title: Antibiotic resistance in isolates recovered from women with community-acquired urinary tract infections presenting to a tertiary care emergency department.
abstract: BACKGROUND
  We sought to determine the antibiotic susceptibility of organisms causing community-acquired urinary tract infections (UTIs) in adult females attending an urban emergency department (ED) and to identify risk factors for antibiotic resistance.
  
  
  METHODS
  We reviewed the ED charts of all nonpregnant, nonlactating adult females with positive urine cultures for 2008 and recorded demographics, diagnosis, complicating factors, organism susceptibility, and risk factors for antibiotic resistance. Odds ratios (ORs) and 95% confidence intervals (CIs) for potential risk factors were calculated.
  
  
  RESULTS
  Our final sample comprised 327 UTIs: 218 were cystitis, of which 22 were complicated cases and 109 were pyelonephritis, including 22 complicated cases. Escherichia coli accounted for 82.3% of all UTIs, whereas Staphylococcus saprophyticus accounted for 5.2%. In uncomplicated cystitis, 9.5% of all isolates were resistant to ciprofloxacin and 24.0% to trimethoprim-sulfamethoxazole (TMP-SMX). In uncomplicated pyelonephritis, 19.5% of isolates were resistant to ciprofloxacin and 36.8% to TMP-SMX. In UTI (all types combined), any antibiotic use within the previous 3 months was a significant risk factor for resistance to both ciprofloxacin (OR 3.34, 95% CI 1.16-9.62) and TMP-SMX (OR 4.02, 95% CI 1.48-10.92). Being 65 years of age or older and having had a history of UTI in the previous year were risk factors only for ciprofloxacin resistance.
  
  
  CONCLUSIONS
  E. coli was the predominant urinary pathogen in this series. Resistance to ciprofloxacin and TMP-SMX was high, highlighting the importance of relevant, local antibiograms. Any recent antibiotic use was a risk factor for both ciprofloxacin and TMP-SMX resistance in UTI. Our findings should be confirmed with a larger prospective study.
authors.affiliation: Department of Emergency Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. filiatra@interchange.ubc.ca
authors.forename: Lyne
authors.initials: L
authors.lastname: Filiatrault
authors.forename: Rachel M
authors.initials: RM
authors.lastname: McKay
authors.forename: David M
authors.initials: DM
authors.lastname: Patrick
authors.forename: Diane L
authors.initials: DL
authors.lastname: Roscoe
authors.forename: Grahame
authors.initials: G
authors.lastname: Quan
authors.forename: Jeff
authors.initials: J
authors.lastname: Brubacher
authors.forename: Ken M
authors.initials: KM
authors.lastname: Collins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001955:British Columbia / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D004352:Drug Resistance, Microbial; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents