Ciprofloxacin resistance in community- and hospital-acquired Escherichia coli urinary tract infections: a systematic review and meta-analysis of observational studies

Abstract

BackgroundDuring the last decade the resistance rate of urinary Escherichia coli (E. coli) to fluoroquinolones such as ciprofloxacin has increased. Systematic reviews of studies investigating ciprofloxacin resistance in community- and hospital-acquired E. coli urinary tract infections (UTI) are absent. This study systematically reviewed the literature and where appropriate, meta-analysed studies investigating ciprofloxacin resistance in community- and hospital-acquired E. coli UTIs.MethodsObservational studies published between 2004 and 2014 were identified through Medline, PubMed, Embase, Cochrane, Scopus and Cinahl searches. Overall and sub-group pooled estimates of ciprofloxacin resistance were evaluated using DerSimonian-Laird random-effects models. The I2 statistic was calculated to demonstrate the degree of heterogeneity. Risk of bias among included studies was also investigated.ResultsOf the identified 1134 papers, 53 were eligible for inclusion, providing 54 studies for analysis with one paper presenting both community and hospital studies. Compared to the community setting, resistance to ciprofloxacin was significantly higher in the hospital setting (pooled resistance 0.38, 95 % CI 0.36-0.41 versus 0.27, 95 % CI 0.24-0.31 in community-acquired UTIs, P < 0.001). Resistance significantly varied by region and country with the highest resistance observed in developing countries. Similarly, a significant rise in resistance over time was seen in studies reporting on community-acquired E. coli UTI.ConclusionsCiprofloxacin resistance in E. coli UTI is increasing and the use of this antimicrobial agent as empirical therapy for UTI should be reconsidered. Policy restrictions on ciprofloxacin use should be enhanced especially in developing countries without current regulations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1282-4) contains supplementary material, which is available to authorized users.

Occurrence and characterization of class 1 integrons in Escherichia coli from healthy individuals and those with urinary infection

“…The predominant multidrug resistance phenotype was AMP, AMX, KAN, TET, NAL, CIP, TMP-SMX (19.5 % of UPEC isolates), followed by AMP, AMX, TET, NAL, CIP, TMP-SMX (14.6 % of UPEC isolates). The high incidence of resistance in UPEC isolates to TMP-SMX (100 %) and CIP (100 %) agrees with the findings of previous studies reporting an increasing trend in resistance to CIP in UPEC [35,36]. Thus, resistance to fluoroquinolone in all UPEC isolates is alarming, as this agent is one of the few available therapies for serious E. coli infections.…”

Antimicrobial resistance in patients with urinary tract infections and the impact on empiric therapy in Serbia

“…In our study however, overall resistance rates to these drugs were 48.4% and 38.1%, respectively. There are more studies demonstrating high resistance rates to both agents [23,28,[31][32][33][34], which together with our findings, question the position of trimethoprimsulfamethoxazole and ciprofloxacin as first-line therapy for UTIs. Furthermore, neither gentamicin nor cephalosporins -including cefepime, ceftriaxone, cefuroxime, and cephalexin -could be used as empiric therapy in Serbia [5,16,26] due to high resistance rates observed in this study: 29.7% for gentamicin, and 20.2%, 26.5%, 29.8%, and 31.7% for the cephalosporins respectively.…”

Escherichia Coli Resistente a Ciprofloxacina em Pacientes Internados em Hospital Universitário de Manaus, 2015

“…Fato este que demonstra a importância em se repensar o uso empírico de ciprofloxacina em infecções urinárias hospitalares, em especial nas UTI's. 5 Semelhantemente à literatura, este estudo mostrou que nas infecções urinárias por Escherichia coli o sexo feminino é o predominante. 18,19 Conforme observado nesta análise, o fator sondagem vesical como determinante para aumento das infecções é corroborado pela maior prevalência de Escherichia coli resistente à ciprofloxacina junto às clínicas, com destaque para a clínica médica e neurocirurgia.…”