French results of the ARESC study: clinical aspects and epidemiology of antimicrobial resistance in female patients with cystitis. Implications for empiric therapy.

OBJECTIVE: Uncomplicated cystitis is one of the most frequent community infections. We report the French results of the international ARESC study on the clinical aspects, epidemiology, and antimicrobial susceptibility of uropathogens.

PATIENT AND METHODS: Female patients between 18 and 65 years of age, with symptoms of uncomplicated cystitis, were investigated clinically with urinalysis and urine culture. Uropathogens were identified and their susceptibility was tested with nine antimicrobials.

RESULTS: Four thousand and four hundred patients were included, 871 in France, forming the largest national cohort. Urine culture was positive (cfu≥10(4)/ml) in 550 (63.1%); 533 (96.9%) presented with a single bacterium infection. 488 uropathogens, collected from 479 patients, were analyzed. The most frequent were: Escherichia coli (83.8%), Staphylococcus saprophyticus (4.3%), Proteus mirabilis (3.1%), enterococci (1.2%), and Klebsiella pneumoniae (1.0%). E. coli was highly susceptible to fosfomycin (99.0%) (97.1%), nitrofurantoin (97.3%), and ciprofloxacin (98.3%). The lowest susceptibility rates were found for ampicillin (60.9%) and cotrimoxazole (87.8%). Fosfomycin (97.8%), ciprofloxacin (98.3%), and nitrofurantoin (91.5%) had the highest susceptibility rate. The lowest susceptibility rates were observed with ampicillin (61.4%) and cotrimoxazole (86.5%).

CONCLUSIONS: Fosfomycin, pivmecillinam (not available in France), and nitrofurantoin have preserved their in vitro activity and are suitable for empiric therapy. Cotrimoxazole (trimethoprim+sulfamethoxazole) and fluoroquinolones are not usually recommended as first intention drugs for the empiric therapy of uncomplicated cystitis, because of increasing resistance rates.