Mapping antimicrobial susceptibility of community-acquired uropathogenic Escherichia coli across low, middle and high-income countries highlights significant differences: insights for empiric treatment.
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Rizvi Meher, Khan Maria, Al-Jardani Amina, Al-Abri Seif Salem, Ghoshal Ujjala, Jabri Zaaima Al, Ahanjan Mohammad, Mamari Azza Al, Shizawi Nawal Al, Sami Hiba, Balkhair Abdullah, Shaukat Adila, Alkharusi Alwarith Nasser Salem, Almahrouqi Abdulrahman, Hassan Afreenish, Kumar Ajay, Malehi Amal Saki, Gul Amina, Singh Ashima, Shidhani Asma Said Hamed Al, Siddiqui Areena Hoda, Poojary Aruna, Rashdi Azza Al, Langford Bradley, Stepanskyi Dmytro, Dolatabadi Abbas, Maani Amal Al, Mufarji Aisha Al, AlRisi Elham Said Ahmed, Kapoor Garima, Princess Isabella, Lawati Hawra J Al, Eltahir Hatim Ali, Sidairi Hilal Al, Iskandar Katia, Masters Ken, Al-Busaidi Ibrahim Khalaf Hamdan, Yazidi Laila Al, Nasrin Mahfuza, Subhi Mahmood Salim Al, Sengupta Mallika, Khandait Manisha, Tamtami Nada Khalfan Al, Siyabi Nada Khafan Al, Kindi Nawal Al, Luthfee Nazla Musthafa, Shreshtha Neha, Riyami Nihal Mohamed Amur Al, Busaidi Noora Hilal Ali Al, Goel Nupur, Ishchenko Oksana, Taher Omnia Mohamed Elnabawy Ahmed, Jena Pragnya Paramita, Ekadashi Rajni, Al Zadjali Razan, Kanungo Reba, Abolghasemi Sara, Maqbali Salima Al, Banerjee Sayantan, Yaqoob Shadma, Sali Shahnaz, Khan Shafqat Husnain, Malhotra Shalini, Hughes Stephen, Shaukat Sundas, Atif Syed Mohammed, Patwardhan Vrushali Vishwas, Dougnon Victorien, Khan Wahid, Wali Walid, Muharrmi Zakariya Al, Basit Zeeshana, Choudhury Jasashree, Pravalina Rachita, John Keith H St, Singh Sanjeev, Singh Sarman, Taneja Neelam, Sardana Raman, Ghafur Abdul, Kapoor Pawan, Soman Rajeev, Abri Rashid Al
Аннотация
METHODS: The study was conducted in 37 representative centers across 13 countries in Asia (Middle East and Indian Subcontinent), Africa, Europe, and North America. A rigorous comparative analysis of the antimicrobial susceptibility of E. coli isolated from cases of simple cystitis presenting in outpatient or emergency departments was carried out. The impact of gross domestic product, climate, and population density per km2 on E. coli susceptibility profile was analyzed using the Kruskal-Wallis test and two-way analysis of variance.
RESULTS: Antimicrobial susceptibility varied significantly between LMICs and HICs, with nitrofurantoin (89%) and fosfomycin (96%) emerging as empiric choices globally. Across most centers, susceptibility to other oral antimicrobials was low: co-trimoxazole <60%, amoxicillin-clavulanic acid <70%, first-generation cephalosporins <50%, fluoroquinolones <60%. Injectable antibiotics fared better: piperacillin-tazobactam >70%, amikacin and meropenem >80%. Higher susceptibilities were noted in countries with high gross domestic product (P < 0.001) and humidity (P = 0.002).
CONCLUSION: Marked geographical differences in E. coli susceptibility patterns support the need for localized antibiograms and tailored empirical therapy. This study reinforces the utility of nitrofurantoin and fosfomycin as first-line agents and discourages the use of fluoroquinolones and third-generation cephalosporins.