{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:53:24Z","timestamp":1792788804788,"version":"4.5.0"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"ABR Zorgnetwerk","award":["REBUS Study"],"award-info":[{"award-number":["REBUS Study"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n \n General practice patients with an acute urinary tract infection are usually treated empirically. Urine is only cultured if initial therapy fails. This study aimed to assess whether resistance rates of\n \n Escherichia coli<\/jats:italic>\n <\/jats:italic>\n (\n \n E. coli<\/jats:italic>\n <\/jats:italic>\n ) from initial urine samples differ from those observed after treatment failure, and whether current surveillance data used for treatment guidelines may overestimate resistance in first-line care.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A prospective observational study was conducted from October 2022 to June 2024 at Isala Hospital in Zwolle, the Netherlands, involving patients from two general practices. Patients with suspected acute UTI were included, excluding those with indwelling catheters. Initial urine samples were cultured, and resistance rates for all\n \n E. coli<\/jats:italic>\n <\/jats:italic>\n strains isolated were compared with data from the Dutch national AMR database ISIS-AR and regional data. Treatment success or failure was evaluated by recording the prescribed antibiotics and follow-up visits within 28 days.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 366 urine samples from 272 patients were analyzed.\n \n E. coli<\/jats:italic>\n <\/jats:italic>\n was the most common pathogen (82.2%). Resistance rates for\n \n E. coli<\/jats:italic>\n <\/jats:italic>\n were lower than those reported in national and regional datasets. Empirical treatment success rates were 95% for nitrofurantoin, 90% for fosfomycin, 92% for ciprofloxacin, and 100% for trimethoprim. Repeat cultures were performed in 19 cases due to persistent symptoms.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The study confirms that the Dutch national guideline for empirical UTI treatment in general practice is effective. However, periodic reviews of resistance rates for common uropathogens are recommended to ensure continued guideline validity and promote responsible antibiotic use.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0334222","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:27:12Z","timestamp":1760030832000},"page":"e0334222","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Escherichia coli antimicrobial resistance in acute urinary tract infection lower than reported in Dutch national surveillance database"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3494-490X","authenticated-orcid":true,"given":"Marjan J.","family":"Bruins","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Eijkelkamp-Biesterbos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemiek M.","family":"Meutstege","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudy Oliveira","family":"dos Santos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"pone.0334222.ref001","author":"J Bes","year":"2024"},{"key":"pone.0334222.ref002","unstructured":"Dutch College of General Practitioners (NHG). The practice guideline \u201cUrinary tract infections\u201d. https:\/\/richtlijnen.nhg.org\/standaarden\/urineweginfecties. 2020. 2025 March 18."},{"issue":"7","key":"pone.0334222.ref003","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1111\/j.1699-0463.1999.tb01458.x","article-title":"Are resistance patterns in uropathogens published by microbiological laboratories valid for general practice?","volume":"107","author":"A Baerheim","year":"1999","journal-title":"APMIS"},{"key":"pone.0334222.ref004","first-page":"494","article-title":"Antibiotic-Resistant E. coli in Uncomplicated Community-Acquired Urinary Tract Infection","volume":"115","author":"A Klingeberg","year":"2018","journal-title":"Dtsch Arztebl Int"},{"issue":"2","key":"pone.0334222.ref005","article-title":"Routine laboratory surveillance of antimicrobial resistance in community-acquired urinary tract infections adequately informs prescribing policy in England","volume":"2","author":"V Watts","year":"2020","journal-title":"JAC Antimicrob Resist"},{"key":"pone.0334222.ref006","article-title":"Urinary tract infection in outpatients in Germany - a cross-sectional study of diagnostics and susceptibility testing in medical laboratories","author":"H Bender","year":"2025","journal-title":"BJGP Open"},{"issue":"46","key":"pone.0334222.ref007","doi-asserted-by":"crossref","first-page":"17","DOI":"10.2807\/1560-7917.ES.2017.22.46.17-00062","article-title":"National laboratory-based surveillance system for antimicrobial resistance: a successful tool to support the control of antimicrobial resistance in the Netherlands","volume":"22","author":"W Altorf-van der Kuil","year":"2017","journal-title":"Euro Surveill"},{"issue":"5","key":"pone.0334222.ref008","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1038\/nrmicro3432","article-title":"Urinary tract infections: epidemiology, mechanisms of infection and treatment options","volume":"13","author":"AL Flores-Mireles","year":"2015","journal-title":"Nat Rev Microbiol"},{"issue":"4","key":"pone.0334222.ref009","doi-asserted-by":"crossref","DOI":"10.3399\/bjgpopen17X101145","article-title":"Bacteriology in uncomplicated urinary tract infections in Norwegian general practice from 2001-2015","volume":"1","author":"M Bollestad","year":"2017","journal-title":"BJGP Open"},{"key":"pone.0334222.ref010","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.jgar.2018.11.004","article-title":"Antimicrobial resistance of Escherichia coli isolates from outpatient urinary tract infections in women in six European countries including Russia","volume":"17","author":"S Ny","year":"2019","journal-title":"J Glob Antimicrob Resist"},{"issue":"5","key":"pone.0334222.ref011","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1093\/jac\/dkac045","article-title":"Oral fosfomycin activity against Klebsiella pneumoniae in a dynamic bladder infection in vitro model","volume":"77","author":"IJ Abbott","year":"2022","journal-title":"J Antimicrob Chemother"},{"issue":"1","key":"pone.0334222.ref012","first-page":"106","article-title":"Update on Urinary Tract Infection Antibiotic Resistance-A Retrospective Study in Females in Conjunction with Clinical Data","volume":"14","author":"C Mare\u0219","year":"2024","journal-title":"Life (Basel)"},{"issue":"5","key":"pone.0334222.ref013","doi-asserted-by":"crossref","DOI":"10.1093\/cid\/cir102","article-title":"International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases","volume":"52","author":"K Gupta","year":"2011","journal-title":"Clin Infect Dis"},{"key":"pone.0334222.ref014","unstructured":"Public Health England. Diagnosis of urinary tract infections: quick reference tool for primary care. 2018. https:\/\/www.gov.uk\/government\/publications\/urinary-tract-infection-diagnosis"},{"key":"pone.0334222.ref015","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1016\/j.cmi.2021.12.003","article-title":"What is the evidence base of used aggregated antibiotic resistance percentages to change empirical antibiotic treatment? A scoping review","volume":"7","author":"A Auzin","year":"2022","journal-title":"Clin Microbiol Infect"},{"issue":"10","key":"pone.0334222.ref016","doi-asserted-by":"crossref","first-page":"2723","DOI":"10.1093\/jac\/dkw223","article-title":"Antimicrobial resistance surveillance in urinary tract infections in primary care","volume":"71","author":"TL Chin","year":"2016","journal-title":"J Antimicrob Chemother"},{"issue":"6","key":"pone.0334222.ref017","first-page":"175","article-title":"The Percentage of Antibiotic Resistance in Uncomplicated Community-Acquired Urinary Tract Infections","volume":"121","author":"A Klingeberg","year":"2024","journal-title":"Dtsch Arztebl Int"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0334222","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:27:16Z","timestamp":1760030836000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0334222"}},"subtitle":[],"editor":[{"given":"Tsegaye","family":"Alemayehu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,9]]},"references-count":17,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0334222","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,9]]}}}