Resistance Patterns and Optimization of Empirical Therapy for Urinary Tract Infections in Patients on Trimethoprim-Sulfamethoxazole Prophylaxis Against Pneumocystis jirovecii
Abstract
Background: Trimethoprim-sulfamethoxazole (SXT) is widely used for Pneumocystis pneumonia prophylaxis. However, prolonged use may induce antimicrobial resistance, potentially compromising empirical therapy for urinary tract infections (UTIs). Methods: We retrospectively analyzed 3,525 patients with positive urine cultures at Shizuoka General Hospital (2018-2023). Among them, 149 received SXT prophylaxis. Antimicrobial susceptibility and the relationship between prophylaxis duration and resistance were evaluated. Results: Escherichia coli and Klebsiella pneumoniae were the most common pathogens. In the SXT prophylaxis group, E. coli susceptibility to SXT was significantly reduced (21.2% vs. 87.4%). Susceptibility to other antibiotics also declined, including ampicillin (31.2% vs. 71.6%), piperacillin (32.5% vs. 74.8%), levofloxacin (57.5% vs. 74.7%), and ciprofloxacin (56.2% vs. 74.1%). Susceptibility to expanded-spectrum cephalosporins, including second-, third-, and fourth-generation agents remained preserved. Receiver operating characteristic analysis identified a prophylaxis duration >406 days as predictive of SXT resistance (area under the curve 0.82, sensitivity 94%, and specificity 60%). Short-term prophylaxis (≤30 days) mitigated resistance, although E. coli susceptibility to SXT was still limited (47.8%). Conclusions: Prophylactic SXT use markedly reduces susceptibility to multiple antibiotics, especially penicillins and fluoroquinolones. Resistance correlates with…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 3,525 participants or records.
Read the paper
Related studies
- Association of lower urinary tract symptoms and OAB severity with quality of life and mental health in China, Taiwan and South Korea: results from a cross-sectional, population-based study
- Ten-Day Quadruple Therapy Comprising Low-Dose Rabeprazole, Bismuth, Amoxicillin, and Tetracycline Is an Effective and Safe First-Line Treatment for Helicobacter pylori Infection in a Population with High Antibiotic Resistance: a Prospective, Multicenter, Randomized, Parallel-Controlled Clinical Trial in China
- The Role of the NLR and PLR in Urinary Tract Infection
- Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic
- Leclercia adecarboxylata urinary tract infection in a patient with bladder cancer and recurrent hematuria
- A Case Series of Staphylococcus lugdunensis Infection in Cancer Patients at an Academic Cancer Institute in the United States
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.