Antibiotic Resistance Among Uropathogenic Escherichia coli

Abstract

Urinary tract infections (UTIs) belong to the most common community-acquired and nosocomial infections. A main etiological factor of UTIs is uropathogenic Escherichia coli (UPEC). This review describes the current state of knowledge on the resistance of UPEC to antibiotics recommended for the treatment of UTIs based on the available literature data. Nitrofurantoin and fosfomycin are recommended as first-line therapy in the treatment of uncomplicated cystitis, and the resistance to these antimicrobial agents remains low between UPEC. Recently, in many countries, the increasing resistance is observed to trimethoprim-sulfamethoxazole, which is widely used as the first-line antimicrobial in the treatment of uncomplicated UTIs. In European countries, the resistance of UPEC to this antimicrobial agent ranges from 14.6% to 60%. The widespread use of fluoroquinolones (FQs), especially ciprofloxacin, in the outpatients is the cause of a continuous increase in resistance to these drugs. The resistance of UPEC to FQs is significantly higher in developing countries (55.5–85.5%) than in developed countries (5.1–32.0%). Amoxicillin-clavulanic acid is recommended as first line-therapy for pyelonephritis or complicated UTI. Resistance rates of UPEC to amoxicillin-clavulanic acid are regionally variable. In European countries the level of resistance to this antimicrobial ranges from 5.3% (Germany) to 37.6% (France). Increasing rates of UPEC resistance to antimicrobials indicate that careful monitoring of their use for UTI treatment is necessary.

Peer Review #1 of "Distribution of phylogenetic groups, adhesin genes, biofilm formation, and antimicrobial resistance of uropathogenic Escherichia coli isolated from hospitalized patients in Thailand (v0.2)"

“…Currently, the empirical treatment of UTIs is an issue of concern due to the increasing rates of antibiotic resistance. The resistance to trimethoprim-sulfamethoxazole (TMP-SMZ), ciprofloxacin, and amoxicillin-clavulanate (AMC) among UPEC isolates is higher in developing countries (ranging from ~50% to 85%) than in developed countries (ranging from 3% to 40%) (Kot, 2019). Routine standard antimicrobial susceptibility testing must be performed in order to reduce the rates of inappropriate empirical antibiotic therapy of UTIs and thereby decrease the occurrence of multidrug-resistant (MDR) UPEC (Adamus-Białek et al, 2018).…”

Multidrug-Resistance Among Uropathogenic Escherichia coli Strains

“…It has been reported that 40% of women and 12% of men experience UTI infection at least once in their lifetime. 1 Both genders are affected by UTIs, but the infections are much more common in women aged 15-44 years. 2 This kind of infection is responsible for 40% of nosocomial infections and 50% of bacterial infections which prolongs hospitalization and increases mortality.…”

“…3 In addition, healthcare-associated UTI, as one of the most common infections that occur in healthcare centers, is considered a significant threat to patients due to increased mortality. 1 Community-acquired UTI is also one of the most prevalent community infections. Uropathogenic Escherichia coli (UPEC) is the primary cause of UTIs in both healthcare centers and community.…”

“…4 In the clinical classification, community and healthcare-associated UTIs include complicated and uncomplicated infections which determine the type of antibiotic treatment. 1 Further, the emergence of multi-drug resistance (MDR) during the course of UTIs is mainly related to insufficient and empirical antibiotic therapies. The association between the increased uses of extended-spectrum antibiotics and increased multi-antibiotic resistance has been documented as well.…”

“…The association between the increased uses of extended-spectrum antibiotics and increased multi-antibiotic resistance has been documented as well. 1 Increasing antimicrobial resistance among UPEC strains has made the treatment of infections caused by these bacteria very problematic. 4 It has been reported that increasing the prevalence of MDR UPEC strains, mainly in developing countries, leads to the redundant prescription of broad-spectrum antibiotics including extended-spectrum cephalosporins and fluoroquinolones, which enhances the cost of treatment, the length of hospitalization, and antibiotic resistance spread.…”