1365 THE CHANGING PATTERN OF ANTIMICROBIAL RESISTANCE WITHIN 42033 ESCHERICHIA COLI ISOLATES FROM NOSOCOMIAL, COMMUNITY, AND UROLOGY PATIENT SPECIFIC URINARY TRACT INFECTIONS, DUBLIN 1999–2009

Abstract

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder1 Apr 20111365 THE CHANGING PATTERN OF ANTIMICROBIAL RESISTANCE WITHIN 42033 ESCHERICHIA COLI ISOLATES FROM NOSOCOMIAL, COMMUNITY, AND UROLOGY PATIENT SPECIFIC URINARY TRACT INFECTIONS, DUBLIN 1999–2009 Ivor Cullen, Rustom Manecksha, McCullagh Eddie, Ted McDermott, Robert Flynn, Philip Murphy, Ron Grainger, John Thornhill, and Jerome Fennell Ivor CullenIvor Cullen Dublin, Ireland More articles by this author , Rustom ManeckshaRustom Manecksha Dublin, Ireland More articles by this author , McCullagh EddieMcCullagh Eddie Dublin, Ireland More articles by this author , Ted McDermottTed McDermott Dublin, Ireland More articles by this author , Robert FlynnRobert Flynn Dublin, Ireland More articles by this author , Philip MurphyPhilip Murphy Dublin, Ireland More articles by this author , Ron GraingerRon Grainger Dublin, Ireland More articles by this author , John ThornhillJohn Thornhill Dublin, Ireland More articles by this author , and Jerome FennellJerome Fennell Dublin, Ireland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1189AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Escherichia coli (E.Coli) is the most common uropathogen in community and nosocomial urinary tract infection (UTI). Knowledge of local antimicrobial resistance patterns is essential for evidence based empirical antibiotic prescribing. A cut off point of 20% has been suggested as the level of resistance at which an agent should no longer be used empirically. Resistance rates vary depending on whether the sample represents a nosocomial, community acquired or urology patient specific UTI. METHODS A retrospective analysis of the 42033 E.Coli urine isolates from the eleven-year period 1999 to 2009 in a single Dublin teaching hospital was performed. WHONET™ software was used to analyse the changing pattern of sensitivity and resistance of E.Coli to commonly used antibiotics over the study period. The origins of the urine samples were stratified into three groups - inpatients with nosocomial UTIs, urines originating from the emergency department and general practice (community UTIs), and UTIs in urology patients. RESULTS Ampicillin and trimethoprim were the least active agents against E.Coli with total eleven-year resistance rates of 58.3% and 33.8% respectively. The overall gentamicin resistance rate was 3.4% and is climbing at a rate of 0.7% per year (p<0.0001). Within the urology sample population the rate of resistance was 6.4%. Significant trends of increasing resistance over the eleven-year period were identified for ampicillin, trimethoprim, gentamicin and ciprofloxacin. Significant differences were demonstrated in co-amoxyclav, gentamicin, nitrofurantion and ciprofloxacin resistance rates depending on the sample origin. Ciprofloxacin resistance approaches 20% in the nosocomial UTI population and approaches 30% in the urology population. It remains reasonable empirical antibiotic choice in this community with eleven-year resistance of 10.6%. UTIs in the urology patient population demonstrate higher antibiotic resistance rates than nosocomial or community UTIs. CONCLUSIONS E.coli remains the commonest infecting uropathogen in the community and hospital setting with its incidence climbing from 50% to 60% of UTIs over the eleven-year period. Penicillins and trimethoprim are unsuitable empirical antimicrobials for UTI. Ciprofloxacin resistance in this Dublin based study renders it unsuitable empirical therapy for nosocomial UTI and UTI in the urology population. The dramatic eleven-year rate increase in gentamicin resistance is of paramount concern. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e545 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ivor Cullen Dublin, Ireland More articles by this author Rustom Manecksha Dublin, Ireland More articles by this author McCullagh Eddie Dublin, Ireland More articles by this author Ted McDermott Dublin, Ireland More articles by this author Robert Flynn Dublin, Ireland More articles by this author Philip Murphy Dublin, Ireland More articles by this author Ron Grainger Dublin, Ireland More articles by this author John Thornhill Dublin, Ireland More articles by this author Jerome Fennell Dublin, Ireland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...