Escherichia coli antibiotic resistance in emergency departments. Do local resistance rates matter?

  • O. Grignon
  • E. Montassier
  • S. Corvec
  • D. Lepelletier
  • J.-B. Hardouin
  • J. Caillon
  • E. BatardEmail author
  • EDBAC Study Group


Ciprofloxacin and cotrimoxazole are recommended to treat uncomplicated pyelonephritis and uncomplicated cystitis, respectively, provided that local resistance rates of uropathogens do not exceed specified thresholds (10 and 20 %, respectively). However, Escherichia coli resistance rates in Emergency Departments (ED) remain poorly described. Our objectives were to assess E. coli ciprofloxacin and cotrimoxazole resistance rates in EDs of a French administrative region, and to determine if resistance rates differ between EDs. This was a retrospective study of E. coli urine isolates sampled in ten EDs between 2007 and 2012. The following risk factors for resistance were tested using logistic regression: ED, sex, age, sampling year, sampling month. A total of 17,527 isolates were included. Ciprofloxacin local resistance rates (range, 5.3 % [95 % CI, 4.0–7.1 %] to 11.7 % [95 % CI, 5.2–23.2 %]) were ≤10 % in nine EDs in 2012. Five EDs were risk factors for ciprofloxacin resistance, as were male sex, age and sampling in April or October. Cotrimoxazole local resistance rates (range, 13.3 % [95 % CI, 6.3–25.1 %] to 20.4 % [95 % CI, 18.9–22.0 %]) were ≤20 % in seven EDs in 2012. Five EDs were risk factors for cotrimoxazole resistance, as were age, sampling between October and December, and sampling in 2011 and 2012. We found a significant variability of E. coli ciprofloxacin and cotrimoxazole resistance rates among EDs of a small region. These differences impact on the feasibility of empirical treatment of urinary tract infections with ciprofloxacin or cotrimoxazole in a given ED. Continuous local survey of antibacterial resistance in ED urinary isolates is warranted to guide antibacterial therapy of urinary tract infections.


Emergency Department Moxifloxacin Resistance Rate Bacterial Resistance Antibacterial Therapy 
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Conflicts of interest

None to declare.

Supplementary material

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • O. Grignon
    • 1
  • E. Montassier
    • 1
    • 2
  • S. Corvec
    • 2
    • 3
  • D. Lepelletier
    • 2
    • 3
  • J.-B. Hardouin
    • 4
  • J. Caillon
    • 2
    • 3
  • E. Batard
    • 1
    • 2
    Email author
  • EDBAC Study Group
  1. 1.Emergency Department, Hôtel-DieuCentre Hospitalier Universitaire de NantesNantesFrance
  2. 2.EA3826 Thérapeutiques Cliniques et Expérimentales des Infections, Faculté de Médecine & PharmacieUniversité de NantesNantesFrance
  3. 3.Department of Microbiology and Infection Control, Hôtel-DieuCentre Hospitalier Universitaire de NantesNantesFrance
  4. 4.EA4275 SPHERE Biostatistics Pharmacoepidemiology and Human Science Research Team, Faculté de Médecine & PharmacieUniversité de NantesNantesFrance

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