title: Susceptibility to antibiotics in urinary tract infections in a secondary care setting from 2005-2006 and 2010-2011, in São Paulo, Brazil: data from 11,943 urine cultures.
abstract: BACKGROUND
  Urinary tract infection (UTI) has a high incidence and recurrence, therefore, treatment is empirical in the majority of cases.
  
  
  OBJECTIVE
  The aim of this study was to analyze the urine cultures performed at a secondary hospital, during two periods, 2005-2006 and 2010-2011, and to estimate the microbial resistance.
  
  
  METHODS
  We analyzed 11,943 aerobic urine cultures according to basic demographic data and susceptibility to antibiotics in accordance with the Clinical and Laboratory Standards Institute (CLSI) for Vitek 1 and 2.
  
  
  RESULTS
  Most of our cohort consisted of young adult females that were seen at the Emergency Department. E. coli was the most frequent (70.2%) among the 75 species isolated. Resistance of all isolates was ≥ 20% for trimethoprim/sulfamethoxazole (TMP/SMX), norfloxacin, nitrofurantoin, cefazolin and nalidixic acid. Although E. coli was more susceptible (resistance ≥ 20% for TMP/SMX and nalidixic acid) among all of the isolates, when classified by the number and percentage of antibiotic resistance. Global resistance to fluoroquinolones was approximately 12%. Risk factors for E. coli were female gender and an age less than 65 years. Men and patients older than 65 years of age, presented more resistant isolates. Extended spectrum beta-lactamases (ESBL) were identified in 173 out of 5,722 Gram-negative isolates (3.0%) between 2010 and 2011.
  
  
  CONCLUSIONS
  E. coli was the most frequent microbe isolated in the urine cultures analyzed in this study. There was a significant evolution of bacterial resistance between the two periods studied. In particular, the rise of bacterial resistance to fluoroquinolones was concerning.
authors: Internal Medicine Division of the University Hospital of the University of São Paulo, University of São Paulo, Brazil.
authors: Erique José Peixoto de
authors: EJ
authors: Miranda
authors: Internal Medicine Division of the University Hospital of the University of São Paulo, University of São Paulo, Brazil.
authors: Gerson Sobrinho Salvador de
authors: GS
authors: Oliveira
authors: Internal Medicine Division of the University Hospital of the University of São Paulo, University of São Paulo, Brazil.
authors: Felício Lopes
authors: FL
authors: Roque
authors: Clinic Laboratory of the University Hospital of the University of São Paulo, University of São Paulo, Brazil.
authors: Sílvia Regina dos
authors: SR
authors: Santos
authors: Department of Internal Medicine, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Rodrigo Diaz
authors: RD
authors: Olmos
authors: Department of Internal Medicine, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Paulo Andrade
authors: PA
authors: Lotufo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D063127:Secondary Health Care; D014552:Urinary Tract Infections / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents