Antibiotic Resistance to Escherichia coli in Urinary Isolates from College Women with Urinary Tract Infections

Of 176 urine isolates from female students positive for Escherichia coli, 29.6% were trimethoprim-sulfamethoxazole resistant and none were nitrofurantoin resistant. Among students with a history of UTI (n=119), resistance to ciprofloxacin was 11.8% compared to 1.8% without prior UTI. Nitrofurantoin should be considered for empiric therapy of lower tract UTI. AC CE PT ED on N ovem er 3, 2017 by gest httpaac.asm .rg/ D ow nladed fom Urinary tract infections (UTIs) are a common cause of morbidity in women.(7) The majority of cases involve only the lower urinary tract, and the most common pathogen is E. coli. (9, 21) For uncomplicated infections, especially those without signs of upper tract infection, empiric therapy without culture and susceptibility analysis is recommended. (3, 4, 19) Resistance to amoxicillin has been established for years, and resistance to trimethoprim-sulfamethoxazole (TMP-SMX) has emerged more recently with rates > 20% in some areas.(9) The Infectious Diseases Society of America (IDSA) recommends that in regions where resistance rates to TMP-SMX exceed 10% to 20%, TMP-SMX should not be used for empiric therapy.(19) Fluoroquinolones, in particular ciprofloxacin, are used increasingly, (10, 11) but resistance to ciprofloxacin is also increasing. (12, 15) College women have a high incidence of uncomplicated urinary tract infections (UTIs), and are frequently treated empirically. Unfortunately, since studies of resistance patterns include mostly complicated UTIs in older women, (9,21) resistance may develop undetected among college students with lower tract UTI. The objective of this analysis was determine resistance patterns among E. coli isolates from young women with UTI in a college setting in the southeastern United