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Enterococcus species in urinary tract infection
D Felmingham1, A P Wilson, A I Quintana
1Department of Clinical Microbiology, University College Hospital, London, United Kingdom.
Abstract:
Significant urinary isolates have been prospectively recorded since 1971. Enterococcus species, a common cause of nosocomial urinary tract infection, have been identified, and susceptibilities to a range of antibiotics have been determined. In addition, isolates in 1988 were tested for breakpoint susceptibility to vancomycin and teicoplanin. Despite changes in the hospitals covered, isolation of Enterococcus species rose steadily from 4% in 1971 to 12.6% in 1990 in hospital patients and from 2% to 5.6% in general-practice patients (P less than .01). All isolates of Enterococcus species were sensitive to ampicillin. Teicoplanin inhibited all 526 strains tested at a concentration of 2 micrograms/mL, but the same concentration of vancomycin inhibited only 370 (70%). The increased prevalence of enterococcal urinary tract infection is probably the result of increasing use of catheterization and broad-spectrum antibiotics. Glycopeptides reach high levels in the urine, and teicoplanin might be an alternative for the treatment of urinary tract infections due to enterococci.
Insights
Enterococcus species are increasingly causing urinary tract infections. Teicoplanin shows promise for treating these infections, as all tested strains were susceptible.
Area of Science:
- Microbiology
- Infectious Diseases
- Clinical Pharmacy
Background:
- Enterococcus species are a significant cause of nosocomial urinary tract infections.
- Urinary tract infections (UTIs) due to Enterococcus have shown a steady increase in prevalence since 1971.
- Factors such as increased catheterization and broad-spectrum antibiotic use likely contribute to this rise.
Purpose of the Study:
- To analyze the trends in Enterococcus species isolation from urinary samples.
- To determine the antibiotic susceptibility patterns of Enterococcus isolates, with a focus on glycopeptides.
- To evaluate the potential of teicoplanin as a treatment option for enterococcal UTIs.
Main Methods:
- Prospective recording of significant urinary isolates since 1971.
- Identification of Enterococcus species and determination of antibiotic susceptibilities.
- Breakpoint susceptibility testing for vancomycin and teicoplanin on 1988 isolates.
Main Results:
- Isolation of Enterococcus species increased from 4% (1971) to 12.6% (1990) in hospitals and 2% to 5.6% in general practice.
- All Enterococcus species isolates remained sensitive to ampicillin.
- Teicoplanin (2 µg/mL) inhibited all 526 tested strains, while vancomycin inhibited only 70%.
Conclusions:
- The rising prevalence of enterococcal UTIs necessitates effective treatment strategies.
- Teicoplanin demonstrates potent in vitro activity against Enterococcus species relevant to UTIs.
- Teicoplanin's high urinary levels suggest its potential as an alternative therapeutic agent for enterococcal UTIs.