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Urinary tract infections

Noah Fongwen updates on resistance trends in pathogens causing urinary tract infections (UTIs) and advances in the laboratory diagnosis of UTIs.
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NOAH FONGWEN: In this section, we’ll be looking at the update on common clinical syndromes affected by AMR. These are urinary tract infections, gastrointestinal infections, respiratory infections, and sexually transmitted infections with a focus on gonorrhoea. The table shows the AMR data submission to GLASS in 2020. The pathogens highlighted, which are some of the pathogens that cause common clinical syndromes, will be covered this week. We’ll start with urinary tract infections. We’ll look at the AMR data submission to GLASS in 2020. Then we’ll look at E. coli-resistant and Klebsiella-resistant to ciprofloxacin and co-trimoxazole from the GLASS data. Then we’ll look at the treatment guidelines and any changes that have occurred due to resistance.
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And we’ll talk about the diagnoses and updates on urinary tract infections.
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The slide shows the proportion of patients with urinary tract infections caused by E. coli resistant to both ciprofloxacin and co-trimoxazole. We see that for both community and hospital settings, the proportion of patients with urinary tract infections caused by E. coli resistant to ciprofloxacin and co-trimoxazole is way above 10%. However, a higher proportion is seen from hospital settings. In fact, many of the cases, many of the patients with urinary tract infections caused by E. coli resistant to ciprofloxacin and co-trimoxazole are patients that are in hospital settings.
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A similar trend is seen for Klebsiella pneumoniae resistant to ciprofloxacin and co-trimoxazole with the majority of the patients in hospital settings. These are two widely available drugs that are used in community and hospital settings. And their resistance should be the point– a real cause for concern.
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In terms of treatment guidelines for urinary tract infections, there are some changes that have occurred due to resistance. Previously, for cystitis, aminopenicillins or fluoroquinolones were used as first line. Currently, aminopenicillins are no longer used. For complicated urinary tract infections, fluoroquinolones were used previously in combination with beta-lactams. Currently, fluoroquinolones are not automatically given as empirical therapy. Instead, second generation cephalosporins are used. And intravenous third generation cephalosporins are also used for empirical treatment In terms of diagnosis of urinary tract infections, procalcitonin is used. And it’s becoming of interest to emergency medicine providers. Lateral flow immunoassays are also used. And they’re a good choice for point-of-care screening. They are inexpensive and easy to use.
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We also have flow cytometry, which is only used to screen for bacteria, as it does not provide species identification or antimicrobial stability testing for definitive diagnoses. We have the adopted molecular platforms. And we have real-time microscopy systems for AST. It should be noted that these microscopy systems for AST can conduct phenotypic AST, which remains a crucial part for the diagnosis of urinary tract infections.

In the next steps, Dr. Noah Fongwen provides information on common clinical syndromes affected by AMR – urinary tract infections, gastrointestinal infections, respiratory infections, and sexually transmitted infections with a focus on gonorrhoea.

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