The Percentage of Antibiotic Resistance in Uncomplicated Community-Acquired Urinary Tract Infections

Abstract

Background: Uncomplicated bacterial urinary tract infections (uUTIs) are commonly seen in outpatient practice. They are usually treated empirically with antibiotics. The pertinent German Clinical Practice Guideline contains recommendations on antibiotic selection, with the additional advice that the local resistance situation should be considered as well. However, up-to-date information on local resistance is often unavailable, because microbiological testing is mainly recommended for complicated UTIs. Resistance rates are often higher in recurrent uUTIs than in single episodes. In this study, we aimed to determine the resistance rates of Escherichia coli (E. coli) in patients with community-acquired uUTIs and to make these data available to the treating physicians.

Methods: In a nationwide cross-sectional study in Germany (DRKS 00019059), we determined the percentages of resistance to antibiotics recommended for uUTIs (first choice: fosfomycin, nitroxoline, mecillinam, nitrofurantoin, trimethoprim; second choice: cefpodoxime, ciprofloxacin, cotrimoxazole, levofloxacin, norfloxacin, ofloxacin) over the period 2019–2021. The data were stratified by single episodes vs. recurrent UTIs (rUTIs).

Results: Data from 2390 subjects were analyzed. E. coli was found in 75.4% of the samples with positive urine cultures (1082 out of 1435). The resistance rate of E. coli in single episodes (n = 725) was less than 15% for all antibiotics tested. In rUTIs (n = 357), resistance rates were also less than 15% for the most part; the only exceptions were trimethoprim (21.4%) and cotrimoxazole (19.3%).

Conclusion: For single episodes of uUTI, all of the antibiotics studied can be recommended, at least as far as their resistance profiles are concerned. For recurrent UTI, all but trimethoprim and cotrimoxazole can be recommended. The second-choice antibiotics examined do not have a more favorable resistance profile than the first-choice antibiotics.