Risk factors for community-acquired urinary tract infection due to quinolone-resistant E-coli

Background: Resistance to fluoroquinolone drugs is emerging among E. coli causing community acquired urinary tract infections (COMA-UTI). Objectives: To evaluate demographic and clinical risk factors associated with COMA-UTI due to quinolone-resistant E. coli (QREc). Methods: In this case-control study, clinical and demographic data from 300 COMA-UTI due to E. coli (including 150 QREc) were analyzed. Results: By univariate analysis QREc was associated to males, older patients, nursing home residents, functionally dependent, dementia, diabetes, cardiovascular diseases, immunosupression, nephrolithiasis, recurrent UTI, invasive procedures, hospitalization, and antibiotic use within previous 6 months. By multivariate analysis, use of ciprofloxacin (OR 20.6 [CI 2.3-179.2], p = 0.006) or ofloxacin (OR 7.5 [CI 2.9-19.4], p < 0.0001), previous invasive procedure (OR 6.6 [CI 3.0-14.7], p < 0.0001), recurrent UTI (OR 4.7 [CI 2.3-9.3], p < 0.0001), and previous hospitalization (OR 2.9 [CI 1.4-6], p = 0.003) were identified as independent risk factors for COMA-UTI due to QREc. Conclusion: In patients with one or more of the risk factors identified here, the empiric use of quinolones should be reconsidered.