title: Antibiotic resistance patterns of Escherichia coli urinary isolates and comparison with antibiotic consumption data over 10 years, 2005-2014.
abstract: BACKGROUND
  Escherichia coli is a common cause of urinary tract infections (UTI). Reviews of antibiotic resistance of this organism can inform choice of empiric treatment of UTI and other infections and strategies for combating antimicrobial resistance. We reviewed laboratory and hospital pharmacy records to assess trends in non-susceptibility rates and the effect of antimicrobial stewardship interventions.
  
  
  METHODS
  A retrospective observational study of isolates of E. coli from MSU samples at a Dublin teaching hospital from inpatients and community, obtained from January 2005 to December 2014. Susceptibility to a panel of antibiotics was determined using the disc diffusion method, as well as extended-spectrum beta-lactamase (ESBL) production status. Trends in resistance were plotted graphically and analysed in a descriptive manner.
  
  
  RESULTS
  Except for nitrofurantoin and gentamicin, non-susceptibility increased for all antimicrobials tested. Co-amoxiclav non-susceptibility reached 48% in hospital and 32.6% in the community by 2014. Piperacillin-tazobactam non-susceptibility increased from 6.8 to 23.8% in hospital and from <1 to 12.5% in community, with similar increases for ESBL producing isolates. Ciprofloxacin non-susceptibility peaked at 25.5% in hospital in 2012 and 11.44% in the community in 2014.
  
  
  CONCLUSIONS
  Escherichia coli isolates from community MSU samples have high rates of non-susceptibility to trimethoprim and co-amoxiclav. Nitrofurantoin remains the best empiric therapy for cystitis. Increasing non-susceptibility to co-amoxiclav and piperacillin-tazobactam in hospital isolates is concerning. Ciprofloxacin non-susceptibility is increasing faster in the community than in hospital. A sharp reduction in hospital fluoroquinolone consumption did not result in a significant reduction in ciprofloxacin non-susceptibility of hospital E. coli isolates.
authors.affiliation: Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland. patstaps@gmail.com.
authors.forename: P J
authors.initials: PJ
authors.lastname: Stapleton
authors.affiliation: Department of Urology and Reconstructive Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: D J
authors.initials: DJ
authors.lastname: Lundon
authors.affiliation: Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: McWade
authors.affiliation: Department of Pharmacy, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: N
authors.initials: N
authors.lastname: Scanlon
authors.affiliation: Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: M M
authors.initials: MM
authors.lastname: Hannan
authors.affiliation: Department of Urology and Reconstructive Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: F
authors.initials: F
authors.lastname: O'Kelly
authors.affiliation: Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Lynch
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial / Q000276:immunology*; D004926:Escherichia coli / Q000187:drug effects*; D004927:Escherichia coli Infections / Q000188:drug therapy*; D005260:Female; D049674:History, 21st Century; D006801:Humans; D012189:Retrospective Studies; D013997:Time Factors; D014552:Urinary Tract Infections / Q000209:etiology* / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic consumption; Antibiotic resistance; E. coli; Epidemiology