#Community-acquired #UTIs in #children: #Resistance patterns of #uropathogens in a tertiary care center in #Saudi Arabia (Int J Pediatr Adolesc Med., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Int J Pediatr Adolesc Med. 2019 Jun;6(2):51-54. doi: 10.1016/j.ijpam.2019.02.010. Epub 2019 Mar 8.

Community-acquired urinary tract infections in children: Resistance patterns of uropathogens in a tertiary care center in Saudi Arabia.

Hameed T1,2,3, Al Nafeesah A4, Chishti S1,3, Al Shaalan M1,2,3, Al Fakeeh K1,2,3.

Author information: 1 Department of Pediatrics, King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City – Central Region, Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia. 2 King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. 3 King Abdullah International Medical Research Center, Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia. 4 Unaizah College of Medicine and Medical Sciences, Al-Qassim University, Unaizah, Saudi Arabia.

 

Abstract

OBJECTIVE:

The aim of the present study was to investigate the bacterial pathogens and their resistance patterns in children presenting with their first admission for a urinary tract infection (UTI) in a large tertiary care center in Riyadh, Saudi Arabia.

METHODS:

A retrospective chart review was conducted of pediatric patients 0-14 years of age who were admitted for their first community-acquired UTI in a large tertiary care center in Riyadh, Saudi Arabia. The review covered a 6-year period (2006-2012).

RESULTS:

Data were obtained from 202 children, of which 162 (80.2%) were female. The most frequently isolated uropathogens were Escherichia coli (75.7%), followed by Klebsiella pneumoniae (9.4%), Pseudomonas aeruginosa (5.9%) and Enterococcus species (3.5%). Sixteen (7.9%) isolates were ESBLs. Among all uropathogens, 68% were resistant to ampicillin, 54% resistant to co-trimoxazole, and 30% resistant/intermediate sensitivity to amoxicillin/clavulinic acid. Overall, there was a low resistance rate to cefotaxime (4.4%).

CONCLUSION:

E. coli is the predominant uropathogen causing UTIs in children, yet there is a high rate of multidrug-resistant organisms. For children admitted for a community-acquired UTI, a third-generation cephalosporin remains an appropriate empiric antibiotic. Our study and the work of others emphasize the importance of choosing empiric antibiotics for pediatric UTIs based on local resistance patterns.

PMID: 31388546 PMCID: PMC6676371 DOI: 10.1016/j.ijpam.2019.02.010

Keywords: Antibiotics; Drugs Resistance; UTI; Pediatrics; Saudi Arabia.

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Susceptibility of #carbapenemase-producing #Enterobacterales (CPE) to #nitroxoline (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Susceptibility of carbapenemase-producing Enterobacterales (CPE) to nitroxoline

Frieder Fuchs, Axel Hamprecht

Journal of Antimicrobial Chemotherapy, dkz275, https://doi.org/10.1093/jac/dkz275

Published: 10 July 2019

 

Abstract

Background

Infections caused by carbapenemase-producing Enterobacterales (CPE) constitute a major global health concern and are associated with increased morbidity and mortality. Nitroxoline is an old antibiotic, which has recently been re-launched for the treatment of uncomplicated urinary tract infection. Because of low resistance rates it could be an interesting option for treatment of MDR isolates, yet data on CPE susceptibility are scarce.

Objectives

To analyse the in vitro activity of nitroxoline against CPE.

Methods

MICs of nitroxoline were determined by agar dilution for a collection of well-characterized carbapenemase producers (n = 105), producing OXA-48-like (n = 36), VIM (n = 21), IMI (n = 9), IMP (n = 6), NDM (n = 22), KPC (n = 11), OXA-58 (n = 2) and GES (n = 2). For comparison, MICs of ertapenem, imipenem and meropenem were determined by agar gradient diffusion.

Results

For all 105 isolates, the MIC50/90 of nitroxoline was 8/16 mg/L. All Escherichia coli isolates (30/30, 100%) showed low MICs of 2–8 mg/L and were susceptible to nitroxoline. MICs of 32 mg/L were recorded for five isolates of VIM- and IMI-producing Enterobacter cloacae (n = 3) and OXA- and VIM-producing Klebsiella pneumoniae (n = 2).

Conclusions

Nitroxoline exhibited excellent in vitro activity against most isolates producing common and rare carbapenemases. If the current EUCAST susceptibility breakpoint of ≤16 mg/L for E. coli in uncomplicated urinary tract infections was applied, 95.2% (100/105) of isolates would be classified as susceptible. Nitroxoline could therefore be an alternative oral option for treatment of uncomplicated urinary tract infections caused by CPE.

Topic: antibiotics – urinary tract infections – diffusion – agar – enterobacter cloacae – imipenem – klebsiella pneumoniae – world health – infection – morbidity – mortality – meropenem – ertapenem – escherichia coli – dilution technique – dilute (action) – malnutrition-inflammation-cachexia syndrome

Issue Section: ORIGINAL RESEARCH

© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Antibiotics; Drugs Resistance; UTI; Enterobacteriaceae; Nitroxoline.

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#Trends and prediction of #antimicrobial susceptibility in #urinary #bacteria isolated in #European emergency departments: the #EuroUTI 2010-2016 Study (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Trends and prediction of antimicrobial susceptibility in urinary bacteria isolated in European emergency departments: the EuroUTI 2010-2016 Study

Alice Quaegebeur, Loïc Brunard, François Javaudin, Marie-Anne Vibet, Pascale Bemer, Quentin Le Bastard, Eric Batard, Emmanuel Montassier, EuroUTI 2010-2016 Study Group

Journal of Antimicrobial Chemotherapy, dkz274, https://doi.org/10.1093/jac/dkz274

Published: 30 June 2019

 

Abstract

Objectives

To assess recent trends in susceptibility to antibiotics among urinary isolates isolated in European emergency departments (EDs) and to identify isolates with a high (90% or more) predicted probability of susceptibility to fluoroquinolones or third-generation cephalosporins (3GCs).

Methods

In this cross-sectional study, we included urine cultures obtained from adult patients between 2010 and 2016 in 24 European EDs. Temporal trends were assessed using time-series analysis and multivariate logistic models. Multivariate logistic models were also used to predict susceptibility to fluoroquinolones or 3GCs from patient age and sex, year, month and ED.

Results

We included 88 242 isolates. Time-series analysis found a significant increase in susceptibility to fluoroquinolones and no significant trend for susceptibility to 3GCs. Adjusting for patient age and sex, ED and organism, multivariate models showed that susceptibility to 3GCs decreased from 2014 to 2016, while susceptibility to fluoroquinolones increased in 2015 and 2016. Among isolates from 2016, multivariate models predicted high probability of susceptibility to fluoroquinolones in 11% of isolates (positive predictive value 91%) and a high probability of susceptibility to 3GCs in 35% of isolates (positive predictive value 94%).

Conclusions

Susceptibility of ED urinary isolates to fluoroquinolones increased from 2014, while susceptibility to 3GCs decreased from 2015. Predictive models identified isolates with a high probability of susceptibility to fluoroquinolones or 3GCs. The ability of such models to guide the empirical treatment of pyelonephritis in the ED remains to be determined.

Topic: antibiotics – cephalosporins – adult – emergency service, hospital – fluoroquinolones – pyelonephritis – urinary tract – bacteria – urine culture – antimicrobial susceptibility

Issue Section: ORIGINAL RESEARCH

© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Antibiotics; Drugs Resistance; Fluoroquinolones; Cephalosporins; UTI; European Region.

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Joint #modelling of #resistance to six #antimicrobials in #urinary #Escherichia coli isolates in #Quebec, #Canada (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Joint modelling of resistance to six antimicrobials in urinary Escherichia coliisolates in Quebec, Canada

Jean-Paul R. Soucy, Alexandra M. Schmidt, Charles Frenette, Patrick Dolcé, Alexandre A. Boudreault, David L. Buckeridge, Caroline Quach

DOI: 10.1128/AAC.02531-18

 

ABSTRACT

Empirical treatment of urinary tract infections should be based on susceptibility profiles specific to the locale and patient population. Additionally, these susceptibility profiles should account for correlations between resistance to different types of antimicrobials. We used hierarchical logistic regression models to investigate geographic, temporal, and demographic trends in resistance to six antimicrobials in community-acquired and nosocomial urinary E. coli isolates from three communities in the province of Quebec, Canada procured between April 2010 and December 2017. A total of 74,986 community-acquired (age ≥ 18) and 4,384 nosocomial isolates (age ≥ 65) were analyzed. In both community-acquired and nosocomial isolates, we found geographic variation in the prevalence of resistance. Male sex (community-acquired hierarchical mean OR = 1.24, 95% credible interval: 1.02–1.50; nosocomial hierarchical mean OR = 1.16, 95% CI: 0.92–1.41) and recent hospitalization (community-acquired hierarchical mean OR = 1.49, 95% CI: 1.33–1.66; nosocomial hierarchical mean OR = 1.31, 95% CI: 0.99–1.78) were associated with a higher risk of resistance to most types of antimicrobials. We found distinct seasonal trends in both community-acquired and nosocomial isolates, but only community-acquired isolates showed a consistent annual pattern. Ciprofloxacin resistance increased sharply with patient age. We found clinically relevant differences in antimicrobial resistance in urinary E. coli isolates between locales and patient populations in the province of Quebec. These results could help inform empirical treatment decisions for urinary tract infections. In the future, similar models integrating local, provincial, and national resistance data could be incorporated into decision-support systems for clinicians.

Copyright © 2019 Soucy et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.

Keywords: Antibiotics; Drugs Resistance; E. Coli; Ciprofloxacin; Canada; UTI.

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#Chlorhexidine for #meatal #cleaning in reducing #catheter-associated #UTIs: a multicentre stepped-wedge randomised controlled trial (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Chlorhexidine for meatal cleaning in reducing catheter-associated urinary tract infections: a multicentre stepped-wedge randomised controlled trial

Oyebola Fasugba, PhD, Prof Allen C Cheng, PhD, Victoria Gregory, MSc, Prof Nicholas Graves, PhD, Jane Koerner, PhD, Prof Peter Collignon, PhD, Anne Gardner, PhD, Prof Brett G Mitchell, PhD

Published: April 12, 2019 / DOI: https://doi.org/10.1016/S1473-3099(18)30736-9

 

Summary

Background

Evidence for the benefits of antiseptic meatal cleaning in reducing catheter-associated urinary tract infection (UTI) is inconclusive. We assessed the efficacy of 0·1% chlorhexidine solution compared with normal saline for meatal cleaning before urinary catheter insertion in reducing the incidence of catheter-associated asymptomatic bacteriuria and UTI.

Methods

A cross-sectional, stepped-wedge, open-label, randomised controlled trial was undertaken in Australian hospitals. Eligible hospitals were Australian public and private hospitals, with an intensive care unit and more than 30 000 hospital admissions per year. Hospitals were randomly assigned to an intervention crossover date using a computer-generated randomisation system. Crossover dates occurred every 8 weeks; during the first 8 weeks of the study, no hospitals were exposed to the intervention (control phase), after which each hospital sequentially crossed over from the control to the intervention every 8 weeks. Patients requiring a urinary cathetwer were potentially eligible for inclusion in this hospital-wide study. Participants were excluded if they were younger than 2 years, had a medical reason preventing the use of the chlorhexidine, had the catheter inserted in theatre, did not have the catheter insertion date documented, required in-and-out or suprapubic catheterisation, had symptoms and signs suggestive of UTI at the time of catheter insertion, or were currently undergoing treatment for UTI. The intervention was the use of 0·1% chlorhexidine solution for meatal cleaning before urinary catheterisation with 0·9% normal saline used in the control phase. Masking of hospitals was not possible because it was not feasible to mask staff administering the intervention. The co-primary outcomes were the number of cases of catheter-associated asymptomatic bacteriuria and UTI per 100 catheter-days and were assessed within 7 days of catheter insertion in the intention-to-treat population. This trial is registered with Australian New Zealand Clinical Trials Registry, number ACTRN12617000373370.

Findings

21 hospitals were assessed for eligibility between Jan 5, 2017, and May 1, 2017; of these, three were successfully enrolled and randomised to one of three intervention crossover dates. 1642 participants in these hospitals were included in the study between Aug 1, 2017, and March 12, 2018, 697 (42%) in the control phase and 945 (58%) in the intervention period. In the control period, 13 catheter-associated UTI and 29 catheter-associated asymptomatic bacteriuria events in 2889 catheter-days (0·45 catheter-associated UTI cases and 1·00 catheter-associated asymptomatic bacteriuria cases per 100 catheter-days) were recorded compared with four catheter-associated UTI and 16 catheter-associated asymptomatic bacteriuria events in 2338 catheter-days (0·17 catheter-associated UTI cases and 0·68 catheter-associated asymptomatic bacteriuria cases per 100 catheter-days) during the intervention period. The intervention was associated with a 74% reduction in the incidence of catheter-associated asymptomatic bacteriuria (incident rate ratio 0·26, 95% CI 0·08–0·86, p=0·026), and a 94% decrease in the incidence of catheter-associated UTI (0·06, 95% CI 0·01–0·32, p=0·00080). There were no reported adverse events.

Interpretation

The use of chlorhexidine solution for meatal cleaning before catheter insertion decreased the incidence of catheter-associated asymptomatic bacteriuria and UTI and has the potential to improve patient safety.

Funding

HCF Research Foundation.

Keywords: Chlorhexidine; UTIs; Bacteriuria.

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#Cefiderocol versus #imipenem-cilastatin for the #treatment of complicated #UTIs caused by Gram-negative #uropathogens: a phase 2, randomised, double-blind, non-inferiority trial (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Cefiderocol versus imipenem-cilastatin for the treatment of complicated urinary tract infections caused by Gram-negative uropathogens: a phase 2, randomised, double-blind, non-inferiority trial

Simon Portsmouth, MD,  David van Veenhuyzen, MBChB, Roger Echols, MD, Mitsuaki Machida, MS, Juan Camilo Arjona Ferreira, MD, Mari Ariyasu, BPharm, Prof Peter Tenke, MD, Tsutae Den Nagata, MD

Published: October 25, 2018 / DOI: https://doi.org/10.1016/S1473-3099(18)30554-1

 

Summary

Background

Carbapenem-resistant Gram-negative bacteria represent the highest priority for addressing global antibiotic resistance. Cefiderocol (S-649266), a new siderophore cephalosporin, has broad activity against Enterobacteriaceae and non-fermenting bacteria, such asPseudomonas aeruginosa and Acinetobacter baumannii, including carbapenem-resistant strains. We assessed the efficacy and safety of cefiderocol versus imipenem-cilastatin for the treatment of complicated urinary tract infection in patients at risk of multidrug-resistant Gram-negative infections.

Methods

We did a phase 2, multicentre, double-blind, parallel-group non-inferiority trial at 67 hospitals in 15 countries. Adults (≥18 years) admitted to hospital with a clinical diagnosis of complicated urinary tract infection with or without pyelonephritis or those with acute uncomplicated pyelonephritis were randomly assigned (2:1) by an interactive web or voice response system to receive 1 h intravenous infusions of cefiderocol (2 g) or imipenem-cilastatin (1 g each) three times daily, every 8 h for 7–14 days. Patients were excluded if they had a baseline urine culture with more than two uropathogens, a fungal urinary tract infection, or pathogens known to be carbapenem resistant. The primary endpoint was the composite of clinical and microbiological outcomes at test of cure (ie, 7 days after treatment cessation), which was used to establish non-inferiority (15% and 20% margins) of cefiderocol versus imipenem-cilastatin. The primary efficacy analysis was done on a modified intention-to-treat population, which included all randomly assigned individuals who received at least one dose of study drug and had a qualifying Gram-negative uropathogen (≥1 × 10 5 colony-forming units [CFU]/mL). Safety was assessed in all randomly assigned individuals who received at least one dose of study drug, according to the treatment they received. This study is registered withClinicalTrials.gov, number NCT02321800.

Findings

Between Feb 5, 2015, and Aug 16, 2016, 452 patients were randomly assigned to cefiderocol (n=303) or imipenem-cilastatin (n=149), of whom 448 patients (n=300 in the cefiderocol group; n=148 in the imipenem-cilastatin group) received treatment. 371 patients (n=252 patients in the cefiderocol group; n=119 patients in the imipenem-cilastatin group) had qualifying Gram-negative uropathogen (≥1 × 105 CFU/mL) and were included in the primary efficacy analysis. At test of cure, the primary efficacy endpoint was achieved by 183 (73%) of 252 patients in the cefiderocol group and 65 (55%) of 119 patients in the imipenem-cilastatin group, with an adjusted treatment difference of 18·58% (95% CI 8·23–28·92; p=0·0004), establishing the non-inferiority of cefiderocol. Cefiderocol was well tolerated. Adverse events occurred in 122 (41%) of 300 patients in the cefiderocol group and 76 (51%) of 148 patients in the imipenem-cilastatin group, with gastrointestinal disorders (ie, diarrhoea, constipation, nausea, vomiting, and abdominal pain) the most common adverse events for both treatment groups (35 [12%] patients in the cefiderocol group and 27 [18%] patients in the imipenem-cilastatin group).

Interpretation

Intravenous infusion of cefiderocol (2 g) three times daily was non-inferior compared with imipenem-cilastatin (1 g each) for the treatment of complicated urinary tract infection in people with multidrug-resistant Gram-negative infections. The results of this study will provide the basis for submission of a New Drug Application to the US Food and Drug Administration. Clinical trials of hospital-acquired pneumonia and carbapenem-resistant infections are ongoing.

Funding

Shionogi & Co Ltd, Shionogi Inc.

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Imipenem-Cilastatin; Cefiderocol.

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Effect of 5-Day #Nitrofurantoin vs Single-Dose #Fosfomycin on Clinical Resolution of Uncomplicated Lower #UTI in Women – A RCT (JAMA, abstract)

[Source: Journal of the American Medical Association, full page: (LINK). Abstract, edited.]

Original Investigation / April 22, 2018

Effect of 5-Day Nitrofurantoin vs Single-Dose Fosfomycin on Clinical Resolution of Uncomplicated Lower Urinary Tract Infection in Women – A Randomized Clinical Trial

Angela Huttner, MD1,2; Anna Kowalczyk, MS3; Adi Turjeman, MSc4; et al Tanya Babich, MSc4; Caroline Brossier, RN1; Noa Eliakim-Raz, MD4,5; Katarzyna Kosiek, MD, PhD6; Begoña Martinez de Tejada, MD, PhD7; Xavier Roux, MD8; Shachaf Shiber, MD9; Ursula Theuretzbacher, PhD10; Elodie von Dach, PhD2,11; Dafna Yahav, MD4,12; Leonard Leibovici, MD4,5; Maciek Godycki-Ćwirko, MD, PhD3,6; Johan W. Mouton, MD, PhD13; Stephan Harbarth, MD1,2

Author Affiliations: 1 Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; 2 Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; 3 Centre for Family and Community Medicine, Medical University of Lodz, Lodz, Poland; 4 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 5 Department of Internal Medicine E, Rabin Medical Center, Beilinson Campus, Peta-Tiqva, Israel; 6 Faculty of Health Sciences, Division of Public Health, Medical University of Lodz, Lodz, Poland; 7 Obstetrics Division, Department of Obstetrics and Gynecology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; 8 Department of Internal Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; 9 Department of Emergency Medicine, Rabin Medical Center, Beilinson Campus, Peta-Tiqva, Israel; 10 Center for Anti-Infective Agents, Vienna, Austria; 11 Clinical Trials Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; 12 Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel; 13 Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands

JAMA. Published online April 22, 2018. doi:10.1001/jama.2018.3627

 

Key Points

  • Question  – What is the effect of 5-day nitrofurantoin, compared with single-dose fosfomycin, on clinical resolution of uncomplicated lower urinary tract infection (UTI) in women?
  • Findings  – In this randomized clinical trial that included 513 women with uncomplicated UTI, clinical resolution at 28 days occurred in 70% of patients in the nitrofurantoin group vs 58% of patients in the fosfomycin group, a statistically significant difference.
  • Meaning  – Five-day nitrofurantoin may be a better alternative to single-dose fosfomycin for treating uncomplicated UTI in women.

 

Abstract

Importance 

The use of nitrofurantoin and fosfomycin has increased since guidelines began recommending them as first-line therapy for lower urinary tract infection (UTI).

Objective 

To compare the clinical and microbiologic efficacy of nitrofurantoin and fosfomycin in women with uncomplicated cystitis.

Design, Setting, and Participants 

Multinational, open-label, analyst-blinded, randomized clinical trial including 513 nonpregnant women aged 18 years and older with symptoms of lower UTI (dysuria, urgency, frequency, or suprapubic tenderness), a positive urine dipstick result (with detection of nitrites or leukocyte esterase), and no known colonization or previous infection with uropathogens resistant to the study antibiotics. Recruitment took place from October 2013 through April 2017 at hospital units and outpatient clinics in Geneva, Switzerland; Lodz, Poland; and Petah-Tiqva, Israel.

Interventions 

Participants were randomized in a 1:1 ratio to oral nitrofurantoin, 100 mg 3 times a day for 5 days (n = 255), or a single 3-g dose of oral fosfomycin (n = 258). They returned 14 and 28 days after therapy completion for clinical evaluation and urine culture collection.

Main Outcomes and Measures 

The primary outcome was clinical response in the 28 days following therapy completion, defined as clinical resolution (complete resolution of symptoms and signs of UTI without prior failure), failure (need for additional or change in antibiotic treatment due to UTI or discontinuation due to lack of efficacy), or indeterminate (persistence of symptoms without objective evidence of infection). Secondary outcomes included bacteriologic response and incidence of adverse events.

Results 

Among 513 patients who were randomized (median age, 44 years [interquartile range, 31-64]), 475 (93%) completed the trial and 377 (73%) had a confirmed positive baseline culture. Clinical resolution through day 28 was achieved in 171 of 244 patients (70%) receiving nitrofurantoin vs 139 of 241 patients (58%) receiving fosfomycin (difference, 12% [95% CI, 4%-21%]; P = .004). Microbiologic resolution occurred in 129 of 175 (74%) vs 103 of 163 (63%), respectively (difference, 11% [95% CI, 1%-20%]; P = .04). Adverse events were few and primarily gastrointestinal; the most common were nausea and diarrhea (7/248 [3%] and 3/248 [1%] in the nitrofurantoin group vs 5/247 [2%] and 5/247 [1%] in the fosfomycin group, respectively).

Conclusions and Relevance 

Among women with uncomplicated UTI, 5-day nitrofurantoin, compared with single-dose fosfomycin, resulted in a significantly greater likelihood of clinical and microbiologic resolution at 28 days after therapy completion.

Trial Registration  ClinicalTrials.gov Identifier: NCT01966653

Keywords: UTI; Nitrofurantoin; Fosfomycin; Antibiotics.

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