Recent Antimicrobial Susceptibilities for Uropathogenic Escherichia coli in Patients with Community Acquired Urinary Tract Infections: A Multicenter Study

Woong Bin Kim; Kyu Hyoung Cho; Sang Wook Lee; Hee Jo Yang; Jong Hyun Yun; Kwang Woo Lee; Jun Mo Kim; Young Ho Kim; Youn Soo Jeon; Min Eui Kim

doi:10.14777/uti.2017.12.01.28

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Kim, Cho, Lee, Yang, Yun, Lee, Kim, Kim, Jeon, and Kim: Recent Antimicrobial Susceptibilities for Uropathogenic Escherichia coli in Patients with Community Acquired Urinary Tract Infections: A Multicenter Study

Original Article

Urogenit Tract Infect 2017;12(1):28-34.

Published online: 19 April 2017

DOI: https://doi.org/10.14777/uti.2017.12.01.28

Recent Antimicrobial Susceptibilities for Uropathogenic Escherichia coli in Patients with Community Acquired Urinary Tract Infections: A Multicenter Study

Woong Bin Kim, Kyu Hyoung Cho¹, Sang Wook Lee, Hee Jo Yang², Jong Hyun Yun¹, Kwang Woo Lee, Jun Mo Kim, Young Ho Kim, Youn Soo Jeon², Min Eui Kim

Department of Urology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,

¹Department of Urology, Soonchunhyang University Gumi Hospital, Soonchunhyang University College of Medicine, Gumi

²Department of Urology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea

Correspondence to: Young Ho Kim http://orcid.org/0000-0003-3959-0928 Department of Urology, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea Tel: +82-32-621-5463, Fax: +82-32-621-5018 E-mail: yhkuro@schmc.ac.kr

Received 4 November 2016 Revised 9 December 2016 Accepted 25 December 2016

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 aim of this study was to determine the prevalence and disease-specific antimicrobial susceptibility of Escherichia coli in urinary tract infections (UTIs).

Materials and Methods:

A total of 862 patients older than 18 years of age, who were diagnosed with UTI between January 2013 and December 2015, were included. The results of urine culture, prevalence of extended-spectrum beta lactamase (ESBL)-producing E. coli, and antimicrobial susceptibility by disease were also examined.

Results:

A total of 862 uropathogens were isolated. Among then, E. coli accounted for 756 (87.7%) isolates. The susceptibility rates of E. coli to the following antimicrobial agents were as follows: ampicillin 29.4%, cefazolin 70.5%, ceftazidime 75.1%, cefotaxime 75.0%, cefepime 76.2%, cefoxitin 88.8%, amoxicillin-clavulanic acid 63.6%, trimethoprim-sulfamethoxazole 60.6%, gentamicin 71.4%, ciprofloxacin 73.0%, piperacillin/tazobactam 93.9%, amikacin 99.2%, imipenem 99.1%, and ertapenem 99.3%. The frequency of ESBL-producing E. coli strains was 24.6%. The antimicrobial susceptibility of UTI varied by each disease, but without statistical significance.

Conclusions:

It is necessary to regularly examine the disease-specific resistance rates to determine the appropriate empiric antibiotic treatment, and the national antibiotic usage policies must be reorganized according to the data obtained from these studies.

Keywords: Escherichia coli, Anti-bacterial agents, Susceptibility, Urinary tract infections

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Table 1.

Demographic and epidemiological characteristics of 756 patients with Escherichia coli positive urinary tract infection

Characteristic	No. of patients (mean±SD; age, y)	Percentage (%)
Examined patients	756 (53.2±17.9)	100
Gender
Female	652 (52.6±21.7)	86.2
Male	104 (52.2±24.2)	13.8
Age group (y)
18-39	198 (30.4±5.7)	26.2
40-64	334 (52.0±6.5)	44.2
≥65	224 (75.2±6.8)	29.6
Region
Bucheon	274 (52.6±17.8)	36.2
Cheonan	289 (54.3±18.1)	38.2
Gumi	193 (52.4±17.8)	25.5
Year
2013	254 (54.2±18.0)	33.6
2014	246 (51.3±17.6)	32.5
2015	256 (53.9±18.1)	33.9

SD: standard deviation.

Table 2.

Microbial spectrum of patients with urinary tract infection

Isolated species	No. of isolates			Total (n=862)
Isolated species	2013	2014	2015	Total (n=862)
Escherichia coli	254	246	256	756 (87.7)
ESBL(+) E. coli	57	62	67	186/756 (24.6)
Klebsiella spp.	8	7	9	24 (2.8)
Enterococcus spp.	5	11	7	23 (2.7)
Enterococcus spp.	5	11	7	23 (2.7)
Proteus spp.	1	1	3	5 (0.6)
Pseudomonas spp.	0	2	1	3 (0.3)
Coagulase negative staphylococci	8	10	15	33 (3.8)
Group B Streptococcus	5	5	3	13 (1.5)
Others	2	1	1	4 (0.5)

Values are presented as number only or number (%).

ESBL: extended-spectrum beta lactamase, spp.: species.

Table 3.

Regional antimicrobial susceptibility of Escherichia coli in urinary tract infection

Antimicrobials	Susceptibility of E. coli
Antimicrobials	Bucheon (n=274)	Cheonan (n=289)	Gumi (n=193)	p-value	Total (n=756)
Ertapenem	273 (99.6)	287 (99.3)	191 (99.0)	0.676	751 (99.3)
Amikacin	272 (99.3)	288 (99.7)	190 (98.4)	0.338	750 (99.2)
Imipenem	273 (99.6)	287 (99.3)	189 (97.9)	0.144	749 (99.1)
Piperacillin/tazobactam	260 (94.9)	268 (92.7)	182 (94.3)	0.545	710 (93.9)
Cefoxitin	244 (89.1)	259 (89.6)	168 (87.0)	0.669	671 (88.8)
Cefepime	210 (76.6)	218 (75.4)	148 (76.7)	0.929	576 (76.2)
Ceftazidime	207 (75.5)	215 (74.4)	146 (75.6)	0.934	568 (75.1)
Cefotaxime	206 (75.2)	213 (73.7)	148 (76.7)	0.757	567 (75.0)
Ciprofloxacin	199 (72.6)	215 (74.4)	138 (71.5)	0.769	552 (73.0)
Gentamicin	195 (71.2)	209 (72.3)	136 (70.5)	0.901	540 (71.4)
Cefazolin	194 (70.8)	201 (69.6)	138 (71.5)	0.891	533 (70.5)
Amoxicillin/clavulanic acid	180 (65.7)	190 (65.7)	111 (57.5)	0.124	481 (63.6)
Trimethoprim/sulfamethoxazole	168 (61.3)	173 (59.9)	117 (60.6)	0.940	458 (60.6)
Ampicillin	80 (29.2)	82 (28.4)	60 (31.1)	0.812	222 (29.4)

Values are presented as number (%).

Table 4.

Disease-specific antimicrobial susceptibility of Escherichia coli in UTI

Antimicrobials	AC (n=401)	PN (n=251)	AP (n=56)	Epi (n=29)	Other UTI (n=19)	p-value	Total (n=756)
Ertapenem	400 (99.8)	250 (99.6)	55 (98.2)	28 (96.6)	18 (94.7)	0.118	751 (99.3)
Amikacin	399 (99.5)	248 (98.8)	56 (100)	29 (100)	18 (94.7)	0.727	750 (99.2)
Imipenem	399 (99.5)	248 (98.8)	55 (98.2)	29 (100)	18 (94.7)	0.028	749 (99.1)
PIP/TAZ	380 (94.8)	232 (92.4)	53 (94.6)	27 (93.1)	18 (94.7)	0.039	710 (93.9)
Cefoxitin	360 (89.8)	218 (86.9)	51 (91.1)	25 (86.2)	17 (89.5)	0.088	671 (88.8)
Cefepime	311 (77.6)	184 (73.3)	43 (76.8)	23 (79.3)	15 (78.9)	0.949	576 (76.2)
Ceftazidime	305 (76.1)	187 (74.5)	42 (75.0)	20 (69.0)	14 (73.7)	0.759	568 (75.1)
Cefotaxime	304 (75.8)	187 (74.5)	42 (75.0)	20 (69.0)	14 (73.7)	0.845	567 (75.0)
Ciprofloxacin	295 (73.6)	183 (72.9)	40 (71.4)	21 (72.4)	13 (68.4)	0.985	552 (73.0)
Gentamicin	290 (72.3)	179 (71.3)	38 (67.9)	21 (72.4)	12 (63.2)	0.780	540 (71.4)
Cefazolin	289 (72.1)	172 (68.5)	39 (69.6)	20 (69.0)	13 (68.4)	0.459	533 (70.5)
AMX/CLA	259 (64.6)	157 (62.5)	34 (60.7)	19 (65.5)	12 (63.2)	0.978	481 (63.6)
TMP/SMX	247 (61.6)	150 (59.8)	33 (58.9)	18 (62.1)	10 (52.6)	0.207	458 (60.6)
Ampicillin	122 (30.4)	68 (27.1)	16 (28.6)	10 (34.5)	6 (31.6)	0.988	222 (29.4)

Values are presented as number (%).

UTI: urinary tract infection, AC: acute cystitis, PN: acute pyelonephritis, AP: acute bacterial prostatitis, Epi: acute epididymitis, PIP/TAZ: piperacillin/tazobactam, AMX/CLA: amoxicillin/clavulanic acid, TMP/SMX: trimethoprim/sulfamethoxazole.

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