title: Evolution of the resistance to antibiotics of bacteria involved in urinary tract infections: a 7-year surveillance study.
abstract: BACKGROUND
  We conducted a retrospective analysis on the identification and antibiogram of all bacteria isolated from urine samples with microbiological confirmation of urinary tract infection (UTI) in a Spanish reference hospital over a 7-year period.
  
  
  METHODS
  A retrospective analysis was performed of the identification and antibiogram data.
  
  
  RESULTS
  A total of 31,758 uropathogens were isolated. Escherichia coli accounted for the majority (55.2%) of these, followed by Enterococcus faecalis (18.0%) and Klebsiella spp (10.3%). The highest E coli susceptibility rates were to imipenem (93.0%-99.8%), amikacin (97.3%-99.5%), nitrofurantoin (96.7%-98.9%), and fosfomycin (95.3%-100%), and the lowest were to cefuroxime (67.8%-86.4%), ciprofloxacin (61.2%-69.8%), and co-trimoxazole (55.0%-65.5%). We highlight the overall high activity of imipenem, piperacillin-tazobactam, nitrofurantoin, and fosfomycin on isolates versus the low activity of fluoroquinolones, co-trimoxazole, or cephalosporins. The activity of amoxicillin-clavulanic acid and fosfomycin decreased significantly over the 7-year study period.
  
  
  CONCLUSIONS
  Imipenem and piperacillin-tazobactam appear to be good options for the empiric treatment of UTI acquired in hospital or requiring hospitalization, whereas nitrofurantoin and fosfomycin can be first-choice antibiotics for the treatment of uncomplicated community-acquired cystitis. However, surveillance studies are required to detect resistance to these antibiotics, given that an increase in uropathogen resistance rates may contraindicate its future use in empiric UTI therapy.
authors.affiliation: Department of Microbiology, School of Medicine, University of Granada, Granada, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sorlozano
authors.affiliation: Department of Urology, Santa Ana Hospital, Motril, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Jimenez-Pacheco
authors.affiliation: Department of Statistics and Operation Research, University of Granada, Granada, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: de Dios Luna Del Castillo
authors.affiliation: Department of Microbiology, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sampedro
authors.affiliation: Department of Microbiology, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Martinez-Brocal
authors.affiliation: Department of Microbiology, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: Consuelo
authors.initials: C
authors.lastname: Miranda-Casas
authors.affiliation: Department of Microbiology, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Navarro-Marí
authors.affiliation: Department of Microbiology, School of Medicine, University of Granada, Granada, Spain; Department of Microbiology, Virgen de las Nieves University Hospital, Granada, Spain. Electronic address: josegf@ugr.es.
authors.forename: José
authors.initials: J
authors.lastname: Gutiérrez-Fernández
mesh_terms: D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D062665:Epidemiological Monitoring; D006761:Hospitals; D006801:Humans; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology*; D014556:Urine / Q000382:microbiology
keywords: Antibiotic susceptibility; Antimicrobial resistance; Infection control; Urine analysis