GUGLIELMO BJ, KILLGORE K, MARCH K; Interscience Conference on Antimicrobial Agents and Chemotherapy (43rd: 2003: Chicago, Ill.).

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2003 Sep 14-17; 43: abstract no. L-267.

University of California San Francisco, San Francisco, CA.

BACKGROUND: Recent studies have demonstrated an increase in the urinary isolation of quinolone-resistant E. coli. Risk factors for this organism in the community setting have not been evaluated. Identification of risk factors for community-acquired ciprofloxacin-resistant E. coli (CREC) urinary tract infection (UTI) would improve the selection of empiric treatment. The objective was to identify risk factors for CREC UTI. METHODS: A retrospective review of patient files at UCSF Medical Center (1/1-12/31/2001) was performed to identify patients with community UTI due to CREC. Patient demographics, prior antibiotic use, co-morbidities, urinary catheter use, previous surgery and/or hospitalization, urinalysis, symptoms, and urinary tract abnormalities were recorded. Utilizing a 2:1 ratio of controls to cases, patients with UTI due to ciprofloxacin-susceptible E. coli during the same time period were randomly selected as controls. RESULTS: Forty patients with CREC were included. Significant univariate risk factors for CREC included prior ciprofloxacin use, other quinolone use, other antibiotic use, self-catheterization, recurrent UTI and diabetes. Independent risk factors for CREC UTI (adjusted odds ratio [95% confidence interval]) were use of quinolones in the 4 weeks prior to the onset of urinary tract symptoms (30.35 [5.82-158.42]), and a history of recurrent UTI (8.13 [2.95-22.37]). Isolates of CREC were 95% susceptible to nitrofurantoin, 78% to cefazolin and 8% to trimethoprim-sulfamethoxazole. CONCLUSION: CREC is primarily associated with patients with recurrent UTI and those with prior experience with quinolones. For most other patients with community-acquired, uncomplicated UTI, quinolones continue to be appropriate empiric treatment. Patients with recurrent lower UTI and previous quinolone use should be empirically treated with nitrofurantoin or a cephalosporin.

Publication Types:

• Meeting Abstracts

Keywords:

• Anti-Bacterial Agents
• Ciprofloxacin
• Humans
• Nitrofurantoin
• Quinolones
• Risk Factors
• Trimethoprim-Sulfamethoxazole Combination
• Urinary Catheterization
• Urinary Tract Infections
• Urologic Diseases

Other ID:

• GWAIDS0026801

UI: 102266425

From Meeting Abstracts