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1 March 2008

Volume 46, Number 5
Clinical Infectious Diseases 2008;46:689–695
© 2008 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2008/4605-0008$15.00
DOI: 10.1086/527386
MAJOR ARTICLE

Temporal Changes in the Prevalence of Community‐Acquired Antimicrobial‐Resistant Urinary Tract Infection Affected by Escherichia coli Clonal Group Composition

Sherry P. Smith,1

Amee R. Manges,2 and

Lee W. Riley1

1School of Public Health, University of California, Berkeley; and 2Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada

Background.The changing prevalence of drug‐resistant community‐acquired urinary tract infection (UTI) is often attributed to local antimicrobial drug use or prescribing practices. However, recent molecular epidemiologic studies of community‐acquired UTI suggest that other factors may play a greater role.

Methods.We conducted a multiyear, cross‐sectional study to characterize temporal changes in the prevalence of drug‐resistant community‐acquired UTI at a university community in California. During four 3.5‐month sampling periods, urine samples from patients consecutively presenting to the university health service with symptoms of UTI were cultured for Escherichia coli. Antimicrobial susceptibility and genotyping tests of the E. coli isolates were performed.

Results.We recovered 780 E. coli isolates from 1667 patients with UTI. The prevalence of trimethoprim‐sulfamethoxazole, ciprofloxacin, and nitrofurantoin resistance showed no trend over the 4 periods. The prevalence of ampicillin resistance decreased significantly over the last 2 study periods. A single clonal group accounted for 75% of this decrease. Enterobacterial repetitive intergenic consensus 2 PCR–based genotyping revealed that only 4 large clonal groups accounted for 52% of the UTIs resistant to trimethoprim‐sulfamethoxazole, ciprofloxacin, or nitrofurantoin. No initially pansusceptible clonal groups gained resistance over time.

Conclusions.This study revealed no obvious trend in the prevalence of drug‐resistant community‐acquired UTI in a single community. Prevalence at any time was influenced by a small number of E. coli clonal groups. This observation suggests that the introduction of strains that are drug resistant into a community plays a greater role in changing the prevalence of drug‐resistant UTI than does the drug use or prescribing habits in that community.

Received 22 May 2007; accepted 16 October 2007; electronically published 28 January 2008.

Reprints or correspondence: Dr. Lee W. Riley, School of Public Health, University of California, 140 Warren Hall, Berkeley, CA 94720 ().

Cited by

M. N. Al-Hasan, B. D. Lahr, J. E. Eckel-Passow, L. M. Baddour. (2009) Antimicrobial resistance trends of Escherichia coli bloodstream isolates: a population-based study, 1998-2007. Journal of Antimicrobial Chemotherapy 64:1, 169-174
Online publication date: 1-Aug-2009.
CrossRef
Ebbing Lautenbach. (2008) Editorial Commentary: Finding the Path of Least Antimicrobial Resistance in Pyelonephritis. Clinical Infectious Diseases 47:9, 1159-1161
Online publication date: 1-Nov-2008.
Citation-Full Text-PDF Version (164 kB)
David A. Talan, Anusha Krishnadasan, Fredrick M. Abrahamian, Walter E. Stamm, and Gregory J. Moran, for the EMERGEncy ID NET Study Group. (2008) Prevalence and Risk Factor Analysis of Trimethoprim‐Sulfamethoxazole– and Fluoroquinolone‐Resistant Escherichia coli Infection among Emergency Department Patients with Pyelonephritis. Clinical Infectious Diseases 47:9, 1150-1158
Online publication date: 1-Nov-2008.
Abstract-Full Text-PDF Version (282 kB)
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