): 1634-7.
(35) Hooton TM, Besser R, Foxman B, Fritsche TR, Nicolle LE. Acute uncomplicated cystitis in an era of increasing antibiotic resistance: a proposed approach to empirical therapy. Clin Infect Dis 2004; 39(1): 75-80.
(36) Gupta K, Hooton TM, Roberts PL, Stamm WE. Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women. Arch Intern Med 2007; 167(20): 2207-12.
(37) Hooper DC. Urinary Tract Agents. Nitrofurantoin and Methenamine. In: Mandell GR, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. Philadelphia: Elsevier Churchil Livinstone, 2009: 423-8.
(2) Stamm WE, Norrby RS. Urinary tract infections: disease panorama and challenges. J Infect Dis 2001; 183(Suppl 1): S1-4.
(3) Foxman B, Barlow R, D’Arcy H, Gillespie B, Sobel JD. Urinary tract infection: self-reported incidence and associated costs. Ann Epidemiol 2000; 10(8): 509-15.
(4) Scholes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE. Risk factors for recurrent urinary tract infection in young women. J Infect Dis 2000; 182(4): 1177-82.
(5) Sobel J, Kaye D. Urinary tract infections. In: Mandell GR, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. Philadelphia: Elsevier Churchil Livinstone, 2005: 875-901.
(6) Gupta K, Hooton TM, Stamm WE. Increasing antimicrobial resistance and the management of uncomplicated community-acquired urinary tract infection. Ann Intern Med 2001; 135(1): 41-50.
(7) Nicolle LE. Epidemiology of urinary tract infection. Infect Med 2001; 18: 153-62.
(8) Facal J. Infección urinaria. Carta infectológica 2006; 6(1): 7-12.
(9) Kahlmeter G, Menday P, Cars O. Non-hospital antimicrobial usage and resistance in community-acquired Escherichia coli urinary tract infection. J Antimicrob Chemother 2003; 52(6): 1005-10.
(10) Karlowsky JA, Hoban DJ, Decorby MR, Laing NM, Zhanel GG. Fluoroquinolone-resistant urinary isolates of Escherichia coli from outpatients are frequently multidrug resistant: results from the North American Urinary Tract Infection Collaborative Alliance-Quinolone Resistance Study. Antimicrob Agents Chemother 2006; 50(6): 2251-4.
(11) Karlowsky J, Thornsberry C, Jones M, Sahm D. Susceptibility of antimmicrobial-resistant urinary Escherichia coli isolates to fluoroquinolones and nitrofurantoin. Clin Infect Dis 2003; 36(2): 183-7.
(12) Karlowsky JA, Kelly LJ, Thornsberry C, Jones ME, Sahm DF. Trends in antimicrobial Resistance among Urinary Tract Infection Isolates of Escherichia coli From Female Outpatients in the United States. Antimicrob Agents Chemother 2002; 46(8): 2540-5.
(13) Zhanel GG, Karlowsky JA, Harding GK, Carrie A, Mazzulli T, Low DE, et al. A Canadian national surveillance study of urinary tract isolates from outpatients: comparison of the activities of trimethoprim-sulfamethoxazole, ampicillin, mecillinam, nitrofurantoin, and ciprofloxacin. Antimicrob Agents Chemother 2000; 44(4): 1089-92.
(14) Ti TY, Kumarasinghe G, Taylor MB, Tan SL, Ee A, Chua C, et al. What is true community-acquired urinary tract infection? Comparison of pathogens identified in urine from routine outpatient specimens and from community clinics in a prospective study. Eur J Clin Microbiol Infect Dis 2003; 22(4): 242-5.
(15) Warren JW, Abrutyn E, Hebel JR, Johnson JR, Schaeffer AJ, Stamm WE. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Disease Society of America (IDSA). Clin Infect Dis 1999; 29(4): 745-58.
(16) Clinical Laboratory Standard Institute. Performance Standards for Antimicrobial Susceptibility Testing; Seventeenth Informational Supplement 2007. CLSI Document M100-S17.
(17) Andreu A, Planells I, Grupo Cooperativo Español para el Estudio de la Sensibilidad Antimicrobiana de los Patógenos Urinarios. Etiología de la infección urinaria adquirida en la comunidad y resistencia de Eschericia coli a los antimicrobianos de primera línea: estudio multicéntrico nacional. Med Clin (Barc) 2008; 130(13): 481-6.
(18) Kahlmeter G, ECO.SENS. An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO-SENS Project. J Antimicrob Chemother. 2003; 51(1): 69-76.
(19) Tabibian JH, Gornbein J, Heidari A, Dien SL, Lau VH, Chahal P, et al. Uropathogens and host characteristics. J Clin Microbiol 2008; 46(12): 3980-6.
(20) Raz R, Colodner R, Kunin CM. Who are you-Staphylococcus saprophyticus? Clin Infect Dis 2005; 40(6): 896-8.
(21) Gupta K, Sahm DF, Mayfield D, Stamm WE. Antimicrobial resistance among uropathogens that cause community-acquired urinary tract infections in women: a nationwide analysis. Clin Infect Dis 2001; 33(1): 89-94.
(22) de Mouy D, Fabre R, Cavallo JD, Arzouni JP, Baynat M, Bicart-See A, et al. Community-acquired urinary tract infections in 15 to 65 years old female patients in France. Susceptibility of E. coli according to history: AFORCOPI-BIO network 2003. Med Mal Infect 2007; 37(9): 594-8.
(23) Organización Panamericana de la Salud. Informe anual de la red de monitoreo/Vigilancia de la resistencia a los antibióticos, 2004. Brasilia: OPS, 2005: 75.
(24) Pedreira W, Anzalone L, Álvez M, Cafferatta A. Fosfomicina trometamol: una opción terapéutica válida en infecciones urinarias bajas. Rev Med Urug 2003; 19(2): 107-16.
(25) Andrade SS, Sader HS, Jones RN, Pereira AS, Pignatari AC, Gales AC. Increased resistance to first-line agents among bacterial pathogens isolated from urinary tract infections in Latin America: time for local guidelines? Mem Inst Oswaldo Cruz 2006; 101(7): 741-8.
(26) Pitout JD, Gregson DB, Church DL, Elsayed S, Laupland KB. Community- wide outbreaks of clonally related CTX-M-14 beta-lactamase-producing Escherichia coli strains in the Calgary Health Region. J Clin Microbiol 2005; 43(6): 2844-9.
(27) Arslan H, Azap OK, Ergönül O, Timurkaynak F; Urinary Tract Infection Study Group. Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey. J Antimicrob Chemother 2005; 56(5): 914-8.
(28) Killgore KM, March KL, Guglielmo BJ. Risk factors for community-acquired ciprofloxacin-resistant Escherichia coli urinary tract infection. Ann Pharmacother 2004; 38(7-8): 1148-52.
(29) Pintos M, Frantchez V, Seija V, Echizarto D, Bravo N. Risk factors for community-acquired urinary tract infection due to quinolone-resistant enterobacteria. World Congress of Internal Medicine, 29. Buenos Aires, 2008.
(30) Gobernado M, Valdés L, Alós JI, García-Rey C, Dal-Ré R, García-de-Lomas J; Spanish Surveillance Group for E. coli Urinary Pathogens. Quinolone resistance in female outpatient urinary tract isolates of Escherichia coli: age-related differences. Rev Esp Quimioter 2007; 20(2): 206-10.
(31) Smith SP, Manges AR, Riley LW. Temporal changes in the prevalence of community-acquired antimicrobial-resistant urinary tract infection affected by Escherichia coli clonal group composition. Clin Infect Dis 2008; 46(5): 689-95.
(32) Cagnacci S, Gualco L, Debbia E, Schito GC, Marchese A. European emergence of ciprofloxacin-resistant Escherichia coli clonal groups O25:H4-ST 131 and O15:K52:H1 causing community-acquired uncomplicated cystitis. J Clin Microbiol 2008; 46(8): 2605-12.
(33) Manges AR, Smith SP, Lau BJ, Nuval CJ, Eisenberg JN, Dietrich PS, et al. Retail meat consumption and the acquisition of antimicrobial resistant Escherichia coli causing urinary tract infections: a case-control study. Foodborne Pathog Dis 2007; 4(4): 419-31.
(34) Kashanian J, Hakimian P, Blute M Jr, Wong J, Khanna H, Wise G, et al. Nitrofurantoin: the return of an old friend in the wake of growing resistance. BJU Int 2008; 102(11): 1634-7.
(35) Hooton TM, Besser R, Foxman B, Fritsche TR, Nicolle LE. Acute uncomplicated cystitis in an era of increasing antibiotic resistance: a proposed approach to empirical therapy. Clin Infect Dis 2004; 39(1): 75-80.
(36) Gupta K, Hooton TM, Roberts PL, Stamm WE. Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women. Arch Intern Med 2007; 167(20): 2207-12.
(37) Hooper DC. Urinary Tract Agents. Nitrofurantoin and Methenamine. In: Mandell GR, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. Philadelphia: Elsevier Churchil Livinstone, 2009: 423-8.
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2010-03-31
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Seija V, Frantchez V, Pintos M, Bataglino MN, Torales M, Díaz Álvaro, et al. Etiología de la infección urinaria de adquisición comunitaria y perfil de susceptibilidad de Escherichia coli a los principales agentes antimicrobianos. Rev. Méd. Urug. [Internet]. 31 de marzo de 2010 [citado 21 de diciembre de 2024];26(1):14-2. Disponible en: https://revista.rmu.org.uy/index.php/rmu/article/view/441
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