Risk factors of ciprofloxacin resistance in urinary Escherichia coli isolates.
OBJECTIVE
Increasing rates of fluoroquinolone resistance among Escherichia coli have been reported in Taiwan and worldwide. We aimed to identify the risk factors of ciprofloxacin resistance in urinary E. coli isolates.


METHODS
Patients with positive urine culture result for E. coli and resistance to ciprofloxacin between September 1, 1999 and December 31, 1999 were prospectively identified as cases, and compared with ciprofloxacin-susceptible E. coli isolates (controls).


METHODS
control ratio was 1:2. Data were collected with standardized case record forms.


RESULTS
Sixty one cases and 122 controls were compared. Multivariate analysis indicated that urinary tract catheterization (odds ratio [OR] = 2.631, 95% confidence interval [CI] = 1.058-6.544; p=0.037) and prior exposure to quinolones (OR = 13.072, 95% CI = 3.367-50.75; p<0.001) were independent risk factors for ciprofloxacin resistance in urinary E. coli isolates. Compared with ciprofloxacin-susceptible E. coli isolates, ciprofloxacin-resistant E. coli isolates from urine specimens had a significantly higher rate of resistance to all other tested antimicrobial agents, except amikacin and imipenem.


CONCLUSIONS
In patients with urinary tract infection, urinary catheterization and prior quinolone exposure are associated with a high risk of ciprofloxacin-resistant E. coli which may cause treatment failure.
Lin
Chun-Yu
CY
Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Chun-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Huang
Shu-Hua
SH
Chen
Tun-Chieh
TC
Lu
Po-Liang
PL
Lin
Wei-Ru
WR
Chen
Yen-Hsu
YH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002939:Ciprofloxacin / Q000494:pharmacology* / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000382:microbiology / Q000652:urine*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D015363:Quinolones / Q000009:adverse effects / Q000494:pharmacology; D012307:Risk Factors; D013624:Taiwan; D014546:Urinary Catheterization / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology* / Q000652:urine
D000900:Anti-Bacterial Agents; D015363:Quinolones; D002939:Ciprofloxacin