Clinical Risk Factors And Multi-Antimicrobial Resistance Pattern In Community-Acquired Outpatient Urinary Tract Isolates of Escherichia Coli
Abstract
Objective: To evaluate multi-antimicrobial resistance pattern of Escherichia coli (E. coli) urinary isolates and the risk factors associated with commonly prescribed antibiotics in emergency department and primary care clinics.
Method This is a cross-sectional study of patients 18 to 65 years of age reported to have E. coli positive urinary tract infections (UTIs) whose medical and laboratory records were systematically reviewed.
Results: Overall, 37.7% E. coli 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 E. coli 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 E. coli urinary isolates. Patients with histories of genitourinary abnormalities were 1.59 times (CI 1.27-1.98) more likely have E. coli isolates resistant to TMP/SMX, and 2.35 times more likely (CI 1.79-3.09) to ciprofloxacin. Diabetic patients were at increased risk for resistance to TMP/SMX (OR 1.37,CI 1.14-1.65) and ciprofloxacin (OR 2.51,CI 2.00-3.16). Obesity is significantly associated with ciprofloxacin resistance (OR 1.68,CI 1.34-2.09). TMP/SMX and ciprofloxacin resistance rate increased gradually with the number of previous UTIs, hospitalizations, and antibiotic prescriptions.
Conclusions: Ciprofloxacin resistant isolates of E. coli 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.
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DOI: http://dx.doi.org/10.18103/imr.v2i7.138
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