Risk factors associated with trimethoprim-sulfomethoxazole among Escherichia coli strains isolated from community acquired urinary tract infection

Abstract

Urinary tract infections (UTIs) are common infections affecting all age groups particularly adults. The present study was carried out to determine the risk factors for trimethoprim – sulfamethaxoazole (TMP-SMX) and ciprofloxacin-resistant Escherichia coli (E.coli) isolates obtained from community-acquired UTI. For the study, a total of 595 patients aged between 15 and 70 years with community-acquired UTI were prospectively recruited; 492 (82.69%) of these samples were sterile. Of the 93 Gram-negative isolates included in this study, 56 and 37 isolates were obtained from uncomplicated and complicated UTI, respectively. Since all the male patients were categorized in the complicated UTI group, all 56 non-complicated cases were female patients and 61 (84.72%) of the complicated cases were female patients. The median age was 55 (SD 15.7) and 49 (SD 16) for the uncomplicated and the complicated UTI patients, respectively. 30.36% and 86.49% of uncomplicated and complicated UTI patients were from a rural area. E. coli was the causative agent in 83.93% and 67.57% in the uncomplicated and complicated UTI, respectively (P < 0.0174 ). Nitrofurantoin and fosfomycin were having the resistance rates of 3.57% and 1.18%, respectively for uncomplicated UTI strains. ESBL were detected in 3.6% and 5.66% of the E. coli strains isolated from uncomplicated and complicated UTIs, respectively. In summary, TMP/SMX may not be appropriate for the empirical treatment of community-acquired UTI due to its widespread resistance. However, ciprofloxacin may be used warily for both uncomplicated and complicated UTI because of emerging resistance.