Prevalence and predictors of trimethoprim-sulfamethoxazole resistance among uropathogenic Escherichia coli isolates in Michigan.
Resistance among uropathogenic Escherichia coli to trimethoprim-sulfamethoxazole (TMP-SMX) has increased. Risk factors for resistance and the impact on clinical failure have been poorly described. We performed a retrospective cohort study of women with acute uncomplicated cystitis seen at a university health center and at primary care clinics in southeastern Michigan from 1992 to 1999. The prevalence of TMP-SMX resistance increased from 8.1% to 15.8% (P=.01). Women who had taken TMP-SMX recently were >16 times as likely as women who had not taken antibiotics recently to be infected with an isolate resistant to this agent; those who had taken any other antibiotic were more than twice as likely to be infected with a resistant isolate. Women infected with a TMP-SMX-resistant isolate who were treated with TMP-SMX were >17 times as likely to have treatment failure. Recent antibiotic use is a risk factor for infection with a TMP-SMX-resistant isolate; patients who are infected with a TMP-SMX-resistant isolate and who are treated with this agent are at a higher risk for clinical failure.
Brown
Patricia D
PD
Division of Infectious Diseases, Department of Internal Medicine, Wayne State University, School of Medicine, Detroit, MI, USA. Pbrown@intmed.wayne.edu
Freeman
Alison
A
Foxman
Betsy
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000892:Anti-Infective Agents, Urinary / Q000494:pharmacology* / Q000627:therapeutic use; D015331:Cohort Studies; D004338:Drug Combinations; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013420:Sulfamethoxazole / Q000494:pharmacology* / Q000627:therapeutic use; D016896:Treatment Outcome; D014295:Trimethoprim / Q000494:pharmacology* / Q000627:therapeutic use; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*
D000892:Anti-Infective Agents, Urinary; D004338:Drug Combinations; D014295:Trimethoprim; D013420:Sulfamethoxazole