Risk factors for antibiotic-resistant Escherichia coli isolated from hospitalized patients with urinary tract infections: a prospective study.
From November 1998 to February 1999 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.
Sotto
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Laboratoire Universitaire de Thérapeutique, Service de Médecine Interne B, Hôpital Carémeau, Nîmes, France. albert.sotto@chu-nimes.fr
De Boever
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CM
Fabbro-Peray
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Gouby
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Sirot
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Jourdan
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D018550:Cephalosporin Resistance; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000382:microbiology; D004352:Drug Resistance, Microbial; D004926:Escherichia coli / Q000145:classification* / Q000187:drug effects / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D007297:Inpatients; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010403:Penicillin Resistance; D012307:Risk Factors; D014296:Trimethoprim Resistance; D014546:Urinary Catheterization; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology*
D000900:Anti-Bacterial Agents