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Antimicrobial Agents and Chemotherapy, August 2002, p. 2540-2545, Vol. 46, No. 8
0066-4804/02/$04.00+0     DOI: 10.1128/AAC.46.8.2540-2545.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Trends in Antimicrobial Resistance among Urinary Tract Infection Isolates of Escherichia coli from Female Outpatients in the United States

James A. Karlowsky,1* Laurie J. Kelly,1 Clyde Thornsberry,2 Mark E. Jones,3 and Daniel F. Sahm1

Focus Technologies, Inc., Herndon, Virginia 20171,1 Focus Technologies, Inc.Franklin, Tennessee, 37064,2 Focus Technologies, Inc., 1217 KP Hilversum, The Netherlands3

Received 7 March 2002/ Returned for modification 3 April 2002/ Accepted 1 May 2002

The Infectious Diseases Society of America advocates trimethoprim-sulfamethoxazole (SXT) as initial therapy for females with acute uncomplicated bacterial cystitis in settings where the prevalence of SXT resistance does not exceed 10 to 20%. To determine trends in the activities of SXT, ampicillin, ciprofloxacin, and nitrofurantoin among urine isolates of Escherichia coli from female outpatients, susceptibility testing data from The Surveillance Network (TSN) Database-USA (n = 286,187) from 1995 to 2001 were analyzed. Resistance rates among E. coli isolates to ampicillin (range, 36.0 to 37.4% per year), SXT (range, 14.8 to 17.0%), ciprofloxacin (range, 0.7 to 2.5%), and nitrofurantoin (range, 0.4 to 0.8%) varied only slightly over this 7-year period. Ciprofloxacin was the only agent studied that demonstrated a consistent stepwise increase in resistance from 1995 (0.7%) to 2001 (2.5%). In 2001, SXT resistance among E. coli isolates was >10% in all nine U.S. Bureau of the Census regions. At institutions testing >=100 urinary isolates of E. coli (n = 126) in 2001, ampicillin (range, 27.3 to 98.8%) and SXT (range, 7.5 to 47.1%) resistance rates varied widely while ciprofloxacin (range, 0 to 12.9%) and nitrofurantoin (range, 0 to 2.8%) resistance rates were more consistent. In 2001, the most frequent coresistant phenotypes were resistance to ampicillin and SXT (12.0% of all isolates; 82.3% of coresistant isolates) and resistance to ampicillin, ciprofloxacin, and SXT (1.4% of all isolates; 9.9% of coresistant isolates). Coresistance less frequently included resistance to nitrofurantoin (3.5% of coresistant isolates) than resistance to ciprofloxacin (15.8%), SXT (95.7%), and ampicillin (98.1%). In conclusion, among urinary isolates of E. coli from female outpatients in the United States, national resistance rates to SXT were relatively consistent (14.8 to 17.0%) from 1995 to 2001 but demonstrated considerable regional and institutional variation in 2001. Therapies other than SXT may need to be considered in some locations.

* Corresponding author. Mailing address: Focus Technologies, Inc., 13665 Dulles Technology Dr., Suite 200, Herndon, VA 20171-4603. Phone: (703) 480-2575. Fax: (703) 480-2654. E-mail: jkarlowsky{at}focusanswers.com.

Antimicrobial Agents and Chemotherapy, August 2002, p. 2540-2545, Vol. 46, No. 8
0066-4804/02/$04.00+0     DOI: 10.1128/AAC.46.8.2540-2545.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.



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