Trimethoprim and ciprofloxacin resistance and prescribing in urinary tract infection associated with Escherichia coli: A multilevel model - Abstract

OBJECTIVES:Individual and group level factors associated with the probability of antimicrobial resistance of uropathogenic Escherichia coli were analysed in a multilevel model.

METHODS:Adult patients consulting with a suspected urinary tract infection (UTI) in 22 general practices over a 9 month period supplied a urine sample for laboratory analysis. Cases were patients with a UTI associated with a resistant E. coli. Previous antimicrobial exposure and other patient characteristics were recorded from the medical files.

RESULTS:Six hundred and thirty-three patients with an E. coli UTI and a full record for all variables were included. Of the E. coli isolates, 36% were resistant to trimethoprim and 12% to ciprofloxacin. A multilevel logistic regression model was fitted. The odds that E. coli was resistant increased with increasing number of prescriptions over the previous year for trimethoprim from 1.4 (0.8-2.2) for one previous prescription to 4.7 (1.9-12.4) for two and 6.4 (2.0-25.4) for three or more. For ciprofloxacin the ORs were 2.7 (1.2-5.6) for one and 6.5 (2.9-14.8) for two or more. The probability that uropathogenic E. coli was resistant showed important variation between practices and a difference of 17% for trimethoprim and 33% for ciprofloxacin was observed for an imaginary patient moving from a practice with low to a practice with high probability. This difference could not be explained by practice prescribing or practice resistance levels.

CONCLUSIONS: Previous antimicrobial use and the practice visited affect the risk that a patient with a UTI will be diagnosed with an E. coli resistant to this agent, which was particularly important for ciprofloxacin.

Written by:
Vellinga A, Tansey S, Hanahoe B, Bennett K, Murphy AW, Cormican M.   Are you the author?
Discipline of Bacteriology, NUI Galway, Galway, Ireland.

Reference: J Antimicrob Chemother. 2012 Jun 22. Epub ahead of print.
doi: 10.1093/jac/dks222

PubMed Abstract
PMID: 22729920 Infections Section