Antibiotic Resistance Among Uropathogenic Escherichia coli

Abstract

Urinary tract infections (UTIs) belong to the most common community-acquired and nosocomial infections. A main etiological factor of UTIs is uropathogenic Escherichia coli (UPEC). This review describes the current state of knowledge on the resistance of UPEC to antibiotics recommended for the treatment of UTIs based on the available literature data. Nitrofurantoin and fosfomycin are recommended as first-line therapy in the treatment of uncomplicated cystitis, and the resistance to these antimicrobial agents remains low between UPEC. Recently, in many countries, the increasing resistance is observed to trimethoprim-sulfamethoxazole, which is widely used as the first-line antimicrobial in the treatment of uncomplicated UTIs. In European countries, the resistance of UPEC to this antimicrobial agent ranges from 14.6% to 60%. The widespread use of fluoroquinolones (FQs), especially ciprofloxacin, in the outpatients is the cause of a continuous increase in resistance to these drugs. The resistance of UPEC to FQs is significantly higher in developing countries (55.5-85.5%) than in developed countries (5.1-32.0%). Amoxicillin-clavulanic acid is recommended as first line-therapy for pyelonephritis or complicated UTI. Resistance rates of UPEC to amoxicillin-clavulanic acid are regionally variable. In European countries the level of resistance to this antimicrobial ranges from 5.3% (Germany) to 37.6% (France). Increasing rates of UPEC resistance to antimicrobials indicate that careful monitoring of their use for UTI treatment is necessary.

Urinary tract infections (UTIs) belong to the most common community-acquired and nosocomial infections. A main etiological factor of UTIs is uropathogenic Escherichia coli (UPEC). This review describes the current state of knowledge on the resistance of UPEC to antibiotics recommended for the treatment of UTIs based on the available literature data. Nitrofurantoin and fosfomycin are recommended as first-line therapy in the treatment of uncomplicated cystitis, and the resistance to these antimicrobial agents remains low between UPEC. Recently, in many countries, the increasing resistance is observed to trimethoprim-sulfamethoxazole, which is widely used as the first-line antimicrobial in the treatment of uncomplicated UTIs. In European countries, the resistance of UPEC to this antimicrobial agent ranges from 14.6% to 60%. The widespread use of fluoroquinolones (FQs), especially ciprofloxacin, in the outpatients is the cause of a continuous increase in resistance to these drugs. The resistance of UPEC to FQs is significantly higher in developing countries (55.5–85.5%) than in developed countries (5.1–32.0%). Amoxicillin-clavulanic acid is recommended as first line-therapy for pyelonephritis or complicated UTI. Resistance rates of UPEC to amoxicillin-clavulanic acid are regionally variable. In European countries the level of resistance to this antimicrobial ranges from 5.3% (Germany) to 37.6% (France). Increasing rates of UPEC resistance to antimicrobials indicate that careful monitoring of their use for UTI treatment is necessary.

Fig. 1.

Classification of urinary tract infections (Bartoletti et al. 2016).

Fig. 2.

The resistance of UPEC to antimicrobials using in the treatment of UTIs. Amoxicillin-clavulanic acid; the developed countries (USA, 3.1–40%; Germany, 5.3%; Poland, 13.9%; England, 30%; France, 37.6%), developing countries (Nepal, 48%; Pakistan, 71%; Jordan, 83%). Ciprofloxacin; developed countries (USA, 5.1–12.1%; Belgium, 12.9%; Germany, 10.5–17.3%; Switzerland.17.4%; England, 20.4%; France, 24.8%; Spain, 39.8%), developing countries (Jordan, 55.5%, Mongolia, 58.1%; Pakistan, 60.8%; Nepal, 64.6%; Ethiopia, 85.5%). Trimethoprim-sulfamethoxazole; developed countries (Belgium, 14.6%; USA, 17.4%; Germany, 18.45%; Poland, 21.4%; Switzerland, 24.5%; Spain, 30.9%; France, 37.1%), developing countries (Iran, 54%; Mexico, 66%; Ethiopia, 68.5%; Mongolia, 70.9%; Jordan, 73,1%; Pakistan, 82%).