Antibiotic resistance of urinary pathogens in female general practice patients

Abstract

A cross-sectional study was performed to determine the prevalence of antibiotic resistance in women with uncomplicated and complicated lower urinary tract infection (UTI) in Germany. In 36 (of 118 invited) general practices, urine cultures and resistance testing were performed during 4 months on all women presenting with symptoms of UTI. Each patient's symptoms, risk factors and treatment were documented. A total of 445 women were included, and their median age was 53 y. Complicating factors were present in 27% of women. Urine cultures were available for 430 patients. They were sterile in 23%, 53% had 10⁵ cfu/ml or more, and 24% had 10²–10⁴ cfu/ml. E.coli was the most frequent pathogen (68%), followed by Enterococcus faecalis (10%) and Proteus spp. (10%). E.coli resistance levels were 25–40% for amoxicillin, co-amoxiclav, first generation oral cephalosporins, trimethoprim and co-trimoxazole. Nine percent were resistant to fluoroquinolones. E.coli resistance remained low for nitrofurantoin (2%) and third generation oral cephalosporins (3%). Odds for E.coli resistance to most antibiotics were 2–5 times higher in patients with complicating factors, and increased with age. Resistance levels to all common antibiotics were high even in unselected females with UTI in general practices. Older or complicated patients had a significantly higher risk for resistance.