Antibiotic resistance of coliform bacteria from community-acquired urinary tract infections in the Zenica-Doboj Canton, Bosnia and Herzegovina

Abstract

Aim: To collect routine susceptibility data for coliform organisms isolated from patients with community-acquired urinary tract infections (CAUTIs) in Zenica-Doboj Canton during 2004, with a view to guiding empiric therapy.

Methods: Consecutive urine samples were analyzed by standard procedures. Antimicrobial susceptibility testing to fifteen antimicrobials was performed by disc-diffusion method according to causative agents (E. coli/non E. coli), age (0-6, 7-14, 15-19, 20-64, > or = 65) and gender of patients.

Results: E. coli and other coliforms (non-E. coli) were isolated from 2473 (11%) out of 22,451 urine samples submitted, 1,618 (65.4%) and 856 (34.6%), respectively. Inclusion of non-E. coli significantly increased overall resistance rates in all tested antibiotics except for ampicillin and trimethoprim/sulfamethoxazole, and it was significantly higher in males than in females in all analysed subsets (p < 0.05). Specific age resistance rates to nitrofurantoin was in the range of 15-63% and 2-12% in males and females, respectively. Resistance rates to ciprofloxacin in the two oldest age groups were 51% and 57% in males, and 11% i 17% in females.

Conclusions: Because of significant proportion of non-E. coli isolates, CAUTIs represent important problem in this region. Due to high ampicillin and trimethoprim/sulfamethoxazole resistance rates for all analysed subsets these drugs should be left for empiric therapy, and it is highly recommended to perform urinalysis in all patients. Ciprofloxacin and nitrofurantoin should also be considered as the first-line therapy in women above 20 years of age and in children, respectively. Continuous surveillance of antibiotic resistance of CAUTIs as well as introduction of drug prescribing control is important.