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Detection of drug‐resistant Escherichia coli in patients with complicated cystitis: Analysis of risk factors
Author(s) -
Shigehara Kazuyoshi,
Uchibayashi Tadao,
Maeda Emi,
Namiki Mikio
Publication year - 2009
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/j.1442-2042.2009.02360.x
Subject(s) - medicine , odds ratio , cefotaxime , levofloxacin , escherichia coli , risk factor , confidence interval , antibiotics , urine , drug resistance , ciprofloxacin , microbiology and biotechnology , biology , biochemistry , gene
Objectives: To determine the prevalence and risk factors for isolation of drug‐resistant Escherichia coli ( E. coli) in patients with complicated cystitis. Methods: We analyzed 170 patients with complicated cystitis and urine culture was positive for E. coli in all of them. Detailed clinical features were identified and risk factors for isolation of drug‐resistant E. coli were determined. Results: The drug susceptibilities of 170 isolates to levofloxacin and cefotaxime or cefpirome were 77% and 96%, respectively. Fluoroquinolone‐resistant E. coli (FQR Ec ) was detected at least once in 39 patients. Prior use of fluoroquinolones within 1 month, between 1 and 3 months, and hospitalization were risk factors for FQR Ec infection ( P < 0.05), with odds ratios of 24 (95% confidence interval [CI] 6.4–89), 4.7 (95% CI 1.8–12), and 3.1 (95% CI 1.4–6.8), respectively. All six organisms resistant to cephems were extended‐spectrum beta‐lactamase (ESBL)‐producing E. coli . The isolation of ESBL‐producing E. coli tended to be more frequent in patients who were hospitalized ( P < 0.05), with an odds ratio of 7.9 (95% CI 1.4–45). There was no significant correlation between growth rate of ESBL‐producing E. coli and prior use of antibiotics. Conclusions: The frequencies of FQR Ec and ESBL‐producing E. coli were 23% and 4%, respectively. Prior use of fluoroquinolones within 3 months and hospitalization were risk factors for FQR Ec. Hospitalization was a risk factor for ESBL‐producing E. coli infection.