Factors associated with ciprofloxacin- and cefotaxime-resistant Escherichia coli in women with acute pyelonephritis in the emergency department

Summary Background High rates of antimicrobial resistance in Escherichia coli isolated from patients with urinary tract infections have been reported worldwide. The aim of this study was to identify risk factors for resistance to ciprofloxacin (CIP) and cefotaxime (CTX) in E. coli isolated from pati...

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Bibliographic Details
Published in:International journal of infectious diseases 2014-06, Vol.23, p.8-13
Main Authors: Park, Kyung-Hwa, Oh, Won Sup, Kim, Eu Suk, Park, Sang Won, Hur, Ji-An, Kim, Young Keun, Moon, Chisook, Lee, Jae Hoon, Lee, Chang-Seop, Kim, Baek-Nam
Format: Article
Language:English
Subjects:
Acute Disease
Acute pyelonephritis
Aged
Anti-Bacterial Agents - therapeutic use
Cefotaxime
Cefotaxime - therapeutic use
Ciprofloxacin
Ciprofloxacin - therapeutic use
Drug Resistance, Multiple, Bacterial
Emergency Service, Hospital
Escherichia coli - drug effects
Escherichia coli - isolation & purification
Escherichia coli Infections - drug therapy
Escherichia coli Infections - epidemiology
Escherichia coli Infections - microbiology
Female
Fluoroquinolones - therapeutic use
Humans
Infectious Disease
Middle Aged
Multivariate Analysis
Prospective Studies
Pulmonary/Respiratory
Pyelonephritis - drug therapy
Pyelonephritis - epidemiology
Pyelonephritis - microbiology
Republic of Korea - epidemiology
Resistance
Urinary tract infection
UTI
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Summary:Summary Background High rates of antimicrobial resistance in Escherichia coli isolated from patients with urinary tract infections have been reported worldwide. The aim of this study was to identify risk factors for resistance to ciprofloxacin (CIP) and cefotaxime (CTX) in E. coli isolated from patients with acute pyelonephritis (APN). Methods We prospectively identified women over 18 y of age who visited the emergency department of one of 10 hospitals with APN and whose urine culture grew E. coli . The study was conducted from April 16 to June 10, 2012. Results Of the 229 patients identified, 173 (75.5%) had community-associated (CA) infections and 56 (24.5%) had healthcare-associated (HCA) infections. Sixty-seven isolates (29.3%) were resistant to CIP, 45 (19.7%) to CTX, and 29 (12.7%) to both CIP and CTX. Multivariate analyses revealed that hematologic disease, chronic kidney disease, a bed-ridden state, indwelling urinary catheter, antibiotic treatment in the preceding 3 months, and isolation of CIP-resistant E. coli in the urine within the preceding 3 months, were significantly associated with resistance to both CIP and CTX. Conclusions Chronic conditions and healthcare-associated factors were related to resistance to both fluoroquinolones and third-generation cephalosporins in women with APN. Continued and vigilant surveillance is necessary to monitor the dissemination of antimicrobial resistance in uropathogens.
ISSN:1201-9712
1878-3511
DOI:10.1016/j.ijid.2013.12.021