Predictive value of Escherichia coli susceptibility in strains causing asymptomatic bacteriuria for women with recurrent symptomatic urinary tract infections receiving prophylaxis

AbstractA 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 15 months 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 1 month 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

The Use and Abuse of Business History

The use of history in vocational undergraduate courses is contested. Although there has been a recent push to bolster the teaching of history in Australian secondary schools, history in business courses still often seems only to linger at the margins. Pleas to include historical approaches to business education are made from time to time that suggest a role for history in the curriculum that is essentially not historical – they often highlight the skills history students develop or the broader humanistic understanding usually associated with historical knowledge, not necessarily ones based on what is unique to history. This paper argues that historical analysis is essentially different than that represented by other traditional disciplines and that this fundamental aspect of history should be at the core of arguments to include business history in course curriculums.The symposium is organised on behalf of AAHANZBS by the Business and Labour History Group, The University of Sydney, with the financial support of the University’s Faculty of Economics and Business

Antibiotica bij ongecompliceerde urineweginfecties: geen toename van resistentie in de afgelopen 5 jaar.

Doel: Nagaan welke antibiotica worden voorgeschreven voor urineweginfecties bij vrouwelijke patiënten in huisartsenpraktijken. Tevens bepalen van de antibioticagevoeligheid van E. coli-stammen, inclusief de prevalentie van ‘extended’-spectrum bètalactamase(ESBL)- producerende stammen. De resultaten van deze studie uit 2009 werden vergeleken met die van een vergelijkbare studie, die 5 jaar eerder werd uitgevoerd. Opzet Surveillancestudie. Methode: We verzamelden gedurende 6 maanden urinemonsters van vrouwelijke patiënten van 11 jaar en ouder met symptomen van een ongecompliceerde urineweginfectie, uit 42 huisartsenpraktijken verspreid over Nederland. We identificeerden de uropathogenen en bepaalden de antibioticagevoeligheid van E. coli-stammen. Resultaten: We analyseerden 970 urinemonsters, waarvan er 785 (81%) positief werden beschouwd (= 103 kve/ml). E. coli werd geïdentificeerd in 72% van deze monsters. Het percentage ESBL’s liet een toename zien van 0,1% in 2004 tot 1% in 2009 (95%-BI: 0,1-1,9), terwijl er geen verschil werd gevonden in de gevoeligheid voor regulier gebruikte antibiotica bij urineweginfectie. Het voorschrijven van trimethoprim verminderde in de loop der tijd (van 19 naar 5%, 95%-BI: -16,0 - -11,3), terwijl dit voor nitrofurantoïne en fosfomycine juist toenam (respectievelijk van 58 naar 66%, 95%-BI: 4,0-12,1, en van 0 naar 6%, 95%-BI: 3,9–7,2). Conclusie: In 5 jaar veranderde de antibioticagevoeligheid van uropathogene E. coli-stammen niet bij vrouwelijke patiënten met een ongecompliceerde urineweginfectie in Nederland. De ESBL-prevalentie steeg wel. De antibiotica waren grotendeels conform de NHG-standaard ‘Urineweginfecties’ voorgeschreven.(aut. ref.

Antibiotic susceptibility of unselected uropathogenic Escherichia coli from female Dutch general practice patients: a comparison of two surveys with a 5-year interval.

Background: To optimize empirical treatment of urinary tract infections (UTIs), regular evaluation of the antibiotic susceptibility of the most common uropathogen, Escherichia coli, is necessary. We compared the antibiotic prescription rate for UTIs in women and E. coli antibiotic susceptibility results, including the prevalence of extended-spectrum beta-lactamase (ESBL) producing strains, in 2009 with data collected 5 years ago. Methods: Urinary samples of female patients with symptoms of uncomplicated UTI in 42 general practices, all participating in the Sentinel Stations network of NIVEL, were collected during a 6-month period. Uropathogens were identified and the antibiotic susceptibility of E. coli was determined. Results: We analysed 970 urine cultures, of which 785 (81%) were considered positive (103 cfu/ml). Escherichia coli accounted for 72% of the isolates. ESBLs showed an increase between both surveys (0.1 versus 1%, P < 0.05), while no difference in antibiotic susceptibility of the commonly used antimicrobial agents for UTIs was observed. A significantly lower susceptibility rate to co-amoxiclav was observed in the eastern region compared with the northern part of the country (80 versus 92%, P < 0.05). Consistent with national guidelines, the prescription rate of trimethoprim decreased over time (19 versus 5%, P < 0.05) whereas nitrofurantoin and fosfomycin rates showed an increase (58 versus 66% and 0 versus 5% respectively, both P < 0.05). Conclusions: The antibiotic susceptibility of uropathogenic E. coli did not change over a 5-year period in female patients with uncomplicated UTI in The Netherlands, but ESBL-prevalence increased. With respect to the prescription of antimicrobial agents a good compliance to national UTI guidelines was observed

Antibiotic susceptibility of unselected uropathogenic Escherichia coli from female Dutch general practice patients: a comparison of two surveys with a 5 year interval.

Objectives: To optimize empirical treatment of urinary tract infections (UTIs), regular evaluation of the antibiotic susceptibility of the most common uropathogen, Escherichia coli, is necessary. We compared the antibiotic prescription rate for UTIs in women and the E. coli antibiotic susceptibility results, including the prevalence of extended-spectrum beta-lactamase (ESBL)-producing strains, in 2009 with data collected 5 years earlier. Patients and methods: Urinary samples from female patients with symptoms of uncomplicated UTI in 42 general practices were collected over a 6 month period. Uropathogens were identified and the antibiotic susceptibility of E. coli was determined. Results: We analysed 970 urine cultures, of which 785 (81%) were considered positive (>/=10(3) cfu/mL). E. coli accounted for 72% of the isolates. ESBLs showed an increase between the two surveys (0.1% versus 1%; P < 0.001), while no difference in antibiotic susceptibility to the commonly used antimicrobial agents for UTIs was observed. A significantly lower susceptibility rate to co-amoxiclav was observed in the eastern region of the Netherlands, as compared with the northern region (80% versus 92%; P < 0.05). Consistent with national guidelines, the prescription rate of trimethoprim decreased over time (19% versus 5%; P < 0.05) whereas nitrofurantoin and fosfomycin rates showed an increase (58% versus 66% and 0% versus 6% respectively, both P < 0.05). Conclusions: Over a 5 year period, the antibiotic susceptibility of uropathogenic E. coli did not change in female patients with uncomplicated UTI in the Netherlands, but ESBL prevalence increased. With respect to the prescription of antimicrobial agents, compliance with national UTI guidelines was good. (aut. ref.