Skip to main content

Klinik und Epidemiologie der unkomplizierten Zystitis bei Frauen

Deutsche Ergebnisse der ARESC-Studie

Clinical aspects and epidemiology of uncomplicated cystitis in women

German results of the ARESC Study

Der Urologe volume 49, pages 253–261 (2010)Cite this article

Zusammenfassung

Hintergrund und Fragestellung

Die unkomplizierte Zystitis bei der Frau gehört zu den häufigsten ambulant erworbenen Infektionen. Hier wird über die deutschen Ergebnisse der internationalen ARESC-Studie hinsichtlich Klinik, Epidemiologie und Antibiotikaempfindlichkeit der Erreger berichtet.

Patienten und Methoden

Es wurden Patientinnen im Alter von 18–65 Jahren mit den Symptomen einer unkomplizierten Zystitis konsekutiv eingeschlossen. Die klinische Untersuchung wurde durch eine Urinanalyse und -kultur ergänzt. Die Erreger wurden identifiziert und ihre Empfindlichkeit für 9 Antibiotika bestimmt.

Ergebnisse

In Deutschland wurden insgesamt 442 Patientinnen eingeschlossen, davon waren 412 auswertbar. Eine positive Urinkultur (Keimzahl ≥104/ml) fand sich bei 335 (81,3%); 325 (97,1%) hatten ein Monoinfektion. 317 Isolate wurden weiter in einem Zentrallabor (Genua) analysiert. Escherichia coli war der häufigste Erreger (76,7%), gefolgt von Proteus mirabilis (4,7%), Staphylococcus saprophyticus (2,8%), Klebsiella pneumoniae (2,5%), Enterokokken (2,5%) und Staphylococcus aureus (2,2%). Die höchste Empfindlichkeitsrate für Escherichia coli fand sich bei Fosfomycin (97,9%) gefolgt von Mecillinam (97,5%), Nitrofurantoin (95,4%) und Ciprofloxacin (95,4%). Die niedrigste Empfindlichkeitsrate fand sich bei Ampicillin (59,2%), gefolgt von Cotrimoxazol (74,0%). Für das gesamte Spektrum lag die Reihenfolge bei: Fosfomycin (96,1%), Mecillinam (97,5%), Ciprofloxacin (92,3%) und Nitrofurantoin (86,3%). Die niedrigsten Raten fanden sich für Ampicillin (56,6%) und Cotrimoxazol (73,9%).

Schlussfolgerungen

Fosfomycin, Mecillinam (in Deutschland nicht im Handel) und Nitrofurantoin haben ihre gute In-vitro-Aktivität erhalten und eignen sich für die empirische Therapie. Wegen der bereits hohen Resistenzraten bzw. der Gefahr weiterer Resistenzselektion sollten Cotrimoxazol (Trimethoprim) und Fluorchinolone generell nicht mehr als Mittel der ersten Wahl zur empirischen Therapie der unkomplizierten Zystitis bei der Frau empfohlen werden.

Abstract

Objective

Uncomplicated cystitis in women is among the most frequent infections in the community setting. The German results of the international ARESC Study are reported concerning clinical aspects, epidemiology, and antimicrobial susceptibility of uropathogens.

Patients and methods

Patients between 18 and 65 years of age with symptoms of uncomplicated cystitis were consecutively enrolled and investigated clinically including urinalysis and urine culture. Uropathogens were identified and their susceptibility was tested for nine antimicrobials

Results

In Germany a total of 442 patients were enrolled and 412 were eligible. A positive urine culture (cfu≥104/ml) was found in 335 (81.3%); 325 (97.1%) of them had a monoinfection. A total of 317 uropathogens were further analyzed in a central laboratory (Genua). Escherichia coli was the most frequent (76.7%), followed by Proteus mirabilis (4.7%), Staphylococcus saprophyticus (2.8%), Klebsiella pneumoniae (2.5%), enterococci (2.5%), and Staphylococcus aureus (2.2%). E. coli showed the highest rate of susceptibility to fosfomycin (97.9%) followed by mecillinam (97.5%), nitrofurantoin (95.4%), and ciprofloxacin (95.4%). The lowest rate was found for ampicillin (59.2%) followed by cotrimoxazole (74.0%). For the total spectrum the order was fosfomycin (96.1%), mecillinam (97.5%), ciprofloxacin (92.3%), and nitrofurantoin (86.3%). The lowest rates were found again for ampicillin (56.6%) and cotrimoxazole (73.9%).

Conclusions

Fosfomycin, mecillinam (not available in Germany), and nitrofurantoin have preserved their in vitro activity and are suitable for empiric therapy. Because of increasing resistance rates cotrimoxazole (trimethoprim) and fluoroquinolones are generally not recommended as first-choice drugs for empiric therapy of female patients with uncomplicated cystitis.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Literatur

  1. Clinical and Laboratory Standards Institute (2006) Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically, 7. edn. Wayne, PA, CLSI

  2. Clinical and Laboratory Standards Institute (2007) Performance standards for antimicrobial susceptibility testing, 17th Informational supplement. Wayne, PA, CLSI

  3. Deutsches Institut für Normung e.V. (2004) Medizinische Mikrobiologie - Empfindlichkeitsprufung von mikrobiellen Krankheitserregern gegen Chemotherapeutika – Teil 4: Bewertungsstufen fu r die minimalen Hemmkonzentrationen - MHK-Grenzwerte von antibakteriellen Wirkstoffen. Beiblatt zu DIN 58940-1. August 2005, Beuth, Berlin, DIN 58940-4 Bbl 1:2004

  4. Fadda G, Nicoletti G, Schito GC, Tempera G (2005) Antimicrobial susceptibility patterns of contemporary pathogens from uncomplicated urinary tract infections isolated in a multicenter Italian survey: possible impact on guidelines. J Chemother 17:251–257

    CAS  PubMed  Google Scholar 

  5. Fourcroy JL, Berner B, Chiang Y-K et al (2005) Efficacy and safety of a novel once-daily extended-release ciprofloxacin tablet formulation for treatment of uncomplicated urinary tract infection in women. Antimicrob Agents Chemother 49:4137–4143

    Article  CAS  PubMed  Google Scholar 

  6. Foxman B (2002) Epidemiology of urinary tract infections: incidence, morbidity and economic costs. Am J Med 113(Suppl 1A):5–13

    Article  Google Scholar 

  7. Goettsch WG, Janknegt R, Herings RM (2004) Increased treatment failure after 3-days‘ courses of nitrofurantoin and trimethoprim for urinary tract infections in women: a population-based retrospective cohort study using the PHARMO database. Br J Clin Pharmacol 58:184–189

    Article  PubMed  Google Scholar 

  8. Gupta K, Hooton TM, Roberts PL, Stamm WE (2007) Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women. Arch Intern Med 167:2207–2212

    Article  CAS  PubMed  Google Scholar 

  9. Gupta K, Stamm WE (2002) Outcomes associated with trimethoprim/sulphamethoxazole (TMP/SMX) therapy in TMP/SMX resistant community-aquired UTI. Int J Antimicrob Agents 19:554–556

    Article  CAS  PubMed  Google Scholar 

  10. Henry DC Jr, Bettis RB, Riffer E et al (2002) Comparison of once-daily extended-release ciprofloxacin and conventional twice-daily ciprofloxacin for the treatment of uncomplicated urinary tract infection in women. Clin Ther 24:2088–2104

    Article  CAS  PubMed  Google Scholar 

  11. Hooton TM, Scholes D, Gupta K et al (2005) Amoxicillin-clavulanate vs ciprofloxacin for the treatment of uncomplicated cystitis in women: a randomized trial. JAMA 293:949–955

    Article  CAS  PubMed  Google Scholar 

  12. Hooton TM (2003) Fluoroquinolones and resistance in the treatment of uncomplicated urinary tract infection. Int J Antimicrob Agents 22:65–72

    Article  PubMed  CAS  Google Scholar 

  13. Iravani A, Klimberg I, Briefer C et al (1999) A trial comparing low-dose, short-course ciprofloxacin and standard 7 day therapy with co-trimoxazole or nitrofurantoin in the treatment of uncomplicated urinary tract infection. J Antimicrob Chemother 43(Suppl A):67–75

    Article  CAS  PubMed  Google Scholar 

  14. Iravani A, Tice AD, McCarty J et al (1995) Short-course ciprofloxacin treatment of acute uncomplicated urinary tract infection in women. The minimum effective dose. The Urinary Tract Infection Study Group. Arch Intern Med 155(5):485–494

    Article  CAS  PubMed  Google Scholar 

  15. Kahlmeter G (2003) Prevalence and antimicrobial susceptibility of pathogens in uncomplicated cystitis in Europe. The ECO SENS study. Int J Antimicrob Agents 22:49–52

    Article  PubMed  CAS  Google Scholar 

  16. Kahlmeter G (2000) The ECO-SENS Project: a prospective, multinational, multicentre epidemiological survey of the prevalence and antimicrobial susceptibility of urinary tract pathogens – interim report. J Antimicrob Chemother 46(Suppl 1):15–22

    Article  CAS  Google Scholar 

  17. Krieger JN, Ross SO, Simonsen JM (1993) Urinary tract infections in healthy university men. J Urol 149:1046–1048

    CAS  PubMed  Google Scholar 

  18. Kunin C (1997) Detection, prevention and management of UTIs, 5th edn. Lea & Febiger, Philadelphia

  19. Lecomte F, Allaert FA (1997) Single-dose treatment of cystitis with fosfomycin trometanol (Monuril): analysis of 15 comparative trials on 2,048 patients. Giorn It Ost Gin 19:399–404

    Google Scholar 

  20. MacLean AB (1997) Urinary tract infection in pregnancy. Br J Urol 80(Suppl 1):10–13

    PubMed  Google Scholar 

  21. McCarty JM, Richard G, Huck W et al (1999) A randomized trial of short-course ciprofloxacin, ofloxacin, or trimethoprim/sulfamethoxazole for the treatment of acute urinary tract infection in women. Ciprofloxacin Urinary Tract Infection Group. Am J Med 106(3):292–299

    Article  CAS  PubMed  Google Scholar 

  22. Minassian MA, Lewis DA, Chattopadhyay D et al (1998) A comparison between single- dose fosfomycin trometanol (Monuril) and a 5-day course of trimethoprim in the treatment of uncomplicated lower urinary tract infection in women. Int J Antimicrob Agents 10:39–47

    Article  CAS  PubMed  Google Scholar 

  23. Naber KG, Bishop MC, Bjerklund-Johansen TE et al (2007) The management of urinary and male genital tract infections. European Association of Urology. Guidelines edition ISBN-13: 978-90-70244-59-0

  24. Naber KG, Koch EM (1993) Cefuroxime axetil versus ofloxacin for short-term therapy of acute uncomplicated lower urinary tract infections in women. Infection 21:34–49

    Article  CAS  PubMed  Google Scholar 

  25. Naber KG, Schito G, Botto H et al (2008) Surveillance Study in Europe and Brazil on clinical aspects and antimicrobial resistance epidemiology in females with cystitis (ARESC): Implications for empiric therapy. Eur Urol 54:1164–1178

    Article  PubMed  Google Scholar 

  26. Naber KG (2000) Survey on antibiotic usage in the treatment of urinary tract infections. J Antimicrob Chemother 46(Suppl 1):49–52

    Article  CAS  Google Scholar 

  27. Nicolle LE, Madsen KS, Debeeck GO et al (2002) Three days of pivmecillinam or norfloxacin for treatment of acute uncomplicated urinary infection in women. Scand J Infect Dis 34:487–492

    Article  CAS  PubMed  Google Scholar 

  28. Nicolle LE (2000) Pivmecillinam in the treatment of urinary tract infections. J Antimicrob Chemother 46(Suppl 1):35–39

    Article  CAS  Google Scholar 

  29. Nicolle LE (2005) Urinary tract infections in diabetes. Curr Opin Infect Dis 18:49–53

    Article  PubMed  Google Scholar 

  30. Peterson J, Kaul S, Khashab M et al (2008) A doubleblind, randomized comparison of levofloxacin 750 mg once-daily for five days with ciprofloxacin 400/500 mg twice-daily for 10 days for the treatment of complicated urinary tract infections and acute pyelonephritis. Urology 71:17–22

    Article  PubMed  Google Scholar 

  31. Raz R, Chazan B, Kennes Y, Colodner R et al (2002) the Israeli Urinary Tract Infection Group. Empiric use of trimethoprim- sulfamethoxazole (TMP-SMX) in the treatment of women with uncomplicated urinary tract infections, in a geographical area with high prevalence of TMP-SMXresistant uropathogens. Clin Infect Dis 34:1165–1169

    Article  CAS  PubMed  Google Scholar 

  32. Raz R, Gennesin Y, Wasser J et al (2000) Recurrent urinary tract infections in postmenopausal women. Clin Infect Dis 30:152–156

    Article  CAS  PubMed  Google Scholar 

  33. Richard GA, De Abate CA, Ruoff GE et al (1998) A double-blind, randomised trial of the efficacy and safety of short-course, once-daily levofloxacin versus ofloxacin twice daily in uncomplicated urinary tract infection. Infect Dis Clin Pract 9:323–329

    Article  Google Scholar 

  34. Rubin RH, Shapiro ED, Andriole VT et al (1992) Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Infect Dis Soc Am Food Drug Adm Clin Infect Dis 15(Suppl 1):216–227

    Google Scholar 

  35. Schito GC (2003) Why fosfomycin trometanol as first line therapy for uncomplicated UTI? Int J Antimicrob Agents 22(Suppl 20):79–83

    Article  PubMed  CAS  Google Scholar 

  36. Spencer RC, Moseley DJ, Greensmith MJ (1994) Nitrofurantoin modified release versus trimethoprim or cotrimoxazole in the treatment of uncomplicated urinary tract infection in general practice. J Antimicrob Chemother 33(Suppl A):121–129

    PubMed  Google Scholar 

  37. Stamm WE, Counts GW, Running KR et al (1982) Diagnosis of coliform infection in acutely dysuric women. N Engl J Med 307:463–468

    Article  CAS  PubMed  Google Scholar 

  38. Stamm WE (1997) Urinary tract infections in young men. In: Bergan T (ed) Urinary tract infections. Karger, Basel, pp 46–47

  39. Stein GE (1999) Comparison of single-dose fosfomycin and a 7-day course of nitrofurantoin in female patients with uncomplicated urinary tract infection. Clin Ther 21:1824–1872

    Article  Google Scholar 

  40. Vogel F, Naber KG, Adam D et al (2005) Aktuelle Bewertung der Fluorchinolone. Arzneimitteltherapie 23:130–136

    CAS  Google Scholar 

  41. Warren JW, Abrutyn E, Hebel JR et al (1999) Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). Clin Infect Dis 29:745–758

    Article  CAS  PubMed  Google Scholar 

Download references

Danksagung

Die Autoren danken Antonio Colantoni für die statistischen Analysen, Cordula Lebert für die Mithilfe bei der Manuskripterstellung, sowie den übrigen Mitgliedern der Studienleitung, Teresita Mazzei, Henry Botto, Joan Palou für die gute Kooperation und allen Beteiligten in den deutschen Zentren für die Teilnahme an der Beobachtungsstudie. Patientenzahl (n): (23) Thorsten Bruns, Hamburg; (2) Wolfgang Weidner, Gießen; (36) Florian M.E. Wagenlehner, Straubing; (11) Catalin Becheru, Straubing; (8) Harald Schumacher, Straubing; (66) Jürgen Jessberger, Bogen; (16) Michaela Well, Deggendorf; (17) Mitschitzky, Dingolfing; (2) Bernhard Muschol, Landshut; (20) Martin Ludwig, Marburg/L; (9) Marion Weigand, Lich; (40) Andreas Clad, Freiburg; (20) Klaus Bürger, München; (32) Christoph Antwerpen, Eggenfelden; (10) Klaus Rüdiger, Freiburg; (130) Orlin Savov, Nürnberg.

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Die Studie wurde durch eine Forschungsbeihilfe von Zambon Group Spa (Hersteller von Fosfomycin Trometamol), Bresso (MI), Italien, unterstützt. Außerdem führte der korrespondierende Autor klinische Studien mit Unterstützung von Sanofi-Aventis (Hersteller von Levofloxacin), Deutschland, durch. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Gießen und Marburg - Standort Gießen, Gießen, Deutschland

    F.M.E. Wagenlehner

  2. Evangelisches Krankenhaus, Gießen, Deutschland

    C. Wagenlehner

  3. Facharzt für Urologie, Nürnberg, Deutschland

    O. Savov

  4. Mikrobiologisches Institut, Universität, Genua, Italien

    L. Gualco & G. Schito

  5. Technische Universität, München, Deutschland

    K.G. Naber

  6. Karl-Bickleder-Straße 44c, 94315, Straubing, Deutschland

    K.G. Naber

Authors
  1. F.M.E. Wagenlehner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Wagenlehner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. Savov
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Gualco
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Schito
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K.G. Naber
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K.G. Naber.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wagenlehner, F., Wagenlehner, C., Savov, O. et al. Klinik und Epidemiologie der unkomplizierten Zystitis bei Frauen. Urologe 49, 253–261 (2010). https://doi.org/10.1007/s00120-009-2145-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-009-2145-7

Schlüsselwörter

  • Ciprofloxacin
  • Cotrimoxazol
  • Fosfomycin
  • Nitrofurantoin
  • Unkomplizierte Zystitis

Keywords

  • Ciprofloxacin
  • Cotrimoxazol
  • Fosfomycin
  • Nitrofurantoin
  • Uncomplicated cystitis