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Kim, Kim, and Lim: The Ciprofloxacin Resistance Pattern of Escherichia coli Isolated from Female Patients with Community-acquired Urinary Tract Infection in the Jeonnam and Gwangju Region for the Recent 2-years
Original Article

Korean J Urol 2008;49(6):540-548.

Published online: 21 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.6.540

The Ciprofloxacin Resistance Pattern of Escherichia coli Isolated from Female Patients with Community-acquired Urinary Tract Infection in the Jeonnam and Gwangju Region for the Recent 2-years

Kyoung Young Kim, Chul Sung Kim, Dong Hoon Lim

Department of Urology, College of Medicine, Chosun University, Gwangju, Korea

Received 14 April 2008       Accepted 13 May 2008

Copyright © 2008 The Korean Urological Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The overuse of ciprofloxacin has recently increased the resistance of the Escherichia coli (E. coli). We studied the prevalence od the ciprofloxacin-resistant (CR) E. coli that were isolated from female patients with community-acquired urinary tract infection (CAUTI), and we demonstrated the resistant rate to other antibiotics to help physicians choose the suitable antibiotics to properly treat CAUTI.

Results

The incidence of UTI by E. coli increased with age (p＜0.001), and it was highest in the 7th decade (59.0%). One hundred seventeen (30.2%) patients showed ciprofloxacin resistance. It was significantly related to an increased age (p=0.034), complicated UTI (p=0.04) and a previous history of antibiotic use (p=0.023). Trimethoprim/sulfamethoxazole (TMP/SMX) and fosfomycin showed similar resistance rates like ciprofloxacin; 31.8 and 28.2%, respectively. On the other hand, nitrofurantoin showed a low resistant rate of 5.7%. The resistance to cephalosporin was low in general; the lowest was cefepime (5.9%).

Conclusions

Our results imply that the empirical use of ciprofloxacin for female patients with CAUTI is questionable, and especially for patients older than 40 years old, patients with complicated UTI and patients with a previous history of antibiotic use. Nitrofurantoin and cephalosporin can be useful agents for the treatment of female CAUTI.

Keywords: Ciprofloxacin, Antibiotics, Antibacterial drug resistance, Escherichia coli, Community-acquired infections

REFERENCES

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Fig. 1.
Age-specific incidence of the E. coli induced female CAUTI. CAUTI: community-acquired urinary tract infection.
kju-49-540f1.tif
Fig. 2.
Age-specific resistant rate to ciprofloxacin of the E. coli isolated from female patients with CAUTI. CAUTI: community-acquired urinary tract infection.
kju-49-540f2.tif
Fig. 3.
Disease-specific resistant rate to ciprofloxacin of the E. coli isolated from female patients with CAUTI. APN: acute pyelonephritis, CAUTI: community-acquired urinary tract infection.
kju-49-540f3.tif
Fig. 4.
Resistant rate of the E. coli isolated from female patients with CAUTI to the antibiotics recommended by the IDSA guidelines. TMP/SMX: trimethoprim/sulfamethoxazole, IDSA: infectious diseases society of America, CAUTI: community-acquired urinary tract infection.
kju-49-540f4.tif
Fig. 5.
Resistant rate to cephalosporin of the E. coli isolated from female patients with CAUTI. CAUTI: community-acquired urinary tract infection.
kju-49-540f5.tif
Fig. 6.
Resistant rate to cephalosporin and nitrofurantoin of the ciprofloxacin-resistant E. coli isolated from female patients with CAUTI. CAUTI: community-acquired urinary tract infection.
kju-49-540f6.tif
Fig. 7.
Resistant rate to ciprofloxacin of the cephalosporin-resistant and nitrofurantoin-resistant E. coli isolated from female patients with CAUTI. R: resistant, CAUTI: community-acquired urinary tract infection.
kju-49-540f7.tif
Table 1.
Age-specific distribution of the ciprofloxacin-sensitive E. coli and ciprofloxacin-resistant E. coli according to the disease causing the community-acquired urinary tract infection in females
Age Acute pyelonephritis Cystitis Asymptomatic bacteriuria etc Total
Sensitive (%) Resistant (%) Sensitive (%) Resistant (%) Sensitive (%) Resistant (%) Sensitive (%) Resistant (%)
0-19 3 (100) 0 (0) 11 (91.7) 1 (8.3) 12 (92.3) 1 (7.7) 0 (0) 0 (0) 28
20-29 12 (66.7) 6 (33.3) 6 (85.7) 1 (14.3) 4 (100) 0 (0) 4 (66.7) 2 (33.3) 35
30-39 6 (100) 0 (0) 4 (100) 0 (0) 2 (33.3) 4 (66.7) 4 (80) 1 (20) 21
40-49 10 (66.7) 5 (33.3) 6 (85.7) 1 (14.3) 7 (53.8) 6 (46.2) 7 (50) 7 (50) 49
50-59 16 (66.7) 8 (33.3) 3 (50) 3 (50) 12 (75) 4 (25) 9 (60) 6 (40) 61
60-69 12 (75) 4 (25) 8 (66.7) 4 (33.3) 16 (84.2) 3 (15.8) 15 (75) 5 (25) 67
70-79 17 (68) 8 (32) 7 (70) 3 (30) 21 (70) 9 (30) 15 (50) 15 (50) 95
80- 3 (75) 1 (25) 1 (33.3) 2 (66.7) 8 (66.7) 4 (33.3) 9 (75) 3 (25) 31
Total 79 (71.2) 32 (28.8) 46 (75.4) 15 (24.6) 82 (72.6) 31 (27.4) 63 (61.8) 39 (38.2) 387
Table 2.
Association of the previously (recent 1 year) used antibiotics with isolating ciprofloxacin-resistant E. coli
Previous antibiotics use (recent 1 year) CR E. coli CS E. coli Total
Yes (%) 63 (36.4) 110 (63.6) 173 (100)
No (%) 54 (25.2) 160 (74.8) 214 (100)
Total (%) 117 (30.2) 270 (69.8) 387 (100)

p-value=0.023, CR: ciprofloxacin-resistant, CS: ciprofloxacin-sensitive

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