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World J Urol (2013) 31:14271432 DOI 10.1007/s00345-013-1031-5
ORIGINAL ARTICLE
Increasing prevalence of ciprooxacin resistance in extended-spectrum-b-lactamase-producing
Escherichia coli urinary isolates
G. Bonkat G. Mller O. Braissant R. Frei S. Tschudin-Suter
M. Rieken S. Wyler T. C. Gasser A. Bachmann A. F. Widmer
Received: 8 October 2012 / Accepted: 20 January 2013 / Published online: 29 January 2013 Springer-Verlag Berlin Heidelberg 2013
AbstractPurpose To describe the incidence and drug susceptibility proles of uropathogenic extended-spectrum-b-lactamase-producing Escherichia coli (ESBL-EC) during a 10-year period and to identify differences in resistance patterns between urological and non-urological ESBL-EC isolates.
Methods Retrospective analysis of 191,564 urine samples obtained during 2001 to 2010 at the University Hospital Basel, Switzerland. The computerized database of the Clinical Microbiology Laboratory and the Division of Infectious Diseases and Hospital Epidemiology was used to identify ESBL-EC positive urine samples. ESBL-EC isolates were stratied according their origin into two groups: Urology and non-Urology isolates.
Results The rate of ESBL-EC positive urine samples increased signicantly during the study period (3 in 2001
compared to 55 in 2010, p \ 0.05). The most active agents were imipenem, meropenem, and fosfomycin (100 %), followed by amikacin (99.1 %) and nitrofurantoin (84 %). The least active substances were ampicillin-clavulanate (20 %), sulfamethoxazole (28 %), and ciprooxacin(29.6 %). ESBL-EC isolates from urological and nonurological patients showed similar susceptibility proles. However, ESBL-EC isolates from urological patients were signicantly less susceptible to ciprooxacin compared to non-urological isolates (14.7 vs. 32.7 %, p \ 0.05).
Conclusions The rate of urinary ESBL-EC isolates is increasing. Their susceptibility to nitrofurantoin, fosfomycin, and carbapenems is excellent, whereas ampicillinclavulanate, sulfamethoxazole, and ciprooxacin demonstrate only low susceptibility. In particular, the use of ciprooxacin should be strictly avoided in urologic patients with suspicion for an ESBL-EC urinary tract infection as well as routine antibiotic prophylaxis prior to urological interventions if not explicit indicated by current international guidelines or local resistance patterns.
Keywords Epidemiology ESBL Escherichia coli
Urinary tract infection Urology
Introduction
The microbial etiology of urinary tract infections (UTI) has been regarded as well-established and reasonably consistent over the past decades [1]. The majority of cases are caused by Escherichia coli (EC) that accounts for 7090 % of uncomplicated and 5060 % for recurrent or complicated cases [2, 3]. These infections received little...