Escherichia coli antimicrobial resistance in acute urinary tract infection lower than reported in Dutch national surveillance database.

BACKGROUND

General practice patients with an acute urinary tract infection are usually treated empirically. Urine is only cultured if initial therapy fails. This study aimed to assess whether resistance rates of Escherichia coli (E. coli) from initial urine samples differ from those observed after treatment failure, and whether current surveillance data used for treatment guidelines may overestimate resistance in first-line care.

METHODS

A prospective observational study was conducted from October 2022 to June 2024 at Isala Hospital in Zwolle, the Netherlands, involving patients from two general practices. Patients with suspected acute UTI were included, excluding those with indwelling catheters. Initial urine samples were cultured, and resistance rates for all E. coli strains isolated were compared with data from the Dutch national AMR database ISIS-AR and regional data. Treatment success or failure was evaluated by recording the prescribed antibiotics and follow-up visits within 28 days.

RESULTS

A total of 366 urine samples from 272 patients were analyzed. E. coli was the most common pathogen (82.2%). Resistance rates for E. coli were lower than those reported in national and regional datasets. Empirical treatment success rates were 95% for nitrofurantoin, 90% for fosfomycin, 92% for ciprofloxacin, and 100% for trimethoprim. Repeat cultures were performed in 19 cases due to persistent symptoms.

CONCLUSION

The study confirms that the Dutch national guideline for empirical UTI treatment in general practice is effective. However, periodic reviews of resistance rates for common uropathogens are recommended to ensure continued guideline validity and promote responsible antibiotic use.