title: Exposure to co-amoxiclav as a risk factor for co-amoxiclav-resistant Escherichia coli urinary tract infection.
abstract: The objective of the study was to define whether individual exposure to co-amoxiclav is a risk factor for selecting co-amoxiclav-resistant Escherichia coli in vivo. One hundred and eight patients were included in our study as soon as they were found to have a urinary tract infection (UTI) due to E. coli. Stool probes were also undertaken for some of these patients. Co-amoxiclav administration in the month before diagnosing the UTI, and any treatment to cure the current UTI were recorded for all patients. When co-amoxiclav-resistant E. coli was detected in the stools after diagnosis of E. coli UTI, isolates were compared with urinary E. coli isolates in terms of clonal relatedness, beta-lactam susceptibility and mechanisms of beta-lactam resistance. The patients who had taken co-amoxiclav in the month before the reported E. coli UTI had a significantly higher risk of being infected with co-amoxiclav-resistant E. coli. Those patients treated with amoxicillin for a current infection were at greater risk of intestinal carriage of co-amoxiclav-resistant E. coli; those treated with co-amoxiclav had a greater risk of intestinal carriage of co-amoxiclav-resistant Gram-negative bacilli than patients treated with third-generation cephalosporins or fluoroquinolones. Hence, individual exposure to co-amoxiclav is a risk factor for UTIs caused by co-amoxiclav-resistant E. coli or for carrying co-amoxiclav-resistant Gram-negative bacilli in the digestive tract.
authors.affiliation: Microbiology Department, Hôpital Ambroise Paré, AP-HP, and Faculté Paris-Ouest, Université Paris V, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Leflon-Guibout
authors.forename: Géraldine
authors.initials: G
authors.lastname: Ternat
authors.forename: Beate
authors.initials: B
authors.lastname: Heym
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Nicolas-Chanoine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000009:adverse effects* / Q000494:pharmacology*; D000892:Anti-Infective Agents, Urinary / Q000009:adverse effects* / Q000494:pharmacology*; D016001:Confidence Intervals; D024901:Drug Resistance, Multiple, Bacterial / Q000502:physiology*; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007223:Infant; D008875:Middle Aged; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000892:Anti-Infective Agents, Urinary; D019980:Amoxicillin-Potassium Clavulanate Combination