title: Community-acquired antibiotic resistance in urinary isolates from adult women in Canada.
abstract: BACKGROUND
  There are currently limited data regarding the prevalence of antimicrobial-resistant organisms causing community-acquired urinary tract infections among adult women in Canada. Trimethoprim-sulfamethoxazole (TMP-SMX) is the recommended first-line empirical antibiotic treatment, unless resistance of Escherichia coli to TMP-SMX exceeds 20%.
  
  
  OBJECTIVE
  To assess current levels of TMP-SMX-resistant E coli in community-acquired cases of urinary tract infection in adult women.
  
  
  METHODS
  Assessment of urine culture reports obtained from 21 laboratories across Canada, submitted by family physicians for women aged 16 years and older.
  
  
  RESULTS
  In 2199 adult women with a positive urine culture, 1079 (49.1%) of pathogens isolated were resistant to at least one antibiotic and 660 (30.0%) were multidrug-resistant (resistant to two or more antibiotics). TMP-SMX resistance was seen in 245 of 1613 (15.2%) E coli isolates (95% CI 13.5 to 17.0). This proportion was higher in women 50 years of age and older (155 of 863 isolates [18.0%]; P=0.001), in British Columbia (70 of 342 isolates [20.5%]) and in Ontario (62 of 370 isolates [16.8%]) when compared with eastern provinces (65 of 572 isolates [11.4%]; P=0.001). Fluoroquinolone-resistant E coli occurred in 107 of 1557 (6.9%) isolates (95% CI 5.7 to 8.2), with the highest level found in British Columbia (54 of 341 isolates [15.8%]; P=0.001).
  
  
  CONCLUSIONS
  TMP-SMX continues to be appropriate as first-line empirical treatment of acute cystitis in adult women in Canada, as resistance remains below 20%. However, TMP-SMX resistance is higher in older women and in some provinces. The level of fluoroquinolone-resistant E coli is highest in British Columbia.
authors.affiliation: Department of Family Medicine.
authors.forename: Warren J
authors.initials: WJ
authors.lastname: McIsaac
authors.forename: Tony
authors.initials: T
authors.lastname: Mazzulli
authors.forename: Joanne
authors.initials: J
authors.lastname: Permaul
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.forename: Donald E
authors.initials: DE
authors.lastname: Low