Browsing by Author "Mnatzaganian, George"
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Item Antimicrobial Resistance Among Urinary Tract Infection Isolates of Escheria Coli in an Australian Population-Based Sample(2014-08-01) Mitchell, Brett G.; Mnatzaganian, George; Gardner, Anne; Fasugba, OyebolaItem Antimicrobial Resistance Patterns of Urinary Escheria Coli at an Australian Tertiary Hospital(2015-11-01) Gardner, Anne; Mnatzaganian, George; Mitchell, Brett G.; Fasugba, OyebolaItem Ciprofloxacin Resistance in Community- and Hospital-acquired Escherichia coli Urinary Tract Infections: A Systematic Review and Meta-Analysis of Observational Studies(2015-11-25) Mnatzaganian, George; Mitchell, Brett G.; Gardner, Anne; Fasugba, OyebolaBackground
During the last decade the resistance rate of urinary Escherichia coli (E. coli) to fluoroquinolones such as ciprofloxacin has increased. Systematic reviews of studies investigating ciprofloxacin resistance in community- and hospital-acquired E. coli urinary tract infections (UTI) are absent. This study systematically reviewed the literature and where appropriate, meta-analysed studies investigating ciprofloxacin resistance in community- and hospital-acquired E. coli UTIs.
Methods
Observational studies published between 2004 and 2014 were identified through Medline, PubMed, Embase, Cochrane, Scopus and Cinahl searches. Overall and sub-group pooled estimates of ciprofloxacin resistance were evaluated using DerSimonian-Laird random-effects models. The I2 statistic was calculated to demonstrate the degree of heterogeneity. Risk of bias among included studies was also investigated.
Results
Of the identified 1134 papers, 53 were eligible for inclusion, providing 54 studies for analysis with one paper presenting both community and hospital studies. Compared to the community setting, resistance to ciprofloxacin was significantly higher in the hospital setting (pooled resistance 0.38, 95 % CI 0.36-0.41 versus 0.27, 95 % CI 0.24-0.31 in community-acquired UTIs, P < 0.001). Resistance significantly varied by region and country with the highest resistance observed in developing countries. Similarly, a significant rise in resistance over time was seen in studies reporting on community-acquired E. coli UTI.
Conclusions
Ciprofloxacin resistance in E. coli UTI is increasing and the use of this antimicrobial agent as empirical therapy for UTI should be reconsidered. Policy restrictions on ciprofloxacin use should be enhanced especially in developing countries without current regulations.
Item Five-Year Antimicrobial Resistance Patterns of Urinary Escherichia Coli at an Australian Tertiary Hospital: Time Series Analyses of Prevalence Data(2016-10-06) Gardner, Anne; Collignon, Peter; Das, Anindita; Mnatzaganian, George; Mitchell, Brett G.; Fasugba, OyebolaThis study describes the antimicrobial resistance temporal trends and seasonal variation of Escherichia coli (E. coli) urinary tract infections (UTIs) over five years, from 2009 to 2013, and compares prevalence of resistance in hospital- and community-acquired E. coli UTI. A cross sectional study of E. coli UTIs from patients attending a tertiary referral hospital in Canberra, Australia was undertaken. Time series analysis was performed to illustrate resistance trends. Only the first positive E. coli UTI per patient per year was included in the analysis.
A total of 15,022 positive cultures from 8724 patients were identified. Results are based on 5333 first E. coli UTIs, from 4732 patients, of which 84.2% were community acquired. Five-year hospital and community resistance rates were highest for ampicillin (41.9%) and trimethoprim (20.7%). Resistance was lowest for meropenem (0.0%), nitrofurantoin (2.7%), piperacillin-tazobactam (2.9%) and ciprofloxacin (6.5%). Resistance to amoxycillin-clavulanate, cefazolin, gentamicin and piperacillin-tazobactam were significantly higher in hospital- compared to community-acquired UTIs (9.3% versus 6.2%; 15.4% versus 9.7%; 5.2% versus 3.7% and 5.2% versus 2.5%, respectively). Trend analysis showed significant increases in resistance over five years for amoxycillin-clavulanate, trimethoprim, ciprofloxacin, nitrofurantoin, trimethoprim-sulphamethoxazole, cefazolin, ceftriaxone and gentamicin (P
Item Incidence of Antimicrobial Resistant Escherichia coli Urinary Tract Infections in the Australian Capital Territory(2017-11-01) Gardner, Anne; Collignon, Peter; Mitchell, Brett G.; Mnatzaganian, George; Das, Anindita; Fasugba, OyebolaIntroduction: The prevalence of antimicrobial resistance in urinary Escherichia coli (E. coli) is increasing in Australia but incidence and risk factors for resistance are not well described. We evaluated the incidence of antimicrobial resistant E. coli urinary tract infections (UTI) in a cohort of Australian Capital Territory (ACT) residents. The associations of age, gender and urine sample source with risk of resistant infections were also investigated.
Methods: We utilised laboratory-based retrospective data from all ACT residents who submitted urine samples to ACT Pathology between January 2009 and December 2013.
Results: A total of 146,915 urine samples from 57,837 ACT residents were identified over 5 years. The mean age of residents was 48 years (SD 26 years) with 64.4% female. The incidence of single drug resistant E. coli UTI was high for ampicillin, trimethoprim, and cefazolin (6.8%, 3.5%, and 1.9% respectively). No pandrug-resistant E. coli UTI was detected. Five year incidences of multi-drug and extensively drug-resistant E.coli UTI were 1.9% and 0.2% respectively. In multivariate logistic regressions, female age and sex over 38 years were significantly associated with single and multi-drug resistance. The risk of single-drug resistance was significantly higher in samples from after hours general practices compared to hospitals, office-hours general practices, community and specialist health services (adjusted odds ratio (OR) and 95% confidence intervals (CI) 2.6 (2.2-3.1)).
Conclusions: In this study, incidence of multi-drug and extensively drug resistant E.coli UTI are low in comparison to international rates. Our findings have significant implications for antimicrobial prescribing.
Item Incidence of Single-Drug Resistant-, Multidrug- Resistant, and Extensively Drug- Resistant Escheria Coli Urinary Tract Infections: An Australian Laboratory-Based Retrospective Study(2019-03-01) Gardner, Anne; Collignon, Peter; Mitchell, Brett G.; Mnatzaganian, George; Das, Anindita; Fasugba, OyebolaObjectives
To evaluate incidence of single-drug resistant, multidrug-resistant, extensively drug-resistant and pandrug-resistant E. coli urinary tract infections (UTI) in a sample of Australian Capital Territory (ACT) residents.
Methods
We utilised laboratory-based retrospective data from all ACT residents whose urine samples were processed from January 2009 to December 2013. Multivariate logistic regression models were constructed to determine the associations of age, sex, urine sample source and socioeconomic status with risk of resistant infections.
Results
A total of 146,915 urine samples from 57,837 ACT residents were identified over five years. Mean age of people in the sample was 48 years (standard deviation = 26 years) and 64.4% were females. Five-year incidence of single-drug resistant E. coli UTI was high for ampicillin, trimethoprim and cefazolin (6.8%, 3.5% and 1.9% respectively). No pandrug-resistant E. coli UTI was detected. Five-year incidences of multidrug- and extensively drug-resistant E. coli UTI were 1.9% and 0.2% respectively, which is low in comparison to international rates. Female sex and age over 38 years were significantly associated with single- and multidrug-resistance. Compared to hospitals, office-hours general practices, community and specialist health services, risk of single-drug resistance was significantly higher in samples from after-hours general practices (adjusted-odds ratio (OR) and 95% confidence intervals (CI) 2.6 (2.2–3.1)).
Conclusions
Our findings have significant implications for antimicrobial prescribing given identified risk factors for the detection of resistance, especially in patients attending after-hours general practices.