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Treatment facilities for chronic patients can serve as a reservoir for fluoroquinolone-resistant Escherichia coli

Treatment facilities for chronic patients with a high incidence of urinary tract infections (UTIs) caused by Escherichia coli strains resistant to fluoroquinolones may be "reservoirs of resistance", which should be taken into account when transferring patients to emergency services.

Hospital Pharmacist Clinic St. Paul (Canada) has noted an increase in the consumption of ciprofloxacin in the departments of the large multidisciplinary medical organization Providence Health Care. The marked increase in resistance of UTI pathogens required a retrospective study to elucidate the spread of resistance, to assess the selection of the antibiotic and the structure of resistance.

The case histories of 800 patients who were treated in emergency rooms and Providence Health Care chronic patients services over a period of one year were studied. 130 positive urine culture results have been revealed. The most common causative agent of urinary tract infections was E. coli (44%), and nitrofurantoin (sensitivity 92%) and ciprofloxacin were most commonly prescribed for this etiology of infection. Sensitivity to ciprofloxacin was low in both types of services, but in chronic services the rate was significantly lower than in the emergency departments, at 43 and 70%, respectively.

Patients in chronic services often have to be transferred to emergency departments. In this regard, there is a serious threat of transfer of resistant flora to the emergency services. Doctors should remember the possibility of ineffective antibacterial therapy and wait for the results of a culture study before prescribing an antibiotic. Under current conditions, if necessary, urgent initiation of antibiotic treatment should be prescribed for cephalosporins.

The authors of the message stress the importance of educating doctors about the local susceptibility of infectious agents to antibiotics, because these data can change over time.