Background
Methods
Patients
Interventions
Follow-up, outcome measurements, primary outcome definition
Primary outcome
Statistical methods
Results
Total | Stop group | Continuing group | |||||
---|---|---|---|---|---|---|---|
Number | % | Number | % | Number | % |
p-value for stop versus continue | |
Patients with only negative urine tests | 23 | 13.1 | 11 | 12.5 | 12 | 13.6 | |
Patients with one or more positive cultures | 153 | 86.9 | 77 | 87.5 | 76 | 86.4 | Pearson chi-square 0.635 |
SBU | 137 | 77.8 | 70 | 79.5 | 67 | 76.1 | 1,000 |
UTI | 107 | 60.8 | 55 | 62.5 | 52 | 59.1 | 0.643 |
Number of positive cultures | 713 | 14.5 | 370 | 343 | |||
SBU | 398 | 55.8 | 199 | 53.8 | 199 | 58.0 | |
UTI | 315 | 44.2 | 171 | 46.2 | 144 | 42.0 | |
CI | CI | CI | |||||
Mean number of positive cultures per patient (95% CI) | 4.66 | (4.1-5.2) | 4.81 | (4.1-5.5) | 4.51 | (3.8-5.2) | negative binominal analysis 0.573 |
SBU | 2.60 | (2.3-2.9) | 2.58 | (2.2-3.0) | 2.62 | (2.1-3.1) | 0.915 |
UTI | 2.06 | (1.7-2.4) | 2.22 | (1.7-2.7) | 1.89 | (1.4-2.4) | 0.364 |
Uropathogens in positive cultures (% of positive cultures) | % | % | % | ||||
E.coli | 387 | 54.3 | 200 | 54.1 | 187 | 54.5 | Pearson chi-square 0.429 |
Non E.coli | 326 | 45.7 | 170 | 45.9 | 156 | 45.5 | |
Gram negative
| 631 | 88.5 | 326 | 88.1 | 305 | 88.9 | 0.901 |
Enterobacteriaceae | |||||||
AmpC negative | |||||||
E.coli
| 387 | 54.3 | 200 | 54.1 | 187 | 54.5 | |
Klebsiella pneumoniae
| 42 | 5.9 | 21 | 5.7 | 21 | 6.1 | |
Proteus mirabilis
| 34 | 4.8 | 15 | 4.1 | 19 | 5.5 | |
Klebsiella oxytoca
| 21 | 2.9 | 16 | 4.3 | 5 | 1.5 | |
AmpC positive
| |||||||
Enterobacter cloacae
| 18 | 2.5 | 10 | 2.7 | 8 | 2.3 | |
Citrobacter freundii
| 17 | 2.4 | 11 | 3.0 | 6 | 1.7 | |
Non fermenting bacilli | |||||||
Pseudomonas auroginosa
| 47 | 6.6 | 29 | 7.8 | 18 | 5.2 | |
Other | 65 | 9.1 | 24 | 6.5 | 41 | 12.0 | |
Gram positive
| 82 | 11.5 | 44 | 11.9 | 38 | 11.1 | 0.762 |
Enterococcal species | 56 | 7.9 | 30 | 8.1 | 26 | 7.6 | |
Staphylococcus aureus
| 18 | 2.5 | 10 | 2.7 | 8 | 2.3 | |
Other gram positive | 8 | 1.1 | 4 | 1.1 | 4 | 1.2 | |
CI = 95% confidence interval | |||||||
SBU = significant bacteriuria | |||||||
UTI = urinary tract infection |
No prophylaxis | Nitrofurantoin prophylaxis | Trimetoprim prophylaxis | Nitrofurantoin and trimetoprim prophylaxis | Ciprofloxacin prophylaxis | |
---|---|---|---|---|---|
Number of gram-negative cultures | 228 | 166 | 131 | 84 | 15 |
Antibiotic tested | % resistant | ||||
Amoxicillin | 57.0 | 57.3 | 71.3* | 79.0** | 55.6 |
Amoxicillin/clavulanic acid | 23.2 | 21.5 | 26.7 | 40.9** | 46.2 |
Piperacillin | 56.6 | 38.6* | 62.5 | 70.4 | 41.7 |
Piperacillin/tazobactam | 5.6 | 4.9 | 3.4 | 23.3*** | 8.3 |
Cefazolin | 17.3 | 14.0 | 14.9 | 29.0 | 66.7** |
Cefuroxim | 9.0 | 21.5** | 5.2 | 14.3 | 70.0*** |
Ceftazidim | 3.4 | 12.9* | 1.7 | 5.5 | 9.1 |
Ceftriaxon | 1.4 | 7.9* | 0.0 | 3.1 | 10.0 |
Meropenem | 0.0 | 2.4 | 1.6 | 1.2 | 8.3 |
Amikacin | 0.6 | 9.5** | 0.8 | 2.5 | 0.0 |
Gentamicin | 3.2 | 4.4 | 2.6 | 6.3 | 0.0 |
Tobramycin | 3.1 | 6.0 | 1.6 | 8.6* | 0.0 |
Ciprofloxacin | 3.8 | 7.2 | 12.0 | 2.5 | 58.3*** |
Norfloxacin | 5.1 | 8.9 | 11.6 | 3.8 | 63.6*** |
Levofloxacin | 5.9 | 10.2 | 11.8 | 2.5 | 53.8*** |
Trimetoprim | 38.5 | 38.7 | 90.5*** | 83.3*** | 55.6 |
Co-trimoxazol | 32.1 | 30.9 | 79.1*** | 71.8*** | 38.5 |
Nitrofurantoin | 13.2 | 56.1*** | 11.6 | 14.3 | 77.8*** |
Microbial resistance
Gram negative uropathogens | |||||||||
---|---|---|---|---|---|---|---|---|---|
AmpC negative | AmpC positive | Non-fermenting | |||||||
E.coli
|
Klebsiella pneumoniae
|
Proteus mirabilis
|
Klebsiella oxytoca
|
Enterobacter cloacae
|
Citrobacter freundii
|
Pseudomonas aeroginosa
|
p-value AP+ vs AP- | ||
Number of cultures | 387 | 42 | 34 | 21 | 18 | 17 | 47 | ||
Antibiogram | |||||||||
Penicillines
| |||||||||
Amoxicillin | total | 66.7 | NC | 24.2 | NC | NC | NC | NC | 0.031 |
AP+ | 73.8 | NC | 11.5 | NC | NC | NC | NC | ||
AP- | 56.3 | NC | # | NC | NC | NC | NC | ||
Amoxicillin/clavulanic acid | total | 29.7 | 9.5 | 6.1 | 9.5 | NC | NC | NC | 0.172 |
AP+ | 32.8 | 9.1 | 7.7 | # | NC | NC | NC | ||
AP- | 25.3 | # | # | 14.3 | NC | NC | NC | ||
Piperacillin | total | 68.2 | NC | 9.1 | NC | NC | NC | 2.6 | 0.950 |
AP+ | 73.5 | NC | 9.5 | NC | NC | NC | 3.1 | ||
AP- | 59.5 | NC | # | NC | NC | NC | # | ||
Piperacillin/tazobactam | total | 7.8 | 17.1 | 3.0 | 5.3 | # | # | 2.2 | 0.176 |
AP+ | 10.3 | 15.6 | 3.8 | # | # | # | 2.7 | ||
AP- | 4.0 | # | # | 7.7 | # | # | # | ||
Cephalosporines
| |||||||||
Cefazolin (1) | total | 17.9 | 43.8 | 4.5 | 56.3 | NC | NC | NC | 0.346 |
AP+ | 20.6 | 54.5 | 0.0 | # | NC | NC | NC | ||
AP- | 13.5 | # | # | 50.0 | NC | NC | NC | ||
Cefuroxim (2) | total | 11.4 | 45.2 | 3.0 | 14.3 | NC | NC | NC | 0.016 |
AP+ | 13.5 | 51.5 | 0.0 | # | NC | NC | NC | ||
AP- | 8.2 | # | # | 9.1 | NC | NC | NC | ||
Ceftazidim (3) | total | 1.7 | 21.7 | 4.3 | 5.9 | NC | NC | 4.3 | 0.161 |
AP+ | 2.6 | 29.4 | 4.5 | # | NC | NC | 2.6 | ||
AP- | 0.0 | # | # | 4.5 | NC | NC | # | ||
Ceftriaxon (3) | total | 1.9 | 19.4 | 0.0 | 5.9 | # | NC | # | 0.148 |
AP+ | 2.5 | 25.0 | 0.0 | # | # | NC | # | ||
AP- | 0.8 | # | # | 9.1 | # | NC | # | ||
Other bactolactam
| |||||||||
Meropenem | total | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 7.5 | 0.461 |
AP+ | 0.0 | 0.0 | 0.0 | # | # | # | 9.1 | ||
AP- | 0.0 | # | # | 0.0 | # | ? | # | ||
Aminoglycosides
| |||||||||
Amikacin | total | 1.9 | 19.0 | 4.2 | 0.0 | 0.0 | 0.0 | 2.5 | 0.054 |
AP+ | 2.6 | 26.7 | 4.3 | # | # | # | 3.0 | ||
AP- | 0.9 | # | # | 0.0 | # | ? | # | ||
Gentamicin | total | 4.7 | 2.4 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.500 |
AP+ | 4.4 | 3.0 | 0.0 | # | # | # | 0.0 | ||
AP- | 4.8 | # | # | 0.0 | # | 0.0 | # | ||
Tobramicin | total | 4.9 | 4.8 | 3.0 | 0.0 | 0.0 | 0.0 | 2.1 | 0.194 |
AP+ | 4.8 | 6.1 | 3.8 | # | # | # | 2.6 | ||
AP- | 4.4 | # | # | 0.0 | # | 0.0 | # | ||
Fluorquinolones
| |||||||||
Ciprofloxacin | total | 7.8 | 52.9 | 0.0 | 0.0 | 0.0 | 0.0 | 5.0 | 0.021 |
AP+ | 10.2 | 63.6 | 0.0 | # | # | # | 6.1 | ||
AP- | 3.6 | # | # | 0.0 | # | 0.0 | # | ||
Norfloxacin | total | 7.7 | 52.9 | 0.0 | 0.0 | 0.0 | 0.0 | 9.4 | 0.047 |
AP+ | 9.7 | 63.6 | 0.0 | # | # | # | 11.1 | ||
AP- | 4.5 | # | # | 0.0 | # | 0.0 | # | ||
Levofloxacin | total | 9.4 | 29.3 | 0.0 | 0.0 | 0.0 | 0.0 | 9.4 | 0.057 |
AP+ | 10.6 | 33.3 | 0.0 | # | # | # | 11.1 | ||
AP- | 7.7 | # | # | 0.0 | # | 0.0 | # | ||
Other antibiotics
| |||||||||
Trimetoprim | total | 66.6 | 88.2 | 34.8 | 23.5 | 16.7 | 66.7 | NC | <0.001 |
AP+ | 80.7 | 63.6 | 36.4 | # | # | # | NC | ||
AP- | 42.9 | # | # | 18.2 | # | 90.9 | NC | ||
Cotrimoxazol | total | 55.7 | 52.4 | 33.3 | 19.0 | 11.8 | 47.1 | NC | <0.001 |
AP+ | 69.7 | 51.5 | 30.8 | # | # | # | NC | ||
AP- | 35.4 | # | # | 14.3 | # | 10.1 | NC | ||
Nitrofurantoin | total | 16.4 | 90.5 | NC | 28.6 | 64.7 | 0.0 | NC | <0.001 |
AP+ | 22.4 | 93.9 | NC | # | # | # | NC | ||
AP- | 7.7 | # | NC | 21.4 | # | 0.0 | NC |