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Risk factors for fluoroquinolone-resistant Escherichia coli in adults with community-onset febrile urinary tract infection.
J Antimicrob Chemother. 2011 Mar; 66(3):650-6.JA

Abstract

OBJECTIVES

To assess risk factors for fluoroquinolone resistance in community-onset febrile Escherichia coli urinary tract infection (UTI).

METHODS

A nested case-control study within a cohort of consecutive adults with febrile UTI presenting at primary healthcare centres or emergency departments during January 2004 through December 2009. Resistance was defined using EUCAST criteria (ciprofloxacin MIC >1.0 mg/L). Cases were subjects with fluoroquinolone-resistant E. coli, and controls those with fluoroquinolone-susceptible isolates. Multivariable logistic regression analysis was used to identify potential risk factors for fluoroquinolone resistance.

RESULTS

Of 787 consecutive patients, 420 had E. coli-positive urine cultures. Of these, 51 (12%) were fluoroquinolone resistant. Independent risk factors for fluoroquinolone resistance were urinary catheter [odds ratio (OR) 3.1; 95% confidence interval (CI) 0.9-11.6], recent hospitalization (OR 2.0; 95% CI 1.0-4.3) and fluoroquinolone use in the past 6 months (OR 17.5; 95% CI 6.0-50.7). Environmental factors (e.g. contact with animals or hospitalized household members) were not associated with fluoroquinolone resistance. Of fluoroquinolone-resistant strains, 33% were resistant to amoxicillin/clavulanate and 65% to trimethoprim/sulfamethoxazole; 14% were extended-spectrum β-lactamase (ESBL) positive compared with <1% of fluoroquinolone-susceptible isolates.

CONCLUSIONS

Recent hospitalization, urinary catheter and fluoroquinolone use in the past 6 months were independent risk factors for fluoroquinolone resistance in community-onset febrile E. coli UTI. Contact with animals or hospitalized household members was not associated with fluoroquinolone resistance. Fluoroquinolone resistance may be a marker of broader resistance, including ESBL positivity.

Authors+Show Affiliations

Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21123286

Citation

van der Starre, Willize E., et al. "Risk Factors for Fluoroquinolone-resistant Escherichia Coli in Adults With Community-onset Febrile Urinary Tract Infection." The Journal of Antimicrobial Chemotherapy, vol. 66, no. 3, 2011, pp. 650-6.
van der Starre WE, van Nieuwkoop C, Paltansing S, et al. Risk factors for fluoroquinolone-resistant Escherichia coli in adults with community-onset febrile urinary tract infection. J Antimicrob Chemother. 2011;66(3):650-6.
van der Starre, W. E., van Nieuwkoop, C., Paltansing, S., van't Wout, J. W., Groeneveld, G. H., Becker, M. J., Koster, T., Wattel-Louis, G. H., Delfos, N. M., Ablij, H. C., Leyten, E. M., Blom, J. W., & van Dissel, J. T. (2011). Risk factors for fluoroquinolone-resistant Escherichia coli in adults with community-onset febrile urinary tract infection. The Journal of Antimicrobial Chemotherapy, 66(3), 650-6. https://doi.org/10.1093/jac/dkq465
van der Starre WE, et al. Risk Factors for Fluoroquinolone-resistant Escherichia Coli in Adults With Community-onset Febrile Urinary Tract Infection. J Antimicrob Chemother. 2011;66(3):650-6. PubMed PMID: 21123286.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors for fluoroquinolone-resistant Escherichia coli in adults with community-onset febrile urinary tract infection. AU - van der Starre,Willize E, AU - van Nieuwkoop,Cees, AU - Paltansing,Sunita, AU - van't Wout,Jan W, AU - Groeneveld,Geert H, AU - Becker,Martin J, AU - Koster,Ted, AU - Wattel-Louis,G Hanke, AU - Delfos,Nathalie M, AU - Ablij,Hans C, AU - Leyten,Eliane M S, AU - Blom,Jeanet W, AU - van Dissel,Jaap T, Y1 - 2010/12/01/ PY - 2010/12/3/entrez PY - 2010/12/3/pubmed PY - 2011/7/16/medline SP - 650 EP - 6 JF - The Journal of antimicrobial chemotherapy JO - J Antimicrob Chemother VL - 66 IS - 3 N2 - OBJECTIVES: To assess risk factors for fluoroquinolone resistance in community-onset febrile Escherichia coli urinary tract infection (UTI). METHODS: A nested case-control study within a cohort of consecutive adults with febrile UTI presenting at primary healthcare centres or emergency departments during January 2004 through December 2009. Resistance was defined using EUCAST criteria (ciprofloxacin MIC >1.0 mg/L). Cases were subjects with fluoroquinolone-resistant E. coli, and controls those with fluoroquinolone-susceptible isolates. Multivariable logistic regression analysis was used to identify potential risk factors for fluoroquinolone resistance. RESULTS: Of 787 consecutive patients, 420 had E. coli-positive urine cultures. Of these, 51 (12%) were fluoroquinolone resistant. Independent risk factors for fluoroquinolone resistance were urinary catheter [odds ratio (OR) 3.1; 95% confidence interval (CI) 0.9-11.6], recent hospitalization (OR 2.0; 95% CI 1.0-4.3) and fluoroquinolone use in the past 6 months (OR 17.5; 95% CI 6.0-50.7). Environmental factors (e.g. contact with animals or hospitalized household members) were not associated with fluoroquinolone resistance. Of fluoroquinolone-resistant strains, 33% were resistant to amoxicillin/clavulanate and 65% to trimethoprim/sulfamethoxazole; 14% were extended-spectrum β-lactamase (ESBL) positive compared with <1% of fluoroquinolone-susceptible isolates. CONCLUSIONS: Recent hospitalization, urinary catheter and fluoroquinolone use in the past 6 months were independent risk factors for fluoroquinolone resistance in community-onset febrile E. coli UTI. Contact with animals or hospitalized household members was not associated with fluoroquinolone resistance. Fluoroquinolone resistance may be a marker of broader resistance, including ESBL positivity. SN - 1460-2091 UR - https://www.unboundmedicine.com/medline/citation/21123286/Risk_factors_for_fluoroquinolone_resistant_Escherichia_coli_in_adults_with_community_onset_febrile_urinary_tract_infection_ L2 - https://academic.oup.com/jac/article-lookup/doi/10.1093/jac/dkq465 DB - PRIME DP - Unbound Medicine ER -