Risk Factors for Antibiotic-Resistant Escherichia coli Isolated from Hospitalized Patients with Urinary Tract Infections: a Prospective Study

Abstract

we prospectively evaluated the prevalence of resistance to penicillins, cephalosporins, carbapenem, quinolones, aminoglycosides, and trimethoprim-sulfamethoxazole (SXT) in 320 Escherichia coli isolates isolated from hospitalized patients with acute urinary tract infections (UTIs). We also studied for these strains risk factors for resistance to amoxicillin-clavulanic acid (AMC), fluoroquinolones (FQs), and SXT. Resistance rates were consistent with those from major recent studies reported in the literature. Multivariate analyses selected the following factors as being significantly associated with E. coli resistance: (i) for resistance to AMC, prior (1 year) UTI (odds ratio [OR] ‫؍‬ 2.71, P ‫؍‬ 0.006), prior (1 year) urinary catheter (OR ‫؍‬ 2.98, P ‫؍‬ 0.0025), and prior (6 months) antibiotic exposure (OR ‫؍‬ 2.68, P ‫؍‬ 0.005); (ii) for resistance to FQs male sex (OR ‫؍‬ 3.87, P ‫؍‬ 0.03), with a trend toward significance for age >65 years (OR ‫؍‬ 7.67, P ‫؍‬ 0.06) and prior (1 year) UTI (OR ‫؍‬ 2.98, P ‫؍‬ 0.07); and (iii) for resistance to SXT, male sex (OR ‫؍‬ 1.91, P ‫؍‬ 0.046), hospitalization in an intermediate-term-care unit (OR ‫؍‬ 2.18, P ‫؍‬ 0.008), and prior (1 year) UTI (OR ‫؍‬ 2.03, P ‫؍‬ 0.03). Ours results suggest that prior UTI is a common risk factor for resistance to the different antibiotics tested. Although few studies on risk factors for E. coli resistance to antibiotics have been published, careful interpretation of their findings, taking into consideration the population, infection site, and period studied, should contribute to the formulation of a better strategy that can be used to overcome antibiotic resistance.Escherichia coli, the most common member of the family Enterobacteriaceae implicated in human infectious diseases, has not been spared acquisition of antibiotic resistance, a complex therapeutic problem (7,15,38). The evolution of this microorganism's antibiotic resistance patterns identified from clinical isolates has been reported in many studies on amoxicillin (AMZ), amoxicillin-clavulanic acid (AMC), fluoroquinolones (FQs), and trimethoprim-sulfamethoxazole (SXT). Also, the intimate mechanisms of E. coli antibiotic resistance have been studied and explained in numerous publications (23,24,26,35,39). Unfortunately, few analyses of the demographic, epidemiological, and clinical data for patients with E. coli infection for determination of risk factors for resistance to antimicrobial agents have been reported (1,10,13,17,27,31).To evaluate the prevalence of resistance to a panel of antibiotics, including penicillins, cephalosporins, carbapenem, quinolones, aminoglycosides, and SXT, of E. coli strains isolated from hospitalized patients with acute urinary tract infections (UTIs) and to identify the risk factors for E. coli resistance to AMC, FQs, and SXT, which are routinely used to treat these infections, we conducted a prospective study in our hospital over a 3-month period. We discuss our observations, taking into consideration the most recent major studies on E. coli resist...

Antibiotic Resistance in Uropathogenic E. Coli Strains Isolated from Non-Hospitalized Patients in Pakistan

“…Similarly, fourth generation cephalosporins appeared to be no exception as well, because 55% of the isolates showed resistance to cefepime. Similar findings had been previously observed in south east Asian region [12,13,19]. Reported resistance rate against these drugs was comparatively lower in Iran (19.6%) [20] and in Bangladesh, it was 32% [21].…”

“…For MDR strains of UPEC, similar trends were observed in Iran (77%), whereas in India, they were 92%, in Slovenia, they were 42% and in USA, MDR rates were 7.1% [18]. No resistance against meropenem [12,13,19,20] and least resistance against tazocin 1.25% were observed in this study. For the treatment of MDR strains of UPEC, these antibiotics may be considered as an alternative choice; however, prior to the initiation of treatment, patient history should be taken into consideration.…”

“…Importantly, according to WHO recommendations, this antibiotic has been suggested as a first choice for UTI treatments [11]. Furthermore, we found that up to 76.3% of the isolates showed resistance towards co-amoxiclav and that 42% isolates showed resistance to fluoroquinolones [12][13][14]. Fluoroquinolones are considered as first choice for the treatment of UTIs in men, mainly because it has advantages over co-amoxiclav, which are related to its pharmacokinetic properties [15,16].…”

Investigation of Imipenem, Ciprofloxacin, Gentamicin and Co-trimoxazole Resistant Phenotypes in Nosocomial Escherichia coli Strains

“…Dün ya ge ne lin de ise siprof lok sa si ne %5-69, gen ta mi si ne %1.9-64 ve ko-trimok sa zo le %23.5-76 gi bi de ği şen oran lar da di renç bil di ril miş tir. [8][9][10][11][12] Has ta ne le rin yo ğun ba kım üni te le rin de ki hasta lar dan izo le edi len suş lar da da ha yük sek oran da sap tan mak la bir lik te ge nel ola rak GSBL üre ti mi, dün ya nın çe şit li ül ke le rin den de ği şen sık lık ta bil diril mek te dir. E. co li suş la rın da GSBL üre ti mi, Kuzey Ame ri ka' da %3.3-4.7, Gü ney Ame ri ka' da %6.7-25.4, Uzak Do ğu ül ke le rin de %7.9-23.6, Avru pa' da %5.3 ve ül ke miz de ya pı lan ça lış ma lar da ise %13-38 oran la rın da bil di ril mek te dir.…”

“…An cak gü nü müz de En te ro bac te ri a ce a e üye le rin de kar ba pe nem di ren ci ge nel lik le dü şük oran lar da bil di ril me si ne rağ men, ön ce ki yıl la ra gö -re da ha sık bil di ri lir ol muş tur. 16 İmi pe nem di ren ci, ül ke miz de ya pı lan ba zı ça lış ma lar da %0-2, 6,14,15 dün ya ge ne lin de ya pı lan ba zı ça lış ma lar da ise %0-8.8 [8][9][10] ara sın da de ği şen oran lar da bil di ril mek te dir. En te ro bac te ri a ce a e üye si suş lar da kar ba pe nem diren ci hüc re du va rın da ge çir gen li ği nin azal ma sın -dan, kro mo zo mal en zim ler den ya da gü nü müz de ar tan sık lık ta kar şı la şıl dı ğı gi bi plaz mid kay nak lı be ta-lak ta maz lar dan kay nak la na bil mek te dir.…”