Antimicrobial resistance in community-acquired urinary tract infections in Paris in 2015

Abstract

BackgroundUrinary tract infection (UTI) is one of the most frequent community-acquired infection. Escherichia coli resistance has been on the rise since 2000s. MethodsWe conducted a prospective multicenter cohort study including adults who had a positive urine cytobacteriological examination (UCBE) performed in our Parisian suburb laboratory platform from October 2014 to March 2015. ResultsA total of 1223 patients were included: 995 (81.4%) women and 228 (18.6%) men. Gram-negative bacilli were isolated in 91% of cases: E. coli accounted for 69.4% of cases. Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) prevalence was 4.2%. Resistance of ESBL-producing E. coli strains to amoxicillin, fluoroquinolones, nitrofurantoin, and fosfomycin was respectively 100%, 80%, <5%, and <10%. Risk factors for bacteriuria caused by ESBL-PE were older age (OR=3.7 [1.99–14.4]; P=0.02), recurrent UTI (OR=3.7 [1.9–7.2]; P=0.05), immunosuppression (OR=9.2 [4.1–19.47]; P=0.01), recent hospitalization within the last three months (OR=4.5 [2.3–8.3]; P=0.05), and recent antibiotic therapy (OR=13.4 [6.29–31.9]; P<0.01). ConclusionThe prevalence of ESBL-PE bacteriuria seems to be 4%. Older age, immunosuppression, recurrent UTI, recent hospitalization, and antibiotic therapy are the main risk factors associated with ESBL-PE community-acquired UTI.