Abstract
BackgroundEscherichia coli is the commonest cause of community and nosocomial urinary tract infection (UTI). Antibiotic treatment is usually empirical relying on susceptibility data from local surveillance studies. We therefore set out to determine levels of resistance to 8 commonly used antimicrobial agents amongst all urinary isolates obtained over a 12 month period.MethodsAntimicrobial susceptibility to ampicillin, amoxicillin/clavulanate, cefalexin, ciprofloxacin, gentamicin, nitrofurantoin, trimethoprim and cefpodoxime was determined for 11,865 E. coli urinary isolates obtained from community and hospitalised patients in East London.ResultsNitrofurantoin was the most active agent (94% susceptible), followed by gentamicin and cefpodoxime. High rates of resistance to ampicillin (55%) and trimethoprim (40%), often in combination were observed in both sets of isolates. Although isolates exhibiting resistance to multiple drug classes were rare, resistance to cefpodoxime, indicative of Extended spectrum β-lactamase production, was observed in 5.7% of community and 21.6% of nosocomial isolates.ConclusionWith the exception of nitrofurantoin, resistance to agents commonly used as empirical oral treatments for UTI was extremely high. Levels of resistance to trimethoprim and ampicillin render them unsuitable for empirical use. Continued surveillance and investigation of other oral agents for treatment of UTI in the community is required.
Highlights
Escherichia coli is the commonest cause of community and nosocomial urinary tract infection (UTI)
In the UK, trimethoprim or nitrofurantoin are usually recommended for empirical treatment of episodes of uncomplicated cystitis in the community [1], whilst parenteral cephalosporins and aminoglycosides are reserved for complicated infections or pyelonephritis
Annals of Clinical Microbiology and Antimicrobials 2008, 7:13 http://www.ann-clinmicrob.com/content/7/1/13 (ESBL's) and others exhibiting quinolone resistance threatens the empirical use of both cephalosporins and ciprofloxacin [5] seriously limiting treatment regimens
Summary
Escherichia coli is the commonest cause of community and nosocomial urinary tract infection (UTI). We set out to determine levels of resistance to 8 commonly used antimicrobial agents amongst all urinary isolates obtained over a 12 month period. A UK study of the antimicrobial susceptibility of bacterial pathogens causing UTI in 1999 – 2000 showed high levels of resistance to trimethoprim, amoxicillin and oral cephalosporins [3] whilst a study of three collections of E. coli strains obtained from patients in East London in 1991, 1999 and 2004 showed rates of trimethoprim resistance of over 30% [4]. In order to determine current levels of resistance to antibiotics commonly used locally for empirical treatment, we reviewed susceptibility to ampicillin, amoxicillin/ clavaulanate, trimethoprim, nitrofurantoin, cefalexin, gentamicin, ciprofloxacin and cefpodoxime amongst all E. coli urinary isolates obtained in our laboratory over a 1 year period
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