Trends and Risk Factors for Ciprofloxacin Resistance and Extended- spectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients

Abstract

Objective: This study aimed to identify the patterns and temporal changes of ciprofloxacin resistance and extended-spectrum beta-lactamase (ESBL) production in uropathogenic isolates obtained from urology and non-urology outpatients. Materials and Methods: In this cross-sectional study, electronic data of urine culture and antimicrobial susceptibility test results of samples collected in urology and non-urology outpatient departments from 2008 to 2016 were retrospectively analysed to identify correlations between basic demographic features and clinical settings. Results: Escherichia coli (E. coli) was the most prevalent (70\%) uropathogenic isolate in a cohort of 7.973 patients consisting of 82.8\% women, 70.7\% adults and 15.7 \% urology outpatients. Overall, resistance to ciprofloxacin was found in 16.3\% of the patients. Ciprofloxacin resistance was associated with being male and old, observed more frequently in urology outpatients, detected in 19.2\% of E. coli isolates and increased to 54.5\% among ESBL-producing bacterial strains (p<0.05). ESBL production was observed in 12\% of all isolates. Increased ESBL production was associated with old age and isolates of E. coli and Klebsiellaspp. (p<0.05). Statistical analysis using multivariate generalised linear mixed models (mGLMMs) to assess the relationship between the outcomes predicted a significantly higher ESBL production in E. coli and Klebsiella spp. isolates and in geriatric patients. Furthermore, mGLMM analysis predicted a significantly increased likelihood of ciprofloxacin resistance in older adult male patients, especially in E. coil and Enterococcusspp. isolates. Moreover, a high rate of ESBL production was observed, reaching over 15\% in 2015 (p<0.05). The rates of ciprofloxacin resistance remained >10\% and peaked in 2015 (20.2\%, p<0.001). However, in 2016, the rate of ESBL production and ciprofloxacin resistance started to decline, displaying significance only regarding the latter (p<0.05). Conclusion: Empirical ciprofloxacin treatment of community-acquired urinary tract infections carries a higher risk of an unsuccessful outcome in male, geriatric and urology outpatients. Empirical antibacterial therapy for urological infections in the outpatient setting should be conducted based on patient risk profiles and contemporary local resistance data.