Objectives:

To determine in-vitro resistance of the most frequent uropathogen, Escherichia coli, to several antibiotics in our health sector, and to deduce empirical treatment options.

Design:

Retrospective descriptive epidemiological study

Material and methods:

E. coli strains isolated from urine cultures of patients from Primary and Hospital Care in Huesca Sector, between 1 January 2016 and 31 December 2018, were studied. A total of 42004 samples were processed. The sensitivity to eleven frequently used antibiotics was determined. The existence of statistically significant differences in sensitivity for the years under study was analyzed, comparing their corresponding 95% confidence intervals (Fisher´s method).

Results:

E. coli has been the most frequently isolated bacteria during the study period. Resistance to fosfomycin and nitrofurantoin has remained below 4%, and resistance to third generation cephalosporins below 12%. Regarding cefuroxime and amoxicillin-clavulanic acid, a significant increase in resistance in hospital strains with respect to community strains has been observed in this period. The highest levels of resistance (more than 20%) were found in antibiotics administered orally and frequently indicated in uncomplicated urinary tract infections: trimethoprim-sulfamethoxazole, ciprofloxacin, and amoxicillin.

Conclusions:

These results suggest that the first choice empirical treatments for urinary tract infections in our health area are fosfomycin, nitrofurantoin, or second generation cephalosporins. The latter is only at a community level, whereas its use in hospitals without testing in antibiogram is not recommended due to an increasing percentage of resistance. Trimethoprim-sulfamethoxazole or quinolones are not recommended as first choice treatment.

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