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Increasing prevalence of ciprofloxacin resistance in extended-spectrum-β-lactamase-producing Escherichia coli urinary isolates

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Abstract

Purpose

To describe the incidence and drug susceptibility profiles of uropathogenic extended-spectrum-β-lactamase-producing Escherichia coli (ESBL-EC) during a 10-year period and to identify differences in resistance patterns between urological and non-urological ESBL-EC isolates.

Methods

Retrospective analysis of 191,564 urine samples obtained during 2001 to 2010 at the University Hospital Basel, Switzerland. The computerized database of the Clinical Microbiology Laboratory and the Division of Infectious Diseases and Hospital Epidemiology was used to identify ESBL-EC positive urine samples. ESBL-EC isolates were stratified according their origin into two groups: Urology and non-Urology isolates.

Results

The rate of ESBL-EC positive urine samples increased significantly during the study period (3 in 2001 compared to 55 in 2010, p < 0.05). The most active agents were imipenem, meropenem, and fosfomycin (100 %), followed by amikacin (99.1 %) and nitrofurantoin (84 %). The least active substances were ampicillin-clavulanate (20 %), sulfamethoxazole (28 %), and ciprofloxacin (29.6 %). ESBL-EC isolates from urological and non-urological patients showed similar susceptibility profiles. However, ESBL-EC isolates from urological patients were significantly less susceptible to ciprofloxacin compared to non-urological isolates (14.7 vs. 32.7 %, p < 0.05).

Conclusions

The rate of urinary ESBL-EC isolates is increasing. Their susceptibility to nitrofurantoin, fosfomycin, and carbapenems is excellent, whereas ampicillin-clavulanate, sulfamethoxazole, and ciprofloxacin demonstrate only low susceptibility. In particular, the use of ciprofloxacin should be strictly avoided in urologic patients with suspicion for an ESBL-EC urinary tract infection as well as routine antibiotic prophylaxis prior to urological interventions if not explicit indicated by current international guidelines or local resistance patterns.

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Conflict of interest

None of the contributing authors has any conflict of interest relevant to the subject matter or materials discussed in the manuscript. No funding or other financial support was received.

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Authors and Affiliations

  1. Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    G. Bonkat, G. Müller, O. Braissant, M. Rieken, S. Wyler, T. C. Gasser & A. Bachmann

  2. Laboratory of Biomechanics and Biocalorimetry (LOB2), Faculty of Medicine, University of Basel, c/o Biozentrum-Pharmazentrum, Klingelbergstrasse 50-70, 4056, Basel, Switzerland

    G. Bonkat & O. Braissant

  3. Clinical Microbiology Laboratory, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    R. Frei

  4. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    S. Tschudin-Suter & A. F. Widmer

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  1. G. Bonkat
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  2. G. Müller
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  3. O. Braissant
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  4. R. Frei
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Correspondence to G. Bonkat.

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Bonkat, G., Müller, G., Braissant, O. et al. Increasing prevalence of ciprofloxacin resistance in extended-spectrum-β-lactamase-producing Escherichia coli urinary isolates. World J Urol 31, 1427–1432 (2013). https://doi.org/10.1007/s00345-013-1031-5

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  • DOI: https://doi.org/10.1007/s00345-013-1031-5

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