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Active surveillance of antibiotic resistance patterns in urinary tract infections in primary care in Switzerland

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Abstract

Purpose

Urinary tract infections (UTI) are one of the most common reasons for prescribing antibiotics in primary care. In Switzerland, the Swiss Center for Antibiotic Resistances (ANRESIS) provides resistance data by passive surveillance, which overestimates the true resistance rates. The aim of this study was to provide actual data of the antimicrobial resistance patterns in patients with UTI in Swiss primary care.

Methods

From June 2017 to August 2018, we conducted a cross-sectional study in 163 practices in Switzerland. We determined the resistance patterns of uropathogens in patients with a diagnosis of a lower UTI and analyzed risk factors for resistance. Patients with age < 18 years, pregnancy or a pyelonephritis were excluded.

Results

1352 patients (mean age 53.8, 94.9% female) were included in the study. 1210 cases (89.5%) were classified as uncomplicated UTI. Escherichia coli (E. coli) was the most frequent pathogen (74.6%). Susceptibility proportions of E. coli to ciprofloxacin (88.9%) and trimethoprim-sulfamethoxazol (TMP/SMX) (85.7%) were significantly higher than the proportions reported by ANRESIS. We found high susceptibility to the recommended first-line antibiotics nitrofurantoin (99.5%) and fosfomycin (99.4%). Increasing age, antimicrobial exposure and a recent travel history were independently associated with resistance.

Discussion

In this study, we report actual data on the resistance patterns of uropathogens in primary care in Switzerland. Escherichia coli showed low resistance rates to the recommended first-line antibiotics. Resistance to TMP/SMX was significantly lower than reported by ANRESIS, making TMP/SMX a suitable and cheap alternative for the empirical treatment.

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Acknowledgements

We wish to thank primary care physicians and patients that participated in the study; we acknowledge Swiss family medicine institutes in Geneva, Lausanne, Lucerne, Basel and Zürich, the representatives of the local medical networks that supported recruitment of family physicians and the anresis-laboratories for sharing their data; we acknowledge Dr. phil. II Michael Ritzler und Dr. scient. med. Nadia Wohlwend as well as all involved laboratory members of the laboratory Risch, which performed all urine analysis for this study.

Funding

This study was supported by grants from SwissLife, Blumenau-Léonie Hartmann Foundation, and Innova Foundation. ANRESIS is funded by the Swiss federal office of public health and the University of Bern. They had no influence over the study design, study results, interpretation of the data and publication.

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Authors and Affiliations

  1. Institute of Primary Care, University and University Hospital of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland

    Andreas Plate, Stefania Di Gangi, Thomas Rosemann & Oliver Senn

  2. Swiss Center for Antibiotic Resistance, Institute for Infectious Diseases, University Bern, Bern and Medix General Practice Network, Bern, Switzerland

    Andreas Kronenberg

  3. Labormedizinisches zentrum Dr Risch Ostschweiz AG, Buchs, St. Gallen, Switzerland

    Martin Risch

  4. Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland

    Yolanda Mueller

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  1. Andreas Plate
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  2. Andreas Kronenberg
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  3. Martin Risch
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Correspondence to Andreas Plate.

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Plate, A., Kronenberg, A., Risch, M. et al. Active surveillance of antibiotic resistance patterns in urinary tract infections in primary care in Switzerland. Infection 47, 1027–1035 (2019). https://doi.org/10.1007/s15010-019-01361-y

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  • DOI: https://doi.org/10.1007/s15010-019-01361-y

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