Trimethoprim and ciprofloxacin resistance and prescribing in urinary tract infection associated with Escherichia coli: a multilevel model

J Antimicrob Chemother. 2012 Oct;67(10):2523-30. doi: 10.1093/jac/dks222. Epub 2012 Jun 22.


Objectives: Individual and group level factors associated with the probability of antimicrobial resistance of uropathogenic Escherichia coli were analysed in a multilevel model.

Methods: Adult patients consulting with a suspected urinary tract infection (UTI) in 22 general practices over a 9 month period supplied a urine sample for laboratory analysis. Cases were patients with a UTI associated with a resistant E. coli. Previous antimicrobial exposure and other patient characteristics were recorded from the medical files.

Results: Six hundred and thirty-three patients with an E. coli UTI and a full record for all variables were included. Of the E. coli isolates, 36% were resistant to trimethoprim and 12% to ciprofloxacin. A multilevel logistic regression model was fitted. The odds that E. coli was resistant increased with increasing number of prescriptions over the previous year for trimethoprim from 1.4 (0.8-2.2) for one previous prescription to 4.7 (1.9-12.4) for two and 6.4 (2.0-25.4) for three or more. For ciprofloxacin the ORs were 2.7 (1.2-5.6) for one and 6.5 (2.9-14.8) for two or more. The probability that uropathogenic E. coli was resistant showed important variation between practices and a difference of 17% for trimethoprim and 33% for ciprofloxacin was observed for an imaginary patient moving from a practice with low to a practice with high probability. This difference could not be explained by practice prescribing or practice resistance levels.

Conclusions: Previous antimicrobial use and the practice visited affect the risk that a patient with a UTI will be diagnosed with an E. coli resistant to this agent, which was particularly important for ciprofloxacin.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / pharmacology*
  • Anti-Bacterial Agents / therapeutic use
  • Case-Control Studies
  • Ciprofloxacin / pharmacology*
  • Ciprofloxacin / therapeutic use
  • Drug Prescriptions / statistics & numerical data
  • Drug Resistance, Bacterial*
  • Escherichia coli / drug effects*
  • Escherichia coli / isolation & purification
  • Escherichia coli Infections / drug therapy
  • Escherichia coli Infections / microbiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Primary Health Care
  • Prospective Studies
  • Risk Factors
  • Trimethoprim / pharmacology*
  • Trimethoprim / therapeutic use
  • Urinary Tract Infections / drug therapy
  • Urinary Tract Infections / microbiology*


  • Anti-Bacterial Agents
  • Ciprofloxacin
  • Trimethoprim