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KMID : 0390320140240010023
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Chungbuk Medical Journal
2014 Volume.24 No. 1 p.23 ~ p.32
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Prediction for ciprofloxacin-resistant and extended spectrum-β-lactamase producing E.coli in patients with community acquired urinary tract infection
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Lee Sang-Keun
Lim Seung-Woon
Woo Sung-Il
Kim Wun-Jae
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Abstract
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PURPOSE: The overuse of ciprofloxacin has recently increased the resistance of the E. coli (Escherichia coli). We evaluate the antimicrobial susceptibility patterns and determinants for acquiring urinary tract
infections caused by ciprofloxacin-resistant and extended spectrum-β-lactamase producing E. coli.
MATERIAL and METHODS: Total 685 patients who had escherichia coli was isolated in urine cultures with more than 105 colony-forming units per ml were enrolled in this study from March 2009 to December 2011, To determine the risk factors for acquisition of urinary tract infections caused by ciprofloxacin-resistant and extended spectrum-β-lactamase producing E. coli, clinical and epidemiological data including patient age, gender, date of hospitalization, admission history (hospitalized for more than 3day), urine analysis, urine culture, blood culture and antimicrobial susceptibility patterns of E. coli isolated in urine cultures were evaluated. Patient with neurogenic bladder with CIC (clean intermittent
catheterization), a congenital urological anomaly were excluded from study. Multivariate analysis was
performed for detection of risk factors for ciprofloxacin-resistant or extended-spectrum beta-lactamase
positivity.
RESULTS: In 685 subjects, 595 were women and 90 were men and the mean age was 56.4 years (range 11-88 yrs). 209 (30.5%) patients have an admission history and 77 patients (11.2%) were accompanied by bacteremia. One hundred seventy five (25.2%) patients and 68 (9.9%) patients showed ciprofloxacin resistance and extended spectrum-β-lactamase producing E. coli, respectively. Regarding risk factors for ciprofloxacin resistant and extended spectrum-β-lactamase producing E. coli, old age, male gender, and the presence of admission history are the determinants related resistant strains (each P < 0.05). In multivariate logistic regression analysis for prediction of resistant strains, male gender and the presence of admission history were independent predictors of ciprofloxacin resistant (HR=2.147, 95% CI=1.343-3.432, P=0.001 and HR=1.833, 95% CI=1.246-2.696 P=0.002, respectively) and extended spectrum-β-lactamase producing E. coli (HR=2.443, 95% CI=1.329-4.489, P=0.004 and HR=2.889% CI=1.668-5.005 P<0.001, respectively).
CONCLUSIONS: Our study shows that male gender and previous admission history were independent predictors of ciprofloxacin resistant and extended spectrum-β-lactamase producing E .coli in community-acquired urinary tract infection.
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KEYWORD
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Urinary tract infection, antibacterial drug resistance, Escherichiacoli
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