Doom and gloom from the Netherlands regarding antibiotic resistance in E. coli. Although they focus on the resistance rates to fluoroquinolones, the more interesting take-home point from this article is the risk factors described for polypharmacy resistance.
Depending on your local resistance patterns, 88% susceptibility to E. coli for fluoroquinolones either sounds great or it sounds terrible. What’s interesting is that the strains of E. coli in this study that had fluoroquinolone resistance also had 33% resistance to amoxicillin-clavulanate, 65% resistance to TMP-SMX, and 14% had an ESBL gene. So, you can really extend their findings to more a listing of predictive factors for resistance to multiple antibiotics. In there study, the main univariate risk factors were indwelling catheter (OR 6.0) and prior fluoroquinolone use within six months (OR 18.6). Less prominent, but still statistically significant were underlying urinary tract disorder (OR 2.3), recurrent UTI (OR 2.2), or recent hospitalization (OR 2.3).
Their conclusion that the presence of any of these risk factors should result in a urine culture being sent, which is reasonable – although even in the absence of risk factors, there was still an 8.2% chance of fluoroquinolone resistance.