The association of antimicrobial resistance with cure and quality of life among women with acute uncomplicated cystitis
Tóm tắt
The association of in vitro resistance with bacteriologic, clinical, and health-related quality of life (HRQoL) outcomes for acute uncomplicated cystitis is unclear. We conducted a prospective study of women aged 18–40 years with acute uncomplicated cystitis symptoms for ≤7 days who subsequently grew an Enterobacteriaceae sp. and initially received trimethoprim/sulfamethoxazole (TMP/SMX) and phenazopyridine. We conducted telephone follow-up evaluating clinical cure at 1–3 days and in-person follow-up evaluating clinical, bacteriologic, and HRQoL outcomes at 3–7 days and 4–6 weeks post-treatment. An Enterobacteriaceae sp. was isolated in 139 (96.5%) patients (25.2% TMP/SMX-resistant). At 1–3 days post-treatment, clinical cure occurred in 56/81 (69.1%) and 14/31 (45.2%) of cases with susceptible and resistant strains, respectively (difference 23.9%; 95% confidence interval [CI], 1.5–46.4%). At 3–7 days post-treatment, bacteriologic cure occurred in 70/73 (95.9%) and 15/25 (60%) of cases with susceptible and resistant strains, respectively (difference 35.9%; 95% CI, 13.5–58.3%). Sustained clinical cure rates at 3–7 days and 4–6 weeks post-treatment were 65.4 and 56.8% with susceptible strains, and 45.2 and 45.2% with resistant strains, respectively. The HRQoL scale assessing role limitations due to physical health problems was lower in TMP/SMX-resistant versus TMP/SMX-susceptible infections, with twice as many hours of missed activities reported (mean, 18.4 vs. 9.1 h). Differences in HRQoL appeared to be largely related to differences in clinical cure rates. Among women treated for acute uncomplicated cystitis with TMP/SMX, in vitro TMP/SMX resistance was associated with lower bacteriologic and clinical cure rates, and had greater impact on the time lost from daily activities compared to those with TMP/SMX-susceptible infections.
Tài liệu tham khảo
Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med. 2002;113:5S–13S.
Griebling TL. Urologic diseases in America project: trends in resource use for urinary tract infections in women. J Urol. 2005;173:1281–7.
Foxman B, Barlow R, D’Arcy H, Gillespie B, Sobel JD. Urinary tract infection: self-reported incidence and associated costs. Ann Epidemiol. 2000;10:509–15.
Foxman B, Frerichs RR. Epidemiology of urinary tract infection: I. Diaphragm use and sexual intercourse. Am J Public Health. 1985;75:1308–13.
Ellis AK, Verma S. Quality of life in women with urinary tract infections: is benign disease a misnomer? J Am Board Fam Pract. 2000;13:392–7.
Gilbert DN, Moellering RC, Jr, Eliopoulos GM, Chambers HF, Saag MS. The Sanford guide to antimicrobial therapy 2010. 40th ed. Sperryville, VA: Antimicrobial Therapy, Inc; 2010. p. 29–31.
Taur Y, Smith MA. Adherence to the Infectious Diseases Society of America guidelines in the treatment of uncomplicated urinary tract infection. Clin Infect Dis. 2007;44:769–74.
Raz R, Chazan B, Kennes Y, Colodner R, Rottensterich E, Dan M, Lavi I, Stamm W; Israeli Urinary Tract Infection Group. Empiric use of trimethoprim–sulfamethoxazole (TMP-SMX) in the treatment of women with uncomplicated urinary tract infections, in a geographical area with a high prevalence of TMP-SMX-resistant uropathogens. Clin Infect Dis. 2002;34:1165–9.
Talan DA, Stamm WE, Hooton TM, Moran GJ, Burke T, Iravani A, Reuning-Scherer J, Church DA. Comparison of ciprofloxacin (7 days) and trimethoprim–sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis in women: a randomized trial. JAMA. 2000;283:1583–90.
Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing; fifteenth informational supplement. CLSI document M100-S15. Wayne, PA: CLSI; 2005.
Ware JE Jr, Kosinski M, Dewey JE. How to score version 2 of the SF-36 health survey. Lincoln, RI: Quality Metric Incorporated; 2000.
Fleiss JL. Statistical methods for rates and proportions. 2nd ed. New York: Wiley; 1981.
Ernst EJ, Ernst ME, Hoehns JD, Bergus GR. Women’s quality of life is decreased by acute cystitis and antibiotic adverse effects associated with treatment. Health Qual Life Outcomes. 2005;3:45.
Karlowsky JA, Thornsberry C, Jones ME, Sahm DF. Susceptibility of antimicrobial-resistant urinary Escherichia coli isolates to fluoroquinolones and nitrofurantoin. Clin Infect Dis. 2003;36:183–7.
Czaja CA, Scholes D, Hooton TM, Stamm WE. Population-based epidemiologic analysis of acute pyelonephritis. Clin Infect Dis. 2007;45:273–80.
Talan DA, Krishnadasan A, Abrahamian FM, Stamm WE, Moran GJ; EMERGEncy ID NET Study Group. Prevalence and risk factor analysis of trimethoprim–sulfamethoxazole- and fluoroquinolone-resistant Escherichia coli infection among emergency department patients with pyelonephritis. Clin Infect Dis. 2008;47:1150–8.
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 Diseases Society of America (IDSA). Clin Infect Dis. 1999;29:745–58.
Brown PD, Freeman A, Foxman B. Prevalence and predictors of trimethoprim–sulfamethoxazole resistance among uropathogenic Escherichia coli isolates in Michigan. Clin Infect Dis. 2002;34:1061–6.
Hays RD, Morales LS. The RAND-36 measure of health-related quality of life. Ann Med. 2001;33:350–7.