ANTIMICROBIAL SUSCEPTIBILITY PROFILE OF UROPATHOGENIC Escherichia coli ISOLATED FROM OUTPATIENTS AND HOSPITALIZED AT THE UNIVERSITY HOSPITAL OF LONDRINA, PR

Urinary tract infections (UTIs) are one of the most common infectious diseases both in the community and in the hospital settings, and it is estimated that 150 million people worldwide will develop this infection each year. Escherichia coli is the agent responsible for the vast majority of cases, with the ascending route being the main route of contamination. The therapeutic strategies of UTI involve the use of antimicrobials, however, in recent years, resistance to multiple drugs in uropathogenic E. coli isolates (UPEC) has been increasing, especially to those used frequently in clinical practice, a problem that can affect the treatment. Thus, the objective of this study was to evaluate and compare the resistance profile of UPEC isolated from 50 outpatients and 42 hospitalized patients at the University Hospital of Londrina, PR. Through the automated VITEK® 2 system, 20 antimicrobials frequently used in the medical clinic were tested: amikacin, gentamicin, amoxicillin + clavulanic acid, ampicillin, piperacicline + tazobactam, aztreonan, cephalothine, cefuroxime, cefoxitin, ceftazidime, ceftriaxone, cefepime, ertapenem, imipenem, meropenem, nitrofurantoin, ciprofloxacin, norfloxacin, nalidixic acid and sulfamethoxazole + trimethoprim. The highest rates of resistance in both inpatients and outpatients were ampicillin, with 88.1% and 94%, respectively. On the other hand, penicillins tested with beta-lactamases inhibitors were quite effective, mainly piperacicline + tazobactam, with 14.3% resistance in inpatients and only 4% in outpatients. All antibiotics tested of the cephalosporin class showed low efficacy against the isolates, with more than 70% of them resistant. The most satisfactory antibiotics were those of the carbapenen class, with 100% sensitivity among outpatients, and 98% among hospitalized patients. Nitrofurantoin and amikacin demonstrated resistance in less than 5% of isolates, all of which were only ambulatory patients. According to the results analyzed, there was no significant difference between hospital and community infections in relation to resistance. Natural selection of antimicrobial resistance genes occurs naturally; however, it can be aggravated by poor habits of both health care professionals and the community with indiscriminate use. Because of this, the drug susceptibility profile should be taken into consideration prior to the choice of UTI treatment as a way to limit the appearance of multidrug resistant strains.