Gene/Protein
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Drug
Enzyme
Compound
Pivot Concepts:
Gene/Protein
Disease
Symptom
Drug
Enzyme
Compound
Target Concepts:
Gene/Protein
Disease
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Drug
Enzyme
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Query: UMLS:C0011849 (
diabetes
)
277,896
document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)
Inappropriate choices and durations of therapy for urinary tract infections (UTI) are a common and widespread problem. In this qualitative study, we sought to understand why primary care providers (PCPs) choose certain antibiotics or durations of treatment and the sources of information they rely upon to guide antibiotic-prescribing decisions. We conducted semi-structured interviews with 18 PCPs in two family medicine clinics focused on antibiotic-prescribing decisions for UTIs. Our interview guide focused on awareness and familiarity with guidelines (knowledge), acceptance and outcome expectancy (attitudes), and external barriers. We followed a six-phase approach to thematic analysis, finding that many PCPs believe that fluoroquinolones achieve more a rapid and effective control of
UTI symptoms
than trimethoprim-sulfamethoxazole or nitrofurantoin. Most providers were unfamiliar with fosfomycin as a possible first-line agent for the treatment of acute cystitis. PCPs may be misled by advanced patient age,
diabetes
, and recurrent UTIs to make inappropriate choices for the treatment of acute cystitis. For support in clinical decision making, few providers relied on guidelines, preferring instead to have decision support embedded in the electronic medical record. Knowing the PCPs' knowledge gaps and preferred sources of information will guide the development of a primary care-specific antibiotic stewardship intervention for acute cystitis.
...
PMID:Qualitative Analysis of Primary Care Provider Prescribing Decisions for Urinary Tract Infections. 3124 19
Background:
Urinary tract infections (UTIs) are the most common bacterial infections among kidney transplant (KTX) recipients. The purpose of this study was to analyze antimicrobial resistance (AMR) in four most common pathogens responsible for UTIs in KTX recipients and determine risk factors (RF) for resistance in the same group.
Methods:
Analyzed antibiograms were based on urine samples positive for bacterial growth of 10
5
colony-forming units (CFU)/mL obtained from hospitalized adult KTX recipients presenting with
UTI symptoms
upon admission to the center in years 2011-2018.
Results:
In total, 783 antibiograms were analyzed for
Klebsiella
pneumoniae
(258 samples, 33.0%),
Escherichia
coli
(212, 27.0%),
Enterococcus
faecalis
(128, 24.0%), and
Enterococcus
faecium
(125, 16.0%). The decrease in susceptibility of
E. coli
to amoxicillin/clavulanic acid (62.9% vs. 40.0%) and ciprofloxacin (100% to 40.0%) was observed. Susceptibility to gentamicin increased from 33.3% to 92.9% in
E. faecium
. Susceptibility to tigecycline remained 100% through all years in case of
E. faecalis
and
E. faecium
. Male gender was a RF for resistance to amoxicillin/clavulanic acid (
p
= 0.008), ciprofloxacin (
p
= 0.0003), trimethoprim/sulfamethoxazole (
p
= 0.00009), ceftriaxone (
p
= 0.0001), and cefuroxime axetil (
p
= 0.00038) in
K. pneumoniae
and against gentamicin in
E. faecalis
(
p
= 0.015). Higher resistance to ampicillin in
E. faecalis
(
p
= 0.012) and to ciprofloxacin (
p
= 0.0003), trimethoprim/sulfamethoxazole (
p
= 0.007), piperacillin/tazobactam (
p
= 0.003), ceftriaxone (
p
= 0.001), and cefuroxime axetil (
p
= 0.013) in
K. pneumoniae
was observed in higher age groups of patients.
Diabetes
as a cause of kidney insufficiency (
p
= 0.026) and kidney-pancreas transplantation (
p
= 0.014) was RF for resistance to ceftriaxone in
K. pneumoniae
.
Conclusions:
AMR in uropathogens from KTX recipients fluctuated. There were identifiable RFs for resistance in the examined bacteria-antibiotic combinations. We recommend continuous mapping of site-specific microorganisms as etiology and susceptibility may vary between institutions and over time.
...
PMID:Analysis of Susceptibility to Selected Antibiotics in
Klebsiella pneumoniae, Escherichia coli, Enterococcus faecalis
and
Enterococcus faecium
Causing Urinary Tract Infections in Kidney Transplant Recipients over 8 Years: Single-Center Study. 3246 63
