title: Escherichia coli antimicrobial susceptibility profile and cumulative antibiogram to guide empirical treatment of uncomplicated urinary tract infections in women in the province of Québec, 2010-15.
abstract: Empirical treatment of uncomplicated urinary tract infections (UTIs) in women should be based on local susceptibility data. We aimed to generate regional and provincial cumulative antibiograms combining data from different laboratory information systems and determine the impact of basic patient characteristics on susceptibility results.
  
  
  
  All positive urine samples for Escherichia coli obtained from women aged 18-65 years old in outpatient settings between 1 April 2010 and 31 March 2015 from four hospitals in Quebec, Canada, were included. The cumulative antibiogram for ciprofloxacin, nitrofurantoin and trimethoprim/sulfamethoxazole was calculated. A clinically significant difference in susceptibility profile was defined as factor(s) that lowered the susceptibility proportion below 80%.
  
  
  
  A total of 36 293 positive urine cultures were analysed. In the last year of the study, the proportion of susceptibility for ciprofloxacin, nitrofurantoin and trimethoprim/sulfamethoxazole was 90.3%, 95.4% and 81.9%, respectively. The susceptibility proportion was <80% for trimethoprim/sulfamethoxazole in the Montreal region (73.4%; 95% CI 71.1%-75.9%), whereas it remained >80% for the other regions. A significant decrease in susceptibility with time was identified for ciprofloxacin (92.1%-90.3%, P < 0.001) and nitrofurantoin (97.1%-95.4%, P < 0.001). Increasing age, recent hospitalization and site of collection were associated with an increase in resistance for certain antibiotics.
  
  
  
  Overall, all first-line antimicrobials remain acceptable choices for empirical treatment of uncomplicated UTIs in women in Quebec. The regional variability in susceptibility data within a single province emphasizes the importance of local susceptibility data to inform the development of empirical treatment guidelines for UTIs.
authors: Research Institute, McGill University Health Centre, McGill University, 1001 Boulevard Décarie, Montréal, Québec H4A 3J1, Canada.
authors: Gaelle
authors: G
authors: Delisle
authors: Research Institute, McGill University Health Centre, McGill University, 1001 Boulevard Décarie, Montréal, Québec H4A 3J1, Canada.|Epidemiology, Biostatistics & Occupational Health, McGill University, 1001 Boulevard Décarie, Montréal, Québec H4A 3J1, Canada.
authors: Caroline
authors: C
authors: Quach
authors: Institut national de santé publique du Québec, 20045 Chemin Ste-Marie, Sainte-Anne-de-Bellevue, Québec H9X 3R5, Canada.|Département de microbiologie-infectiologie et d'immunologie, Université Laval, 2325 Rue de l'Université, Ville de Québec, Québec G1V 0A6, Canada.
authors: Marc-Christian
authors: MC
authors: Domingo
authors: Département de microbiologie-infectiologie et d'immunologie, Université Laval, 2325 Rue de l'Université, Ville de Québec, Québec G1V 0A6, Canada.|CHU de Québec, Université Laval, 11 Côte du Palais, Ville de Québec, Québec G1R 2J6, Canada.
authors: Alexandre A
authors: AA
authors: Boudreault
authors: Département de microbiologie-infectiologie et d'immunologie, Université Laval, 2325 Rue de l'Université, Ville de Québec, Québec G1V 0A6, Canada.|CHU de Québec, Université Laval, 11 Côte du Palais, Ville de Québec, Québec G1R 2J6, Canada.
authors: Marie
authors: M
authors: Gourdeau
authors: CISSS Bas-St-Laurent, 150 Avenue Rouleau, Rimouski, Québec G5L 5T1, Canada.
authors: Harold
authors: H
authors: Bernatchez
authors: CIUSSS de l'Est-de-l'Île-de-Montréal, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec H1T 2M4, Canada christian.lavallee@umontreal.ca.
authors: Christian
authors: C
authors: Lavallée
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000494:pharmacology / Q000627:therapeutic use; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009582:Nitrofurantoin / Q000494:pharmacology / Q000627:therapeutic use; D010045:Outpatients; D011792:Quebec / Q000453:epidemiology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology / Q000627:therapeutic use; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology*; D014556:Urine / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D009582:Nitrofurantoin