title: Vancomycin resistant enterococci in urine cultures: Antibiotic susceptibility trends over a decade at a tertiary hospital in the United Kingdom.
abstract: OBJECTIVE
  Enterococci are a common cause of urinary tract infection and vancomycin-resistant strains are more difficult to treat. The purpose of this surveillance program was to assess the prevalence of and determine the risk factors for vancomycin resistance in adults among urinary isolates of Enterococcus sp. and to detail the antibiotic susceptibility profile, which can be used to guide empirical treatment.
  
  
  METHODS
  From 2005 to 2014 we retrospectively reviewed 5,528 positive Enterococcus sp. urine cultures recorded in a computerized laboratory results database at a tertiary teaching hospital in Cambridge, United Kingdom.
  
  
  RESULTS
  Of these cultures, 542 (9.8%) were vancomycin resistant. No longitudinal trend was observed in the proportion of vancomycin-resistant strains over the course of the study. We observed emerging resistance to nitrofurantoin with rates climbing from near zero to 40%. Ampicillin resistance fluctuated between 50% and 90%. Low resistance was observed for linezolid and quinupristin/dalfopristin. Female sex and inpatient status were identified as risk factors for vancomycin resistance.
  
  
  CONCLUSIONS
  The incidence of vancomycin resistance among urinary isolates was stable over the last decade. Although resistance to nitrofurantoin has increased, it still serves as an appropriate first choice in uncomplicated urinary tract infection caused by vancomycin-resistant Enterococcus sp.
authors.affiliation: Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia.
authors.forename: Liam
authors.initials: L
authors.lastname: Toner
authors.affiliation: Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Papa
authors.affiliation: Department of Microbiology, Addenbrookes' Hospital, Cambridge University, Cambridge, UK.
authors.forename: Sani H
authors.initials: SH
authors.lastname: Aliyu
authors.affiliation: Department of Urology, Addenbrookes' Hospital, Cambridge University, Cambridge, UK.
authors.forename: Harveer
authors.initials: H
authors.lastname: Dev
authors.affiliation: Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia.; Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia.; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Lawrentschuk
authors.affiliation: Department of Urology, Addenbrookes' Hospital, Cambridge University, Cambridge, UK.
authors.forename: Samih
authors.initials: S
authors.lastname: Al-Hayek
mesh_terms: D000368:Aged; D024881:Drug Resistance, Bacterial; D004739:England; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology*; D020713:Vancomycin Resistance; D065507:Vancomycin-Resistant Enterococci / Q000187:drug effects / Q000302:isolation & purification*
keywords: Antibiotic prophylaxis; Enterococcus; Microbial drug resistance; Urinary tract infection; Vancomycin-resistant enterococci