Antimicrobial resistance of Escherichia coli isolates from outpatient urinary tract infections in women in six European countries including Russia

Objectives In the Northern Dimension Antibiotic Resistance Study (NoDARS), Finland, Germany, Latvia, Poland, Russia and Sweden collected urine samples from outpatient women (aged 18–65 years) with symptoms of uncomplicated urinary tract infection (UTI) to investigate the levels of antimicrobial resistance (AMR) among Escherichia coli isolates. Methods A total of 775 E. coli isolates from 1280 clinical urine samples were collected from October 2015 to January 2017. Antimicrobial susceptibility testing was performed and the results were interpreted according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. Results Overall AMR rates to the commonly used antibiotics nitrofurantoin, fosfomycin and mecillinam (except for Germany that was missing a result for mecillinam) were 1.2%, 1.3% and 4.1%, respectively. The highest overall resistance rates were determined for ampicillin (39.6%), trimethoprim (23.8%), trimethoprim/sulfamethoxazole (22.4%), amoxicillin/clavulanic acid (16.7%) and ciprofloxacin (15.1%), varying significantly between countries. The rate of extended-spectrum β-lactamase (ESBL) production was 8.7%. None of the isolates showed resistance to meropenem. Conclusions In most cases, low AMR rates were detected against the first-line antibiotics recommended in national UTI treatment guidelines, giving support to their future use. These results also support the European Association of Urology guidelines stating that nitrofurantoin, fosfomycin and mecillinam are viable treatment options for uncomplicated UTI.Peer Reviewe

Large variation in ESBL-producing Escherichia coli carriers in six European countries including Russia

We investigated the faecal carriage prevalence of extended-spectrum β-lactamase production in Escherichia coli (EP-EC) and/or Klebsiella pneumoniae (EP-KP) and risk factors associated with carriage among adult study subjects in Finland, Germany, Latvia, Poland, Russia and Sweden (partner countries). The aim was to get indicative data on the prevalence of ESBL-carriage in specific populations in the region. Faecal samples were collected from four study populations and screened on ChromID-ESBL and ChromID-OXA-48 plates. Positive isolates were further characterised phenotypically. Our results show a large variation in carrier prevalence ranging from 1.6% in Latvia to 23.2% in Russia for EP-EC. For the other partner countries, the prevalence of EP-EC were in increasing numbers, 2.3% for Germany, 4.7% for Finland, 6.6% for Sweden, 8.0% for Poland and 8.1% for all partner countries in total. Carriers of EP-KP were identified only in Finland, Russia and Sweden, and the prevalence was < 2% in each of these countries. No carriers of carbapenemase-producing isolates were identified. This is the first study reporting prevalence of carriers (excluding traveller studies) for Finland, Latvia, Poland and Russia. It contributes with important information regarding the prevalence of EP-EC and EP-KP carriage in regions where studies on carriers are limited.Peer Reviewe

Antibiotic resistance of Escherichia coli from outpatient urinary tract infection in women in six European countries including Russia

In the Northern Dimension Antibiotic Resistance Study Finland, Germany, Latvia, Poland, Russia and Sweden investigated the resistance levels of Escherichia coli (E. coli) isolated from urine of outpatient women (18-65 years) that had symptoms of uncomplicated UTI by collecting samples in each respective nation.\nOverall antibiotic resistance (ABR) rates to certain commonly used antibiotics, such as nitrofurantoin, fosfomycin and mecillinam were 1.2%, 1.3% and 4.1% (except for Germany that was missing result for mecillinam). Highest overall resistance rates were determined for ampicillin - 39.6%, trimethoprim -23.8%, trimethoprim/sulfamethoxazole -22.4%, amoxillin/clavulanic acid - 16.7% and ciprofloxacin - 15.1%, varying significantly among the countries. ESBL-production level was 8.7%. None of the isolates showed resistance to meropenem.\nIn total 775 E. coli isolates from 1278 clinical urinary samples were collected from October 2015-January 2017. Susceptibility testing was performed and results were interpreted according to the EUCAST criteria.\nIn most cases, low ABR rates were detected against the first line antibiotics recommended in national UTI treatment guidelines which give support to their future use. Our results also support the European Association of Urology guidelines stating that nitrofurantoin, fosfomycin and mecillinam are viable treatment options for uncomplicated UTI.\nOBJECTIVES\nRESULTS\nMETHODS\nCONCLUSION