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Journal of Clinical Microbiology, February 2001, p. 438-444, Vol. 39, No. 2
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.2.438-444.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Risk Factors for Antibiotic-Resistant Escherichia coli Isolated from Hospitalized Patients with Urinary Tract Infections: a Prospective Study

Albert Sotto,1,* Corinne Merle De Boever,1 Pascale Fabbro-Peray,2 Anne Gouby,3 Danielle Sirot,4 and Jacques Jourdan1

Laboratoire Universitaire de Thérapeutique, Service de Médecine Interne B, Hôpital Carémeau,1 and Département d'Information Médicale2 and Laboratoire de Microbiologie,3 Hôpital Gaston-Doumergue, 30029 Nîmes Cédex, and Laboratoire de Bactériologie, Faculté de Médecine, 63001 Clermont-Ferrand Cedex,4 France

Received 24 April 2000/Returned for modification 12 September 2000/Accepted 8 November 2000

From November 1998 to February 1999 we prospectively evaluated the prevalence of resistance to penicillins, cephalosporins, carbapenem, quinolones, aminoglycosides, and trimethoprim-sulfamethoxazole (SXT) in 320 Escherichia coli isolates isolated from hospitalized patients with acute urinary tract infections (UTIs). We also studied for these strains risk factors for resistance to amoxicillin-clavulanic acid (AMC), fluoroquinolones (FQs), and SXT. Resistance rates were consistent with those from major recent studies reported in the literature. Multivariate analyses selected the following factors as being significantly associated with E. coli resistance: (i) for resistance to AMC, prior (1 year) UTI (odds ratio [OR] = 2.71, P = 0.006), prior (1 year) urinary catheter (OR = 2.98, P = 0.0025), and prior (6 months) antibiotic exposure (OR = 2.68, P = 0.005); (ii) for resistance to FQs male sex (OR = 3.87, P = 0.03), with a trend toward significance for age >65 years (OR = 7.67, P = 0.06) and prior (1 year) UTI (OR = 2.98, P = 0.07); and (iii) for resistance to SXT, male sex (OR = 1.91, P = 0.046), hospitalization in an intermediate-term-care unit (OR = 2.18, P = 0.008), and prior (1 year) UTI (OR = 2.03, P = 0.03). Ours results suggest that prior UTI is a common risk factor for resistance to the different antibiotics tested. Although few studies on risk factors for E. coli resistance to antibiotics have been published, careful interpretation of their findings, taking into consideration the population, infection site, and period studied, should contribute to the formulation of a better strategy that can be used to overcome antibiotic resistance.

* Corresponding author. Mailing address: Laboratoire Universitaire de Thérapeutique, Service de Médecine Interne B, Hôpital Carémeau, rue du Professeur-Debré, 30029 Nîmes Cedex, France. Phone: 33-466-68-32-31. Fax: 33-466-68-38-24. E-mail: albert.sotto{at}chu-nimes.fr.

Journal of Clinical Microbiology, February 2001, p. 438-444, Vol. 39, No. 2
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.2.438-444.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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