Antibiotic resistance patterns of Escherichia coli urinary isolates and comparison with antibiotic consumption data over 10 years, 2005–2014
- 532 Downloads
Escherichia coli is a common cause of urinary tract infections (UTI). Reviews of antibiotic resistance of this organism can inform choice of empiric treatment of UTI and other infections and strategies for combating antimicrobial resistance. We reviewed laboratory and hospital pharmacy records to assess trends in non-susceptibility rates and the effect of antimicrobial stewardship interventions.
A retrospective observational study of isolates of E. coli from MSU samples at a Dublin teaching hospital from inpatients and community, obtained from January 2005 to December 2014. Susceptibility to a panel of antibiotics was determined using the disc diffusion method, as well as extended-spectrum beta-lactamase (ESBL) production status. Trends in resistance were plotted graphically and analysed in a descriptive manner.
Except for nitrofurantoin and gentamicin, non-susceptibility increased for all antimicrobials tested. Co-amoxiclav non-susceptibility reached 48% in hospital and 32.6% in the community by 2014. Piperacillin–tazobactam non-susceptibility increased from 6.8 to 23.8% in hospital and from <1 to 12.5% in community, with similar increases for ESBL producing isolates. Ciprofloxacin non-susceptibility peaked at 25.5% in hospital in 2012 and 11.44% in the community in 2014.
Escherichia coli isolates from community MSU samples have high rates of non-susceptibility to trimethoprim and co-amoxiclav. Nitrofurantoin remains the best empiric therapy for cystitis. Increasing non-susceptibility to co-amoxiclav and piperacillin–tazobactam in hospital isolates is concerning. Ciprofloxacin non-susceptibility is increasing faster in the community than in hospital. A sharp reduction in hospital fluoroquinolone consumption did not result in a significant reduction in ciprofloxacin non-susceptibility of hospital E. coli isolates.
KeywordsAntibiotic resistance Antibiotic consumption E. coli Epidemiology
Compliance with ethical standards
Conflicts of interest
DL: No conflicts of interest to declare. PS: No conflict of interest to declare. RW: No conflict of interest to declare. NS: No conflict of interest to declare. MH: No conflict of interest to declare. FO’K: No conflict of interest to declare. ML: No conflict of interest to declare.
Research involving human participants and/or animals
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
For this type of study, formal consent is not required.
- 2.European Centre for Disease Prevention and Control, Antimicrobial resistance surveillance in Europe (2012) Annual report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). European Centre for Disease Prevention and Contro, StockholmGoogle Scholar
- 6.Lawes T, Lopez-Lozano J-M, Nebot CA et al (2015) Effects of national antibiotic stewardship and infection control strategies on hospital-associated and community-associated meticillin-resistant Staphylococcus aureus infections across a region of Scotland: a non-linear time-series study. Lancet Infect Dis 15:1438–1449. doi: 10.1016/S1473-3099(15)00315-1 CrossRefPubMedGoogle Scholar
- 9.CLSI (2012) Performance Standards for Antimicrobial Disk Susceptibility Tests, Approved Standard–Eleventh Edition. CLSI Document M02–A11. Clinical and Laboratory Standards Institute, WayneGoogle Scholar
- 10.CLSI (2012) Performance Standard for Antimicrobial Disk Susceptibility Testing. Twenty-Second Informational supplement. CLSI document No. M100-S2 CLSI. Clinical and Laboratory Standards InstituteGoogle Scholar
- 12.O'Neill J. Review on antimicrobial resistance. December 2014. http://amr-review.org/
- 14.Gupta K, Hooton TM, Naber KG et al (2011) International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 52:e103–e120. doi: 10.1093/cid/ciq257 CrossRefPubMedGoogle Scholar
- 16.Cullen IM, Manecksha RP, McCullagh E et al (2013) An 11-year analysis of the prevalent uropathogens and the changing pattern of Escherichia coli antibiotic resistance in 38,530 community urinary tract infections, Dublin 1999-2009. Ir J Med Sci 182:81–89. doi: 10.1007/s11845-012-0834-5 CrossRefPubMedGoogle Scholar
- 21.Cullen IM, Manecksha RP, McCullagh E et al (2012) The changing pattern of antimicrobial resistance within 42°033 Escherichia coli isolates from nosocomial, community and urology patient-specific urinary tract infections, Dublin, 1999–2009. BJU Int 109:1198–1206. doi: 10.1111/j.1464-410X.2011.10528.x CrossRefPubMedGoogle Scholar
- 24.Health Protection and Surveillance Centre (2014) European Antimicrobial Resistance Surveillance Network (EARS-Net) Report Quarters 1–4. http://www.hpsc.ie/A-Z/MicrobiologyAntimicrobialResistance/EuropeanAntimicrobialResistanceSurveillanceSystemEARSS/EARSSSurveillanceReports/2014Reports/File,14686,en.pdf. Accessed 12 Oct 2015