Community-acquired urinary tract bacterial infections and drug resistance among patients followed at a reference center in Fortaleza, Ceará, Brazil

ABSTRACT

Background: The aim of this study was to assess the antimicrobial resistance pattern of the most frequent pathogens responsible for community-acquired urinary tract infection (UTI). Methods: This is a retrospective, descriptive epidemiological survey involving all urine samples submitted for culture and antimicrobial susceptibility testing from patients with clinical diagnosis of UTI followed at the outpatient clinic of the Núcleo de Atenção Médica Integrada, University of Fortaleza, Brazil. The study period was from September 2012 to July 2013. Urine cultures were processed with clean-catch midstream urine samples in the local laboratory employing standard methods. A questionnaire was used to collect patient demographic data and the results of the bacterial identification and susceptibility testing. The data were analyzed by SPSS software. Results: A total of 514 urine samples were analyzed. Most patients were females (78.6%). Patients' mean age was 39 years old. Bacterial growth was observed in 16.5% of the samples. This rate was lower in women (13.6%) than in men (27.3%). The most prevalent pathogen was Escherichia coli (57.6%), followed by Klebsiella sp. (35.3%) and Proteus sp. (4.7%). E. coli showed a high frequency of resistance to ampicillin (88.2%) and sulfamethoxazole/trimethoprim (77.1%), as well as significant resistance to ciprofloxacin (38.9%) and norfloxacin (39.4%). Isolates from elderly patients (>60 years) had higher resistance to all tested antibiotics. Conclusions: There is a trend toward increasing bacterial resistance among the main UTI pathogens. Resistance to sulfamethoxazole/trimethoprim follows a worldwide increase rate tendency and it should be avoided as a first-line empirical treatment for UTIs. A significant resistance to quinolones was also observed.