Abstract
This study describes the antimicrobial resistance temporal trends and seasonal variation of Escherichia coli (E. coli) urinary tract infections (UTIs) over five years, from 2009 to 2013, and compares prevalence of resistance in hospital- and community-acquired E. coli UTI. A cross sectional study of E. coli UTIs from patients attending a tertiary referral hospital in Canberra, Australia was undertaken. Time series analysis was performed to illustrate resistance trends. Only the first positive E. coli UTI per patient per year was included in the analysis. A total of 15,022 positive cultures from 8724 patients were identified. Results are based on 5333 first E. coli UTIs, from 4732 patients, of which 84.2% were community-acquired. Five-year hospital and community resistance rates were highest for ampicillin (41.9%) and trimethoprim (20.7%). Resistance was lowest for meropenem (0.0%), nitrofurantoin (2.7%), piperacillin-tazobactam (2.9%) and ciprofloxacin (6.5%). Resistance to amoxycillin-clavulanate, cefazolin, gentamicin and piperacillin-tazobactam were significantly higher in hospital- compared to community-acquired UTIs (9.3% versus 6.2%; 15.4% versus 9.7%; 5.2% versus 3.7% and 5.2% versus 2.5%, respectively). Trend analysis showed significant increases in resistance over five years for amoxycillin-clavulanate, trimethoprim, ciprofloxacin, nitrofurantoin, trimethoprim-sulphamethoxazole, cefazolin, ceftriaxone and gentamicin (P<0.05, for all) with seasonal pattern observed for trimethoprim resistance (augmented Dickey-Fuller statistic = 4.136; P = 0.006). An association between ciprofloxacin resistance, cefazolin resistance and ceftriaxone resistance with older age was noted. Given the relatively high resistance rates for ampicillin and trimethoprim, these antimicrobials should be reconsidered for empirical treatment of UTIs in this patient population. Our findings have important implications for UTI treatment based on setting of acquisition.
Highlights
Urinary tract infections (UTIs) are predominantly bacterial infections affecting people both in the community and in hospitals [1]
The Australian Group on Antimicrobial Resistance (AGAR) which undertakes antimicrobial resistance (AMR) prevalence surveys within Australia noted a gradual rise in overall percentage of E. coli strains resistant to beta-lactam antibiotics and ciprofloxacin [7]
Measuring and comparing the levels of AMR in both hospital- and community-acquired UTIs is essential because effects of AMR are mainly felt in healthcare facilities, the greatest use of antimicrobials occurs in the community [12]
Summary
Urinary tract infections (UTIs) are predominantly bacterial infections affecting people both in the community and in hospitals [1]. In Australia, national data on UTI are unavailable but recent estimates from 82 hospitals and 17 aged care facilities reported a point prevalence of 1.4% and 1.5% respectively for healthcare associated UTIs [4]. In Switzerland, an analysis of urinary E. coli specimens obtained from a university hospital from 1997 to 2007 found an increasing trend in resistance to trimethoprim/sulfamethoxazole, ciprofloxacin and amoxycillin/clavulanic acid (from 17.4% to 21.3%, 1.8% to 15.9%, and 9.5% to 14.5%, respectively) [6]. The Australian Group on Antimicrobial Resistance (AGAR) which undertakes AMR prevalence surveys within Australia noted a gradual rise in overall percentage of E. coli strains resistant to beta-lactam antibiotics and ciprofloxacin [7]. Comparing resistance rates in hospitaland community-acquired UTIs may influence therapeutic recommendations for UTIs based on setting of acquisition
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