Korean J Urol.  2008 Jun;49(6):540-548.

The Ciprofloxacin Resistance Pattern of Escherichia coli Isolated from Female Patients with Community- acquired Urinary Tract Infection in the Jeonnam and Gwangju Region for the Recent 2-years

• Kim KY
• Kim CS
• Lim DH

Abstract

PURPOSE: The overuse of ciprofloxacin has recently increased the resistance of the Escherichia coli(E. coli). We studied the prevalence od the ciprofloxacin-resistant(CR) E. coli that were isolated from female patients with community-acquired urinary tract infection(CAUTI), and we demonstrated the resistant rate to other antibiotics to help physicians choose the suitable antibiotics to properly treat CAUTI.
MATERIALS AND METHODS
From January 2006 to December 2007, we retrospectively analyzed 910 female patients with CAUTI. Among them, we chose 387 patients infected by E. coli and we evaluated the resistance rate to ciprofloxacin and its relationship with age, the disease causing the UTI and the previous antibiotics. We also compared the resistance to ciprofloxacin with that of other antibiotics, including cephalosporin and the other antibiotics recommended by the guidelines of the Infectious Diseases Society of America(IDSA).
RESULTS
The incidence of UTI by E. coli increased with age(p<0.001), and it was highest in the 7th decade (59.0%). One hundred seventeen (30.2%) patients showed ciprofloxacin resistance. It was significantly related to an increased age(p=0.034), complicated UTI(p=0.04) and a previous history of antibiotic use(p=0.023). Trimethoprim/sulfamethoxazole(TMP/SMX) and fosfomycin showed similar resistance rates like ciprofloxacin; 31.8 and 28.2%, respectively. On the other hand, nitrofurantoin showed a low resistant rate of 5.7%. The resistance to cephalosporin was low in general; the lowest was cefepime(5.9%).
CONCLUSIONS
Our results imply that the empirical use of ciprofloxacin for female patients with CAUTI is questionable, and especially for patients older than 40 years old, patients with complicated UTI and patients with a previous history of antibiotic use. Nitrofurantoin and cephalosporin can be useful agents for the treatment of female CAUTI.

Keyword

Ciprofloxacin; Antibiotics; Antibacterial drug resistance; Escherichia coli; Community-acquired infections

MeSH Terms

Anti-Bacterial Agents
Ciprofloxacin
Communicable Diseases
Community-Acquired Infections
Drug Resistance, Bacterial
Escherichia
Escherichia coli
Female
Fosfomycin
Hand
Humans
Incidence
Nitrofurantoin
Prevalence
Retrospective Studies
Urinary Tract
Urinary Tract Infections
Anti-Bacterial Agents
Ciprofloxacin
Fosfomycin
Nitrofurantoin

Figure

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  Fig. 1. Age-specific incidence of the E. coli induced female CAUTI. CAUTI: community-acquired urinary tract infection.

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  Fig. 2. Age-specific resistant rate to ciprofloxacin of the E. coli isolated from female patients with CAUTI. CAUTI: community-acquired urinary tract infection.

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  Fig. 3. Disease-specific resistant rate to ciprofloxacin of the E. coli isolated from female patients with CAUTI. APN: acute pyelonephritis, CAUTI: community-acquired urinary tract infection.

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  Fig. 4. Resistant rate of the E. coli isolated from female patients with CAUTI to the antibiotics recommended by the IDSA guidelines. TMP/SMX: trimethoprim/sulfamethoxazole, IDSA: infectious diseases society of America, CAUTI: community-acquired urinary tract infection.

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  Fig. 5. Resistant rate to cephalosporin of the E. coli isolated from female patients with CAUTI. CAUTI: community-acquired urinary tract infection.

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  Fig. 6. Resistant rate to cephalosporin and nitrofurantoin of the ciprofloxacin-resistant E. coli isolated from female patients with CAUTI. CAUTI: community-acquired urinary tract infection.

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  Fig. 7. Resistant rate to ciprofloxacin of the cephalosporin-resistant and nitrofurantoin-resistant E. coli isolated from female patients with CAUTI. R: resistant, CAUTI: community-acquired urinary tract infection.

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