title: Sex- and age-specific trends in antibiotic resistance patterns of Escherichia coli urinary isolates from outpatients.
abstract: BACKGROUND
  Urinary tract infections (UTIs) are one of the most common infections treated in ambulatory care settings, however the epidemiology differs by age and sex. The incidence of UTI is far greater in females than males, and infection in pediatric patients is more often due to anatomical abnormalities. The purpose of this research was to describe age- and sex-specific trends in antibiotic susceptibility to common urinary anti-infectives among urinary isolates of Escherichia coli from ambulatory primary care patients in a regional health maintenance organization.
  
  
  METHODS
  Clinical microbiology data were collected for all urine cultures from patients with visits to primary care clinics in a regional health maintenance organization between 2005 and 2010. The first positive culture for E. coli tested for antibiotic susceptibilities per patient per year was included in the analysis dataset. The frequency of susceptibility to ampicillin, amoxicillin-clavulanate, ciprofloxacin, nitrofurantoin, and trimethoprim/sulfamethoxazole (TMP/SMX) was calculated for male and female patients. The Cochrane-Mantel-Haenzel test was used to test for differences in age-stratified susceptibility to each antibiotic between males and females.
  
  
  RESULTS
  A total of 43,493 E. coli isolates from 34,539 unique patients were identified for study inclusion. After stratifying by age, E. coli susceptibility to ampicillin, amoxicillin-clavulanate, ciprofloxacin, and nitrofurantoin differed significantly between males and females. However, the magnitude of the differences was less than 10% for all strata except amoxicillin-clavulanate susceptibility in E. coli isolated from males age 18-64 compared to females of the same age.
  
  
  CONCLUSIONS
  We did not observe clinically meaningful differences in antibiotic susceptibility to common urinary anti-infectives among E. coli isolated from males versus females. These data suggest that male sex alone should not be used as an indication for empiric use of second-line broad-spectrum antibiotic agents for the treatment of UTIs.
authors: Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health & Science University, 3303 SW Bond Ave., CH12C, Portland, OR 97239, USA. mcgregoj@ohsu.edu
authors: Jessina C
authors: JC
authors: McGregor
authors: Miriam R
authors: MR
authors: Elman
authors: David T
authors: DT
authors: Bearden
authors: David H
authors: DH
authors: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000494:pharmacology; D000667:Ampicillin / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000494:pharmacology; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009582:Nitrofurantoin / Q000494:pharmacology; D012737:Sex Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology* / Q000652:urine*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D019980:Amoxicillin-Potassium Clavulanate Combination; D000667:Ampicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D009582:Nitrofurantoin