Risk factors for fluoroquinolone-resistant Escherichia coli in adults with community-onset febrile urinary tract infection

• Published in: Journal of antimicrobial chemotherapy Vol. 66; no. 3; pp. 650 - 656
• Main Authors: van der Starre, W. E., van Nieuwkoop, C., Paltansing, S., van't Wout, J. W., Groeneveld, G. H., Becker, M. J., Koster, T., Wattel-Louis, G. H., Delfos, N. M., Ablij, H. C., Leyten, E. M. S., Blom, J. W., van Dissel, J. T.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.03.2011; Oxford Publishing Limited (England)
• Subjects: Adult; Adults; Aged; Aged, 80 and over; Animals; Anti-Bacterial Agents - pharmacology; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacterial diseases; Bacterial diseases of the urinary system; Biological and medical sciences; Case-Control Studies; Cohort Studies; Community-Acquired Infections - microbiology; Drug resistance; Drug Resistance, Bacterial; E coli; Escherichia coli; Escherichia coli - drug effects; Escherichia coli - isolation & purification; Escherichia coli Infections - microbiology; Female; Fluoroquinolones - pharmacology; Hospitalization; Human bacterial diseases; Humans; Infectious diseases; Interstitial nephritis; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Pharmacology. Drug treatments; Risk Factors; Urinary system involvement in other diseases. Miscellaneous; Urinary tract diseases; Urinary Tract Infections - microbiology; Urinary tract. Prostate gland; Human; Kidney disease; Urinary system disease; Escherichia coli; ESBLs; Urinary tract disease; Epidemiology; Fever; Ascending pyelonephritis; Resistance; Antibiotic; Fluoroquinolone derivatives; Urinary tract infection; Age of onset; antibiotic resistance; Pyelonephritis; Risk factor; Bacteria; Adult; Antibacterial agent; Ciprofloxacin; Quinolone derivatives; Enterobacteriaceae
• ISSN: 0305-7453; 1460-2091; 1460-2091
• DOI: 10.1093/jac/dkq465

To assess risk factors for fluoroquinolone resistance in community-onset febrile Escherichia coli urinary tract infection (UTI). A nested case-control study within a cohort of consecutive adults with febrile UTI presenting at primary healthcare centres or emergency departments during January 2004 through December 2009. Resistance was defined using EUCAST criteria (ciprofloxacin MIC >1.0 mg/L). Cases were subjects with fluoroquinolone-resistant E. coli, and controls those with fluoroquinolone-susceptible isolates. Multivariable logistic regression analysis was used to identify potential risk factors for fluoroquinolone resistance. Of 787 consecutive patients, 420 had E. coli-positive urine cultures. Of these, 51 (12%) were fluoroquinolone resistant. Independent risk factors for fluoroquinolone resistance were urinary catheter [odds ratio (OR) 3.1; 95% confidence interval (CI) 0.9-11.6], recent hospitalization (OR 2.0; 95% CI 1.0-4.3) and fluoroquinolone use in the past 6 months (OR 17.5; 95% CI 6.0-50.7). Environmental factors (e.g. contact with animals or hospitalized household members) were not associated with fluoroquinolone resistance. Of fluoroquinolone-resistant strains, 33% were resistant to amoxicillin/clavulanate and 65% to trimethoprim/sulfamethoxazole; 14% were extended-spectrum β-lactamase (ESBL) positive compared with <1% of fluoroquinolone-susceptible isolates. Recent hospitalization, urinary catheter and fluoroquinolone use in the past 6 months were independent risk factors for fluoroquinolone resistance in community-onset febrile E. coli UTI. Contact with animals or hospitalized household members was not associated with fluoroquinolone resistance. Fluoroquinolone resistance may be a marker of broader resistance, including ESBL positivity.