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Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey.
J Antimicrob Chemother. 2005 Nov; 56(5):914-8.JA

Abstract

OBJECTIVES

To determine the risk factors for community-acquired ciprofloxacin-resistant Escherichia coli urinary tract infection (UTI).

METHODS

The study was performed with isolates from community-acquired UTIs collected from 15 centres representing six different geographic regions of Turkey. All microbiological procedures were carried out in a central laboratory. Multivariate analysis was performed for detection of risk factors for resistance. Use of quinolones more than once within the last year, living in a rural area, having a urinary catheter, age >50 and complicated infections were included in the model as variables and logistic regression was performed.

RESULTS

A total of 611 gram-negative isolates were studied: 321 were isolated from uncomplicated UTI and 290 were isolated from complicated UTI. E. coli was the causative agent in 90% of the uncomplicated UTIs and in 78% of the complicated UTIs (P < 0.001). Seventeen percent of E. coli strains isolated from uncomplicated cases and 38% of E. coli strains isolated from complicated UTI were found to be resistant to ciprofloxacin. In multivariate analysis, age over 50 [odds ratio (OR): 1.6; confidence interval (CI): 1.08-2.47; P = 0.020], ciprofloxacin use more than once in the last year (OR: 2.8; CI: 1.38-5.47; P = 0.004) and the presence of complicated UTI (OR: 2.4; CI: 1.54-3.61; P < 0.001) were found to be associated with ciprofloxacin resistance. Detection of strains of E. coli producing extended-spectrum beta-lactamase (ESBL) enzymes was two times more common in the patients who received ciprofloxacin than those who did not (15% versus 7.4%).

CONCLUSIONS

The increasing prevalence of infections caused by antibiotic-resistant bacteria makes the empirical treatment of UTIs more difficult. One of the important factors contributing to these high resistance rates might be high antibiotic use. Urine culture and antimicrobial susceptibility testing are essential in Turkey for patients with UTI who have risk factors for resistance, such as previous ciprofloxacin use. Fluoroquinolone-sparing agents such as nitrofurantoin and fosfomycin should be evaluated as alternative therapies by further clinical efficacy and safety studies.

Authors+Show Affiliations

Department of Clinical Microbiology and Infectious Disease, Baskent University Faculty of Medicine, Ankara, Turkey.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16174685

Citation

Arslan, Hande, et al. "Risk Factors for Ciprofloxacin Resistance Among Escherichia Coli Strains Isolated From Community-acquired Urinary Tract Infections in Turkey." The Journal of Antimicrobial Chemotherapy, vol. 56, no. 5, 2005, pp. 914-8.
Arslan H, Azap OK, Ergönül O, et al. 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.
Arslan, H., Azap, O. K., Ergönül, O., & Timurkaynak, F. (2005). Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey. The Journal of Antimicrobial Chemotherapy, 56(5), 914-8.
Arslan H, et al. 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. PubMed PMID: 16174685.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey. AU - Arslan,Hande, AU - Azap,Ozlem Kurt, AU - Ergönül,Onder, AU - Timurkaynak,Funda, AU - ,, Y1 - 2005/09/20/ PY - 2005/9/22/pubmed PY - 2006/3/1/medline PY - 2005/9/22/entrez SP - 914 EP - 8 JF - The Journal of antimicrobial chemotherapy JO - J Antimicrob Chemother VL - 56 IS - 5 N2 - OBJECTIVES: To determine the risk factors for community-acquired ciprofloxacin-resistant Escherichia coli urinary tract infection (UTI). METHODS: The study was performed with isolates from community-acquired UTIs collected from 15 centres representing six different geographic regions of Turkey. All microbiological procedures were carried out in a central laboratory. Multivariate analysis was performed for detection of risk factors for resistance. Use of quinolones more than once within the last year, living in a rural area, having a urinary catheter, age >50 and complicated infections were included in the model as variables and logistic regression was performed. RESULTS: A total of 611 gram-negative isolates were studied: 321 were isolated from uncomplicated UTI and 290 were isolated from complicated UTI. E. coli was the causative agent in 90% of the uncomplicated UTIs and in 78% of the complicated UTIs (P < 0.001). Seventeen percent of E. coli strains isolated from uncomplicated cases and 38% of E. coli strains isolated from complicated UTI were found to be resistant to ciprofloxacin. In multivariate analysis, age over 50 [odds ratio (OR): 1.6; confidence interval (CI): 1.08-2.47; P = 0.020], ciprofloxacin use more than once in the last year (OR: 2.8; CI: 1.38-5.47; P = 0.004) and the presence of complicated UTI (OR: 2.4; CI: 1.54-3.61; P < 0.001) were found to be associated with ciprofloxacin resistance. Detection of strains of E. coli producing extended-spectrum beta-lactamase (ESBL) enzymes was two times more common in the patients who received ciprofloxacin than those who did not (15% versus 7.4%). CONCLUSIONS: The increasing prevalence of infections caused by antibiotic-resistant bacteria makes the empirical treatment of UTIs more difficult. One of the important factors contributing to these high resistance rates might be high antibiotic use. Urine culture and antimicrobial susceptibility testing are essential in Turkey for patients with UTI who have risk factors for resistance, such as previous ciprofloxacin use. Fluoroquinolone-sparing agents such as nitrofurantoin and fosfomycin should be evaluated as alternative therapies by further clinical efficacy and safety studies. SN - 0305-7453 UR - https://www.unboundmedicine.com/medline/citation/16174685/Risk_factors_for_ciprofloxacin_resistance_among_Escherichia_coli_strains_isolated_from_community_acquired_urinary_tract_infections_in_Turkey_ L2 - https://academic.oup.com/jac/article-lookup/doi/10.1093/jac/dki344 DB - PRIME DP - Unbound Medicine ER -