BERKELEY, CA (UroToday.com) - With respect to antibiotic resistance surveillance systems, several issues need to be considered. For urinary tract infections (UTIs), most guidelines are based on studies that have been performed among women, but with the obvious genito-urinary differences, it is questionable whether these results can be extrapolated to men. In this study we have shown that uropathogen distribution and antibiotic resistance differ substantially between isolates originating from male and female general practice (GP) patients, thereby showing the importance of gender-stratified UTI surveillance.
Furthermore, it is important to acquire surveillance data from different settings, because antibiotic susceptibilities can vary considerably depending upon the patient population, e.g., in the community, hospital, nursing home, etc. This makes it inappropriate to extrapolate data from one setting to another.
In the GP setting, most surveillance systems evaluating the antibiotic resistance of uropathogens have the limitation that only selected isolates are included, i.e., only urine samples are available that were sent in after empirical treatment failure. In this way, the level of antibiotic resistance is exaggerated, which could lead to not including potentially effective (first-line) antibiotics in GP guidelines and favouring the use of broad-spectrum or second-line antibiotics. In the present study, we evaluated the antibiotic resistance levels of unselected Gram-negative bacteria, that were isolated from urinary samples of Dutch male GP patients presenting with symptoms suspected of a UTI. These results can be used to update GP treatment recommendations for male UTIs in the Netherlands. Apart from a low level of resistance to the fluoroquinolones (norfloxacin 8%; ciprofloxacin 6%), this also applied to nitrofurantoin (12%). Despite this low prevalence of resistance, clinical trials on the effectiveness of nitrofurantoin for male UTIs are currently lacking. Since nitrofurantoin does not reach therapeutic concentrations in prostatic tissue, differentiation between cystitis, with and without prostatitis, is important. So far, no symptoms have been found that allow a conclusive differentiation between these two conditions. The Dutch GP guidelines have based their treatment choices on the presence or absence of so-called “symptoms of tissue invasion,” although no reference was given. Results from future trials would support evidence-based treatment of UTI in men and could help to restrict the use of fluoroquinolones, thereby limiting the chance of the development of antibiotic resistance to this antibiotic group. In this perspective, also the clinical usefulness of fosfomycin for male UTIs needs exploration.
Casper D.J. den Heijer,a John Penders,a Gé A. Donker,b Cathrien A. Bruggeman,a and Ellen E. Stobberinghc as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
aDepartment of Medical Microbiology, Maastricht University Medical Centre/CAPHRI, 6202AZ Maastricht, The Netherlands
bNIVEL, The Netherlands Institute for Health Services Research, 3513CR Utrecht, The Netherlands
cNational Institute for Public Health and the Environment, Centre for Infectious Disease Control Netherlands (CIb), Bilthoven, The Netherlands