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. 2023 Nov 17;5(6):dlad122.
doi: 10.1093/jacamr/dlad122. eCollection 2023 Dec.

Nitrofurantoin resistance as an indicator for multidrug resistance: an assessment of Escherichia coli urinary tract specimens in England, 2015-19

Rebecca L Guy  1 , Jamie Rudman  1 , Hannah Higgins  1 , Emma Carter  1 , Katherine L Henderson  1 , Alicia Demirjian  1   2   3 , Sarah M Gerver  1
Affiliations

Nitrofurantoin resistance as an indicator for multidrug resistance: an assessment of Escherichia coli urinary tract specimens in England, 2015-19

Rebecca L Guy et al. JAC Antimicrob Resist. .

Abstract

Objectives: To determine whether MDR occurs more frequently in nitrofurantoin-resistant Escherichia coli urinary isolates in England, compared with nitrofurantoin-susceptible isolates.

Methods: Using routine E. coli urine isolate antibiotic susceptibility laboratory surveillance data for England, 2015-19 inclusive, the percentage of MDR or XDR phenotype was estimated for nitrofurantoin-susceptible and nitrofurantoin-resistant laboratory-reported urinary tract samples by region, patient sex and age group.

Results: Resistance to nitrofurantoin among E. coli urinary samples decreased slightly year on year from 2.9% in 2015 to 2.3% in 2019. Among E. coli UTIs tested for nitrofurantoin susceptibility and ≥3 additional antibiotics, the percentage that were MDR was consistently 15%-20% percentage points higher for nitrofurantoin-resistant isolates compared with nitrofurantoin-susceptible isolates. Similarly, the percentage of isolates with an XDR phenotype was higher among nitrofurantoin-resistant versus -susceptible isolates (8.7% versus 1.4%, respectively, in 2019); this disparity was greater in male patients, although variation was seen by age group in both sexes. Regional variation was also noted, with the highest MDR percentage amongst nitrofurantoin-resistant E. coli urinary samples in the London region (36.7% in 2019); the lowest was in the North East (2019: 16.9%).

Conclusions: MDR and XDR phenotypes occur more frequently in nitrofurantoin-resistant E. coli urinary isolates in England, compared with nitrofurantoin-susceptible isolates. However, nitrofurantoin resistance is low (<3%) overall. This latest study provides important insights into trends in nitrofurantoin resistance and MDR, which is of particular concern for patients ≥75 years old and those who are male. It also emphasises geographical heterogeneities within England in nitrofurantoin resistance and MDR.

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Figures

Figure 1.
Figure 1.
Distribution of isolates resistant to other classes of antibiotics among the nitrofurantoin-susceptible and nitrofurantoin-resistant phenotypes; 2019 data only. CIs are presented at 95% as error bars.
Figure 2.
Figure 2.
Regional-level trends in (a) MDR and (b) XDR in nitrofurantoin-susceptible and nitrofurantoin-resistant E. coli episodes in England by year; 2015–19. (a) Regional trends of percentage MDR by year in E. coli urinary tract specimen episodes that are either nitrofurantoin resistant or nitrofurantoin sensitive; the 95% CIs are presented as an area around each trend line. (b) Trends in percentage XDR by region and years in nitrofurantoin-resistant and nitrofurantoin-sensitive E. coli urinary tract specimen episodes.
See this image and copyright information in PMC

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