title: Uropathogen antibiotic resistance in adult women presenting to family physicians with acute uncomplicated cystitis.
abstract: BACKGROUND
  Increasing rates of trimethoprim-sulfamethoxazole (TMP-SMX) resistance among uropathogens have raised concerns about its continued role in empirical treatment of acute uncomplicated cystitis in adult women.
  
  
  OBJECTIVE
  To determine current rates of antibiotic resistance among uropathogens in the community.
  
  
  METHODS
  Urine culture reports from adult women with symptoms of cystitis attending the offices of family physicians from across Canada were examined. Antibiotic sensitivities and the total number of antibiotics an organism was resistant to was determined.
  
  
  RESULTS
  In 446 women, 235 (61.4%) positive urine cultures were identified. Of these, 38.2% were resistant to at least one antibiotic and 21.5% were resistant to two or more antibiotics. The rate of ampicillin resistance was 34.1%. For TMP-SMX, resistance was reported in 10.8% of samples. Antibiotic resistance was higher in British Columbia (55%) and western provinces (48%), compared with Ontario (33.3%) and the eastern provinces (26.3%, P=0.04, Fisher's exact test). Multidrug resistance was also higher in western Canada (33.9%) than in eastern Canada (16.6%, P=0.007).
  
  
  CONCLUSIONS
  TMP-SMX resistance in Canada remains within current recommended guidelines, allowing for its continued use as a first line empirical treatment for acute cystitis in adult women. The reasons for higher rates of antibiotic resistance in western Canada merit further study.
authors.affiliation: Ray D Wolfe Family Medicine Centre, Mount Sinai Hospital, Toronto, Ontario.
authors.forename: Warren
authors.initials: W
authors.lastname: J McIsaac
authors.forename: Tony
authors.initials: T
authors.lastname: Mazzulli
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.forename: Janet
authors.initials: J
authors.lastname: Raboud
authors.forename: Susan
authors.initials: S
authors.lastname: Ross