Clinical Risk Factors And Multi-Antimicrobial Resistance Pattern In Community-Acquired Outpatient Urinary Tract Isolates of Escherichia Coli
Authors: Ahmed M. Nadeem , Vannoy Debby , Frederick Ann , Bi Xuan 
Published: October 2016

<p><strong><span style="font-size: medium;">Objective:</span></strong><span style="font-size: medium;"> To evaluate multi-antimicrobial resistance pattern of <em>Escherichia coli</em></span><span style="font-size: medium;"> (</span><em><span style="font-size: medium;">E. coli</span></em><span style="font-size: medium;">) urinary isolates and the risk factors associated with commonly prescribed antibiotics in emergency department and primary care clinics.</span><span style="font-size: medium;">    </span></p><p><strong><span style="font-size: medium;">Method</span></strong><span style="font-size: medium;"> This is a cross-sectional study of patients 18 to 65 years of age reported to have <em>E. coli</em></span><span style="font-size: medium;"> positive urinary tract infections (UTIs) whose medical and laboratory records were systematically reviewed.</span><span style="font-size: medium;">   </span></p><p><strong><span style="font-size: medium;">Results: </span></strong><span style="font-size: medium;">Overall, 37.7% <em>E. coli</em></span><span style="font-size: medium;"> urinary isolates were resistant to ampicillin, 18.3% to trimethoprim/sulfamethoxazole (TMP/SMX), and 7.8% to ciprofloxacin. About 21% isolates were resistant to two or more antibiotics. Ciprofloxacin-resistant </span><em><span style="font-size: medium;">E. coli</span></em><span style="font-size: medium;"> isolates from outpatient urine sample were frequently resistant to ampicillin (81.5%), and TMP/SMX (58.2%). The concurrent resistance rate of ciprofloxacin was about 8 times more frequent (24.8% vs. 3.1%) than nitrofurantoin among TMP/SMX-resistant </span><em><span style="font-size: medium;">E. coli</span></em><span style="font-size: medium;"> urinary isolates. Patients with histories of genitourinary abnormalities were 1.59 times (</span><em><span style="font-size: medium;">CI 1.27-1.98</span></em><span style="font-size: medium;">) more likely have </span><em><span style="font-size: medium;">E. coli</span></em><span style="font-size: medium;"> isolates resistant to TMP/SMX, and 2.35 times more likely (</span><em><span style="font-size: medium;">CI 1.79-3.09</span></em><span style="font-size: medium;">) to ciprofloxacin. Diabetic patients were at increased risk for resistance to TMP/SMX (</span><em><span style="font-size: medium;">OR 1.37,</span></em><em><span style="font-size: medium;">CI 1.14-1.65</span></em><span style="font-size: medium;">) and ciprofloxacin (</span><em><span style="font-size: medium;">OR 2.51,</span></em><em><span style="font-size: medium;">CI 2.00-3.16</span></em><span style="font-size: medium;">). Obesity is significantly associated with ciprofloxacin resistance (</span><em><span style="font-size: medium;">OR 1.68,</span></em><em><span style="font-size: medium;">CI 1.34-2.09</span></em><span style="font-size: medium;">). TMP/SMX and ciprofloxacin resistance rate increased gradually with the number of previous UTIs, hospitalizations, and antibiotic prescriptions.</span><span style="font-size: medium;">  </span></p><p><strong><span style="font-size: medium;">Conclusions: </span></strong><span style="font-size: medium;">Ciprofloxacin resistant isolates of <em>E. coli</em></span><span style="font-size: medium;"> from urine were frequently multi-drug resistant and TMP/SMX can induce ciprofloxacin resistant. In addition to demographic factors, history of genitourinary abnormalities, diabetes, obesity, number of hospitalizations, previous diagnosis of UTIs, antibiotic prescriptions in previous 6 months are risk factors for antimicrobial resistance. </span></p><p><span style="font-size: medium;"> </span></p>