Prevalence and risk factors for trimethoprim-sulfamethoxazole-resistant Escherichia coli among women with acute uncomplicated urinary tract infection in a developing country - Abstract

BACKGROUND: Prospective studies from developing countries that have investigated risk factors for trimethoprim-sulfamethoxazole (TMP-SMX)-resistant Escherichia coli in women with uncomplicated urinary tract infection (UTI) remain scarce.

METHODS: Women with acute uncomplicated UTI were enrolled prospectively. Urine was sent for antimicrobial susceptibility testing. Logistic regression analysis was used to identify risk factors for TMP-SMX resistance.

RESULTS: Of 405 participants, 229 (56.5%) had bacteriuria (mean age 31.9±9.5 years). In the previous 12 months, 77 (33.6%) had experienced at least one UTI episode and 106 (46.3%) reported antimicrobial use. The most common uropathogens were E. coli (75.8%) and Staphylococcus saprophyticus (8.9%). For the 179 E. coli, resistance rates were highest for ampicillin (64.3%) and TMP-SMX (41.3%). Resistance to cephalosporins, nitrofurantoin, and fluoroquinolones was much lower compared with the hospital laboratory-based surveillance data. Risk factors for TMP-SMX resistance were UTI in the last 6 months (odds ratio 2.22; p=0.04) and the number of UTI episodes in the past year (odds ratio 2.06; p=0.004). The number of UTI episodes (adjusted odds ratio 2.21; p=0.02) remained significant on multivariate analysis.

CONCLUSIONS: TMP-SMX resistance was high. Number of previous UTI episodes was associated with increased risk of resistance; prior antimicrobial use was not. Hospital antibiograms should be used with caution when treating uncomplicated UTI.

Written by:
Gangcuangco LM, Alejandria M, Henson KE, Alfaraz L, Ata RM, Lopez M, Saniel M.   Are you the author?
Department of Medicine, The Medical City, Pasig, Metro Manila, Philippines; Infectious Disease Practice and Innovations, The Medical City, Ortigas Ave., Pasig, Metro Manila, Philippines; Section of Infectious Diseases, Department of Medicine, University of the Philippines College of Medicine, Pedro Gil, Manila, Philippines.  

Reference: Int J Infect Dis. 2015 May;34:55-60.
doi: 10.1016/j.ijid.2015.02.022

PubMed Abstract
PMID: 25748571 Infections Section