Increasing Prevalence of Antimicrobial Resistance Among Uropathogens Causing Acute Uncomplicated Cystitis in Women

Abstract

The management of acute uncomplicated cystitis, one of the most common community-acquired infections in women, has dramatically changed in the managed care era.¹ In many clinical settings, urine cultures are no longer performed and women with symptoms of acute cystitis are treated empirically.^1-4 The rationale for this strategy is based on the narrow spectrum of etiologic agents causing acute cystitis and knowledge of their antimicrobial resistance patterns. To date, however, most studies reporting antimicrobial resistance have been based on surveys of laboratory isolates, generally without correlation with clinical or epidemiological factors such as the presence and nature of symptoms, age, sex, and whether the infection was complicated. Data from such laboratory-based studies do not provide the information needed to select empirical therapy for women with uncomplicated urinary tract infections (UTIs). To address this issue, we determined the prevalence of and trends in antimicrobial resistance among uropathogens isolated from a large and well-defined population of female health maintenance organization (HMO) enrollees who presented with acute uncomplicated cystitis.