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Susceptibility of Escherichia Coli Isolated from the Urine of Patients with Urinary Tract Infection in Vietnam to Trimethoprim-Sulfamethoxazole, Nitrofurantoin, Fosfomycin, Aminoglycosides, and Fluoroquinolones: A Systematic Review and Meta-Analysis
25 Pages Posted: 25 Jul 2024
More...Abstract
Background: Urinary tract infections (UTIs) are prevalent in Vietnam, with Escherichia coli (E. coli) being the primary cause. The latest clinical guideline was issued by the Ministry of Health in 2017 and may be outdated due to the rapid development of antimicrobial resistance. No systematic review or meta-analysis has yet characterized the susceptibility profile of E. coli to commonly used antibiotics in Vietnam and its change over time.
Methods: Between November and December 2022, we searched EMBASE, PubMed, EBSCO, CitationGate, and the Vietnamese Interlibrary Medical Database. Studies that investigated the resistance of E. coli isolated from the urine of patients with UTI in Vietnam were included in our analysis. The resistance rate reported in these studies was extracted and used to calculate a weighted pooled resistance rate using the inverse variance heterogeneity model under the assumption of random effects. Annual trends in resistance development were assessed using linear regression analysis (PROSPERO: CRD42022371917).
Findings: We included 29 studies published between 2010 and 2022 in English and Vietnamese. The weighted pooled resistance rate of E. coli to trimethoprim-sulfamethoxazole was 70%, to nitrofurantoin was 5% , and to fosfomycin was 6%. Among aminoglycosides, resistance to gentamicin was 51%, to amikacin was 7% , and to netilmicin was 12%. Resistance to fluoroquinolones was high, with ciprofloxacin at 69% and levofloxacin at 64% . Most datasets exhibited high heterogeneity (I² > 90%), except those for fosfomycin (I² = 72.9%) and trimethoprim-sulfamethoxazole (I² = 70.7%).
Interpretation: The high resistance rate against trimethoprim-sulfamethoxazole suggests it should not be used as a first-line treatment but rather as empiric therapy. Nitrofurantoin's low resistance rate supports its inclusion, along with fosfomycin, as a first-line therapy in updated clinical guidelines. While susceptibility to amikacin and netilmicin remains favorable, fluoroquinolones should be used cautiously due to high resistance rates. Future surveillance studies should focus more on nitrofurantoin, fosfomycin, and other fluoroquinolones.
Funding: There was no funding source for this study.
Declaration of Interest: I declare no competing interests.
Keywords: Urinary Tract Infection, Antimicrobial Resistance, Antibiotic Resistance, Escherichia coli, Vietnam, Fosfomycin, Nitrofurantoin, Trimethoprim-Sulfamethoxazole, Fluoroquinolones, Aminoglycosides
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