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Antibiotic resistance in isolates recovered from women with community-acquired urinary tract infections presenting to a tertiary care emergency department

Published online by Cambridge University Press:  11 May 2015

Lyne Filiatrault ,
Rachel M. McKay ,
David M. Patrick ,
Diane L. Roscoe ,
Grahame Quan ,
Jeff Brubacher  and
Ken M. Collins
Lyne Filiatrault*
Affiliation:
Department of Emergency Medicine, School of Population and Public Health, Department of Pathology and Laboratory Medicine, and School of Medicine, University of British Columbia, Vancouver, BC Emergency Department and Division of Medical Microbiology and Infection Control, Vancouver General Hospital
Rachel M. McKay
Affiliation:
BC Centre for Disease Control, Vancouver, BC
David M. Patrick
Affiliation:
Department of Emergency Medicine, School of Population and Public Health, Department of Pathology and Laboratory Medicine, and School of Medicine, University of British Columbia, Vancouver, BC BC Centre for Disease Control, Vancouver, BC
Diane L. Roscoe
Affiliation:
Department of Emergency Medicine, School of Population and Public Health, Department of Pathology and Laboratory Medicine, and School of Medicine, University of British Columbia, Vancouver, BC Emergency Department and Division of Medical Microbiology and Infection Control, Vancouver General Hospital
Grahame Quan
Affiliation:
Department of Emergency Medicine, School of Population and Public Health, Department of Pathology and Laboratory Medicine, and School of Medicine, University of British Columbia, Vancouver, BC
Jeff Brubacher
Affiliation:
Department of Emergency Medicine, School of Population and Public Health, Department of Pathology and Laboratory Medicine, and School of Medicine, University of British Columbia, Vancouver, BC Emergency Department and Division of Medical Microbiology and Infection Control, Vancouver General Hospital
Ken M. Collins
Affiliation:
School of Medicine, Queen's University, Kingston, ON
*
VGH Emergency Department, 855 West 12th Avenue, Vancouver, BC V5Z IM9; filiatra@interchange.ubc.ca.

Abstract

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Introduction:

We sought to determine the antibiotic susceptibility of organisms causing community-acquired urinary tract infections (UTIs) in adult females attending an urban emergency department (ED) and to identify risk factors for antibiotic resistance.

Methods:

We reviewed the ED charts of all nonpregnant, nonlactating adult females with positive urine cultures for 2008 and recorded demographics, diagnosis, complicating factors, organism susceptibility, and risk factors for antibiotic resistance. Odds ratios (ORs) and 95% confidence intervals (CIs) for potential risk factors were calculated.

Results:

Our final sample comprised 327 UTIs: 218 were cystitis, of which 22 were complicated cases and 109 were pyelonephritis, including 22 complicated cases. Escherichia coli accounted for 82.3% of all UTIs, whereas Staphylococcus saprophyticus accounted for 5.2%. In uncomplicated cystitis, 9.5% of all isolates were resistant to ciprofloxacin and 24.0% to trimethoprim-sulfamethoxazole (TMP-SMX). In uncomplicated pyelonephritis, 19.5% of isolates were resistant to ciprofloxacin and 36.8% to TMP-SMX. In UTI (all types combined), any antibiotic use within the previous 3 months was a significant risk factor for resistance to both ciprofloxacin (OR 3.34, 95% CI 1.16–9.62) and TMP-SMX (OR 4.02, 95% CI 1.48–10.92). Being 65 years of age or older and having had a history of UTI in the previous year were risk factors only for ciprofloxacin resistance.

Conclusions:

E. coli was the predominant urinary pathogen in this series. Resistance to ciprofloxacin and TMP-SMX was high, highlighting the importance of relevant, local antibiograms. Any recent antibiotic use was a risk factor for both ciprofloxacin and TMP-SMX resistance in UTI. Our findings should be confirmed with a larger prospective study.

Keywords

antibiotic resistancecommunity acquiredrisk factorsurinary tract infection
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 14 , Issue 5 , September 2012 , pp. 295 - 305
Copyright
Copyright © Canadian Association of Emergency Physicians 2012

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