Acute uncomplicated cystitis: from surveillance data to a rationale for empirical treatment

Ioannis Katsarolis (1) , Garyphallia Poulakou (1) , Sofia Athanasia (1) , Jenny Kourea-Kremastinou (2, 3) , Niki Lambri (1) , Elias Karaiskos (1) , Periklis Panagopoulos (1) , Flora V. Kontopidou (1) , Dionysios Voutsinas (4) , Georgios Koratzanis (5) , Maria Kanellopoulou (1) , Georgios Adamis (6) , Helen Vagiakou (6) , Pigi Perdikaki (7) , Helen Giamarellou (1) , Kyriaki Kanellakopoulou (1)

1 4th Department of Internal Medicine
2 Epidemiology
3 HCTLab - Human Computer Technology Laboratory
4 Tzaneio General Hospital
5 Sismanoglion General Hospital
6 ‘George Gennimatas' General Hospital
7 Primary Health Care Centre of Astros Kynourias

The objectives of this study were to explore the epidemiological features and resistance rates in uropathogens isolated from cases of acute uncomplicated cystitis (AUC) in Greece, and subsequently to guide empirical treatment. Urine samples from outpatients aged >16 years were cultured and for each uropathogen isolated non-susceptibility to orally administered antimicrobial agents was defined. Demographic and clinical data were provided in questionnaire form. From January 2005 to March 2006 a total of 1936 non-duplicate positive urinary cultures were collected and 889 AUC cases were evaluated. was the main aetiological agent (83%). In the AUC group, non-susceptibility rates for isolates were as follows: amoxicillin 25.8%; co-trimoxazole 19.2%; cefalothin 14.9%; nitrofurantoin 10.7%; amoxicillin/clavulanic acid 5.2%; nalidixic acid 6%; mecillinam 3.4%; ciprofloxacin 2.2%; cefuroxime 1.7%, and fosfomycin 1.6%. Amoxicillin and/or co-trimoxazole use in the previous 3 months was significantly associated with isolation of a co-trimoxazole-resistant isolate. The same applied for previous use of a fluoroquinolone agent and isolation of a ciprofloxacin-resistant isolate. In conclusion, increased co-trimoxazole non-susceptibility rates undermine its use as a first-line agent in empirical treatment, especially in cases of recent use of co-trimoxazole and/or amoxicillin. Fluoroquinolones display potent in vitro activity against community uropathogens, but prudent use is warranted for uncomplicated infections. Mecillinam and nitrofurantoin could serve as effective front-line agents in an effort to design fluoroquinolones-sparing regimens.

Mots clés: Resistance; Co-trimoxazole; Fluoroquinolones; Mecillinam; Nitrofurantoin; Cystitis

Ioannis Katsarolis, Garyphallia Poulakou, Sofia Athanasia, Jenny Kourea-Kremastinou, Niki Lambri, et al.. Acute uncomplicated cystitis: from surveillance data to a rationale for empirical treatment. International Journal of Antimicrobial Agents, 2009, 35 (1), pp.62. ⟨10.1016/j.ijantimicag.2009.08.018⟩. ⟨hal-00556364⟩