Resistance Rates to E. Coli

Risk factors for antibiotic resistance include recent broad-spectrum antibiotic use, healthcare exposure, and travel to high resistance areas.  Resistance rates vary across the country but are typically higher in the Mid-Atlantic.3 Resistance to fluoroquinolones and Bactrim continue to increase, as do ESBL E. Coli infections.3,5,6  Nitrofurantoin and fosfomycin have continued to maintain good susceptibility thus remain first-line choices.  Rates of resistance in the U.S. to nitrofurantoin were 1.6% in one survey of antimicrobial isolates.Decision-making includes consideration for patients’ tolerances and potential drug-drug interactions.

It is essential to reiterate the importance of avoiding fluoroquinolones for the empiric treatment of uncomplicated UTIs.  Common uropathogens, including Escherichia coli, are becoming increasingly resistant to fluoroquinolones due to previous overuse.

When developing your UTI prescribing protocols, it is critical to be aware of local resistance rates for agents used to treat uncomplicated UTIs.  In cases where the local rate of resistance to TMP/SMX is <20%, TMP/SMX for three days is a first-line option.

Resistance Rates By Region:

Region

ESBL

Levofloxacin Resistance

TMP-SMX Resistance

National

15.7%

 

24.3%

 

32.1%

 

Pacific

20.8%

23.8%

31.0%

 

Mountain

11.3%

18.0%

29.3%

West South Central

12.5%

22.1%

35.3%

West North Central

10.5%

21.5%

30.4%

East North Central

11.6%

20.7%

26.8%

East South Central

15.3%

27.9%

28.8%

New England

11.9%

22.2%

33.5%

Mid Atlantic

29.6%

38.1%

43.5%

South Atlantic

11.6%

23.9%

31.8%

 

Pacific: Alaska, Washington, Oregon, California, Hawaii

Mountain: Montana, Idaho, Wyoming, Nevada, Arizona, Colorado, New Mexico, Utah

West North Central:  North Dakota, South Dakota, Nebraska, Minnesota, Iowa, Missouri, Kansas

West South Central: Oklahoma, Texas, Arkansas, Louisiana

East North Central:  Wisconsin, Illinois, Indiana, Ohio, Michigan

East South Central:  Kentucky, Tennessee, Mississippi, Alabama

New England:  Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island

Mid Atlantic:  New York, Pennsylvania, Maryland, Delaware, New Jersey

South Atlantic:  West Virginia, Virginia, North Carolina, South Carolina, Georgia, Florida

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