Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 140 No. 2728 (2010)

Risk factors for urinary tract infections due to ciprofloxacin-resistant Escherichia coli in a tertiary care urology department in Switzerland

  • J Nicoletti
  • S Kuster
  • T Sulser
  • B Ledergerber
DOI
https://doi.org/10.4414/smw.2010.13059
Cite this as:
Swiss Med Wkly. 2010;140:w13059
Published
05.07.2010

Summary

Questions under study: Monitoring of antimicrobial resistance is a key component of antibiotic stewardship programs. In 2007, a significantly higher resistance rate of Escherichia coli to ciprofloxacin was found at the Department of Urology, University Hospital Zurich, Switzerland, when compared to other hospital units. Thus, we aimed to determine the risk factors for this increased fluoroquinolone resistance in outpatients and inpatients with urinary tract infection (UTI) or colonisation with E. coli.

Methods: We performed a cross sectional study including 275 patients of the Department of Urology in whom E. coli was isolated from urine or blood cultures between 01.01.2006 and 31.08.2007. Clinical data were collected from patients’ records using a structured questionnaire. Multivariable analysis was performed for the detection of risk factors.

Results:Ciprofloxacin-resistant E. coli was detected in 22% of patients. Risk factors for ciprofloxacin-resistant E. coli included prior use of fluoroquinolones (odds ratio [OR] (95% confidence intervals): 2.24 (1.08–4.62), p= 0.030), prior urinary tract catheterisation (OR: 2.41 (1.02–5.67), p= 0.044) and recurrent UTIs (OR: 2.26 (1.07–4.78), p= 0.032). 60.8% of all prescriptions in urinary tract infections were for fluoroquinolones, and this antibiotic class was the empiric antibiotic regimen of choice in 72.5% of all acute, uncomplicated, urinary tract infections.

Conclusions: The increasing prevalence of ciprofloxacin-resistant E. coli makes empiric therapy in UTIs with this agent questionable, especially in patients with one or several of the above mentioned risk factors. Due to the increasing resistance rate, continuous surveillance and susceptibility testing in individual patients, particularly with complicated UTIs, is indispensable for adequate therapy.

References

  1. Foxman B, Brown P. Epidemiology of urinary tract infections: transmission and risk factors, incidence, and costs. Infect Dis Clin North Am. 2003;17(2):227–41.
  2. Gupta K, Hooton TM, Stamm WE. Increasing antimicrobial resistance and the management of uncomplicated community-acquired urinary tract infections. Ann Intern Med. 2001;135(1):41–50.
  3. Naber KG. Survey on antibiotic usage in the treatment of urinary tract infections. J Antimicrob Chemother. 2000;46(Suppl A):49–52.
  4. Cars O, Molstad S, Melander A. Variation in antibiotic use in the European Union. Lancet. 2001;357(9271):1851–3.
  5. Ena J, Lopez-Perezagua MM, Martinez-Peinado C, Cia-Barrio MA, Ruiz-Lopez I. Emergence of ciprofloxacin resistance in Escherichia coli isolates after widespread use of fluoroquinolones. Diagn Microbiol Infect Dis. 1998;30(2):103–7.
  6. Goossens H, Ferech M, Vander Stichele R, Elseviers M. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365(9459):579–87.
  7. Kahlmeter G. An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project. J Antimicrob Chemother. 2003;51(1):69–76.
  8. Kresken M, Hafner D, Mittermayer H, Verbist L, Bergogne-Berezin E, Giamarellou H, et al. Prevalence of fluoroquinolone resistance in Europe. Study Group “Bacterial Resistance” of the Paul-Ehrlich-Society for Chemotherapy e. V. Infection. 1994;22(Suppl 2):S90–8.
  9. Alos JI, Serrano MG, Gomez-Garces JL, Perianes J. Antibiotic resistance of Escherichia coli from community-acquired urinary tract infections in relation to demographic and clinical data. Clin Microbiol Infect. 2005;11(3):199–203.
  10. Arslan H, Azap OK, Ergonul O, Timurkaynak F. Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey. J Antimicrob Chemother. 2005;56(5):914–8.
  11. Ena J, Amador C, Martinez C, Ortiz de la Tabla V. Risk factors for acquisition of urinary tract infections caused by ciprofloxacin resistant Escherichia coli. J Urol. 1995;153(1):117–20.
  12. Killgore KM, March KL, Guglielmo BJ. Risk factors for community-acquired ciprofloxacin-resistant Escherichia coli urinary tract infection. Ann Pharmacother. 2004;38(7-8):1148–52.
  13. Sotto A, De Boever CM, Fabbro-Peray P, Gouby A, Sirot D, Jourdan J. Risk factors for antibiotic-resistant Escherichia coli isolated from hospitalized patients with urinary tract infections: a prospective study. J Clin Microbiol. 2001;39(2):438–44.
  14. Kuster SP, Ruef C, Zbinden R, Gottschalk J, Ledergerber B, Neuber L, et al. Stratification of cumulative antibiograms in hospitals for hospital unit, specimen type, isolate sequence and duration of hospital stay. J Antimicrob Chemother. 2008;62(6):1451–61.
  15. Clarddige JE, Johnson JR, Pezzlo M. Laboratory diagnosis of urinary tract infections. Cumitech 3B. American Society for Microbiology, Washington, D.C. Cumitech 3B American Society for Microbiology, Washington, DC. 1998.
  16. Clinical and Laboratory Standards Institute. 2008. Performance Standards for Antimicrobial Susceptibility Testing; Eigtheenth Informational Supplement 100-S18. Clinical and Laboratory Standards Instiute, Wayne, PA, USA.
  17. McGregor JC, Kim PW, Perencevich EN, Bradham DD, Furuno JP, Kaye KS, et al. Utility of the Chronic Disease Score and Charlson Comorbidity Index as comorbidity measures for use in epidemiologic studies of antibiotic-resistant organisms. Am J Epidemiol. 2005;161(5):483-93.
  18. Ti TY, Kumarasinghe G, Taylor MB, Tan SL, Ee A, Chua C, et al. What is true community-acquired urinary tract infection? Comparison of pathogens identified in urine from routine outpatient specimens and from community clinics in a prospective study. Eur J Clin Microbiol Infect Dis. 2003;22(4):242–5.
  19. Richards DA, Toop LJ, Chambers ST, Sutherland MG, Harris BH, Ikram RB, et al. Antibiotic resistance in uncomplicated urinary tract infection: problems with interpreting cumulative resistance rates from local community laboratories. N Z Med J. 2002;115(1146):12–4.
  20. van Hees BC, de Ruiter E, Wiltink EH, de Jongh BM, Tersmette M. Optimizing use of ciprofloxacin: a prospective intervention study. J Antimicrob Chemother. 2008;61(1):210–3.
  21. Feucht CL, Rice LB. An interventional program to improve antibiotic use. Harvey Whitney Books; 2003. p. 646–51.
  22. Kahlmeter G, Menday P, Cars O. Non-hospital antimicrobial usage and resistance in community-acquired Escherichia coli urinary tract infection. J Antimicrob Chemother. 2003;52(6):1005–10.
  23. Goettsch W, van Pelt W, Nagelkerke N, Hendrix MG, Buiting AG, Petit PL, et al. Increasing resistance to fluoroquinolones in escherichia coli from urinary tract infections in the netherlands. J Antimicrob Chemother. 2000;46(2):223–8.
  24. Gagliotti C, Nobilio L, Moro ML. Emergence of ciprofloxacin resistance in Escherichia coli isolates from outpatient urine samples. Clin Microbiol Infect. 2007;13(3):328–31.
  25. Filippini M, Masiero G, Moschetti K. Socioeconomic determinants of regional differences in outpatient antibiotic consumption: evidence from Switzerland. Health Policy. 2006;78(1):77–92.
  26. anresis.ch – Sentinel Surveillance of Antibiotic Resistance in Switzerland [Internet]. University of Bern. c2005 – [cited 2009 Oct 10]. Available from: http://www.search.ifik.unibe.ch.
  27. Baquero F. Resistance to quinolones in gram-negative microorganisms: mechanisms and prevention. Eur Urol. 1990;17(Suppl 1):3–12.
  28. Vila J, Ruiz J, Marco F, Barcelo A, Goni P, Giralt E, et al. Association between double mutation in gyrA gene of ciprofloxacin-resistant clinical isolates of Escherichia coli and MICs. Antimicrob Agents Chemother. 1994;38(10):2477–9.
  29. Komp Lindgren P, Karlsson A, Hughes D. Mutation rate and evolution of fluoroquinolone resistance in Escherichia coli isolates from patients with urinary tract infections. Antimicrob Agents Chemother. 2003;47(10):3222–32.