[Etiology and antimicrobial susceptibility among uropathogens causing community-acquired lower urinary tract infections: a nationwide surveillance study].
BACKGROUND
Knowledge of antimicrobial susceptibility patterns is required to prescribe empirical therapy and formulate guidelines for the treatment of community-acquired urinary tract infections. This multicenter study assesses the etiology and antimicrobial susceptibility of the main community-acquired uropathogens in Spain.


METHODS
Between March and July 2002, a prospective, multicenter study was conducted in 15 microbiology laboratories located in nine autonomous regions. Each laboratory used its standard methods for sample processing and culture, bacterial identification and susceptibility testing.


RESULTS
A total of 2724 isolates were recovered from outpatients with lower urinary tract infections. The most frequent pathogen found was Escherichia coli (73%), followed by Proteus spp. (7.4%), Klebsiella spp. (6.6%) and Enterococcus spp. (4.8%). The susceptibility rates of E. coli were 97.9% for fosfomycin, 95.8% for cefixime, 94.3% for nitrofurantoin, 90.8% for amoxicillin-clavulanic acid and 77.2% for ciprofloxacin. E. coli resistance to fluoroquinolones was significantly higher in men (28.9% vs. 19% in women; P < 0.001), elderly patients (33.7% in 80 years or older vs. 7.1% in 40 years or younger; P < 0.001), complicated infections (24.8% vs. 13.7% in non-complicated; P < 0.001) and some regions (> 32% in Andalusia, Aragon and Castilla-Leon vs. 9.2% in Galicia).


CONCLUSIONS
E. coli was the main uropathogen in outpatients. Almost all E. coli isolates were susceptible to fosfomycin, cefixime and nitrofurantoin. Overall fluoroquinolone resistance was near 23%, but this rate varied significantly according to sex, age, type of urinary infection, and geographic region. This information should be considered when empirical therapy is recommended or prescribed in Spain.
Andreu
Antonia
A
Servicio de Microbiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain. anandreu@vhebron.net
Alós
Juan Ignacio
JI
Gobernado
Miguel
M
Marco
Francesc
F
de la Rosa
Manuel
M
García-Rodríguez
José Antonio
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D015897:Comorbidity; D003556:Cystitis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000472:pathogenicity; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D014556:Urine / Q000382:microbiology; D014774:Virulence; D018440:beta-Lactam Resistance
D024841:Fluoroquinolones