Resistance to fluoroquinolones and treatment failure/short-term relapse of community-acquired urinary tract infections caused by Escherichia coli.
OBJECTIVE
This study aims to evaluate the impact of resistance to fluoroquinolones on the short-term outcome of community-acquired urinary tract infections (UTIs) caused by Escherichia coli.


METHODS
Patients were identified and followed, during 2006, using the health care databases of the Emilia-Romagna Region. The outcome of interest was the treatment failure/short-term relapse (the re-isolation of E. coli from urine between 4 and 30 days after the first isolation).


RESULTS
Resistance to fluoroquinolones increases the risk of treatment failure/short-term relapse in women with uncomplicated community-acquired UTIs caused by E. coli (Rate Ratio=1.85, 95% CI 1.32-2.60). The efficacy of fluoroquinolones for community-acquired UTIs of men was significantly modified by the resistance status of E. coli. Prescription of these agents was associated with a reduced occurrence of the outcome only in men with a ciprofloxacin sensitive first isolate (Rate Ratio=0.50, 95% CI 0.25-0.99).


CONCLUSIONS
Resistance to fluoroquinolones of E. coli is a growing problem with a negative impact on the outcome of community-acquired UTIs; therefore, the prescription of these agents should be limited to infections for which they are recommended, avoiding their use in uncomplicated UTIs.
Gagliotti
Carlo
C
Agenzia Sanitaria e Sociale Regionale Emilia-Romagna, Area di Programma Rischio Infettivo, Viale Aldo Moro 21, 40127 Bologna, Italy. cgagliotti@regione.emilia-romagna.it
Buttazzi
Rossella
R
Sforza
Stefano
S
Moro
Maria Luisa
ML
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007558:Italy; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012008:Recurrence; D017211:Treatment Failure; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology*
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones