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Uropathogen distribution and antimicrobial susceptibility in uncomplicated cystitis in Belgium, a high antibiotics prescribing country: 20-year surveillance

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Abstract

Treatment of cystitis in primary care is usually empirical, guided by the prior probability of causal pathogens and their susceptibility. To re-evaluate empirical treatment guidelines, the actual distribution and susceptibility of uropathogens was examined and compared with two previous surveys in Belgium over the past 20 years. Because of the alarming increase in carriage of extended-spectrum β-lactamase (ESBL)- and carbapenemase-producing Escherichia coli, this specific resistance was explored. From May 2014 to December 2015, 120 general practitioners collected midstream urine specimens from adult pre- and postmenopausal female patients with suspected cystitis. A dipslide was inoculated and sent for microbiological analysis. Anal swabs were collected for ESBL and carbapenemase detection. Of 265 enrolled patients, 203 (79.3 %) had a positive culture. Escherichia coli (81.6 %) was the most frequently isolated uropathogen, followed by Staphylococcus saprophyticus (8 %), confirming the results of the 1995 and 2005 surveys. The susceptibility of E. coli remained nearly 100 % for nitrofurantoin and fosfomycin, decreased from nearly 100 % in 1995 to 94.2 % for quinolones, from 73.2 to 55.5 % for ampicillin, and from 83.3 to 76.3 % for trimethoprim–sulfamethoxazole (TMP-SMX). In E. coli present in positive urine cultures, ESBLs were found in 2.5 % and carbapenemases were absent. In fecal specimens, ESBL-producing E. coli were found in 7.9 % and carbapenemases were not detected. Over a 20-year period, the distribution of uropathogens in women with cystitis remained unchanged. Susceptibility remained excellent for nitrofurantoin and fosfomycin. For TMP-SMX, ampicillin, and quinolones, there was a decrease.

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Acknowledgments

We thank all the participating GPs for their collaboration. All our gratitude also goes to the laboratory technicians who not only supported the study with their executive skills but were so kind to involve me in their work. Especially, I want to thank Therese Lippens who took over a great deal of the preparing administrative work for this study.

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Authors and Affiliations

  1. Department of Family Medicine and Primary Health Care, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium

    S. Heytens & A. DeSutter

  2. Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium

    J. Boelens & G. Claeys

  3. Department of Clinical Pharmacology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium

    T. Christiaens

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  1. S. Heytens
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  2. J. Boelens
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  3. G. Claeys
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  4. A. DeSutter
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  5. T. Christiaens
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Corresponding author

Correspondence to S. Heytens.

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Funding

This study was funded by the Belgian Society for Infectiology and Clinical Microbiology (BVIKM) (grant number: KW/1392/LBV/001/013) and Belgian Antibiotic Policy Coordination Committee (BAPCOC) (grant number: KW/1392/LBV/001/013/023).

Conflict of interest

The authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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Heytens, S., Boelens, J., Claeys, G. et al. Uropathogen distribution and antimicrobial susceptibility in uncomplicated cystitis in Belgium, a high antibiotics prescribing country: 20-year surveillance. Eur J Clin Microbiol Infect Dis 36, 105–113 (2017). https://doi.org/10.1007/s10096-016-2776-8

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  • DOI: https://doi.org/10.1007/s10096-016-2776-8

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