Current Trends in Urinary Tract Infections: Is Cipro Really Necessary?

Urinary tract infections are one of the most common causes of ambulatory care visits, physician-office visits and hospitalization each year in the US. Sexual activity primarily contributes to acquisition of UTI in women; nearly half of adult women have had a UTI at least once. The most common causative agent is E. coli, followed by Enterobacter spp., Klebsiella spp., Pseudomonas aeruginosa, Proteus mirabilis, other Gram-negative rods and Group B streptococci, depending on geographical location. 1 Until the late 1990\u27s, trimethoprim-sulfamethoxazole (TMP-SMX) was the most commonly prescribed and effective treatment option, but the rampant development of resistance to this drug has caused the IDSA to mandate a switch to Cipro as the first-line empiric treatment. This study was designed to compare Cipro\u27s efficacy to that of TMP-SMX and nitrofurantoin, comparing two samples in the greater Chattanooga area. The samples were used to study the relationship between various factors, such as age, sex, previous UTI, previous antimicrobial treatment, sexual activity and chronic illness, and UTI incidence and resistance. Total resistance to TMP-SMX was 17%, to nitrofurantoin, 20%, and to Cipro, 8%. UTI incidence occurred in the order: Escherichia coli\u3e Klebsiella pneumoniae\u3e Pseudomonas aeruginosa\u3e Proteus mirabilis\u3e Enterobacter spp, Citrobacter spp., and other Gram negative bacilli. Age was not found to be related to antimicrobial resistance in women, but may link to resistance in men. Sexual activity and menopause may be related to UTI incidence in both samples, while previous UTI, previous antimicrobial treatment and chronic illness may correlate with resistance. The Collegedale sample was too small to substantiate results. A study over a longer time period is needed to confirm these preliminary findings