oa Southern African Journal of Epidemiology and Infection - Antimicrobial susceptibility patterns of Escherichia coli strains isolated from urine samples in South Africa from 2007-2011 : review
Escherichia coli is the most common cause of urinary tract infections. Knowledge of its local antimicrobial susceptibility patterns can be used to inform choice of empiric antimicrobial therapy. In this article, we review data on antimicrobial susceptibility patterns of E. coli isolated from unselected urine specimens, in both the private and public sectors of South Africa from 2007-2011. Between 65 000-84 000 E. coli urinary isolates were reported annually from 19 laboratories located across South Africa. Susceptibility to fluoroquinolone and beta-lactam antibiotics decreased significantly and steadily in both private and public sectors over the five-year period, although laboratory-based surveillance data may underestimate susceptibility rates due to selection bias and lack of differentiation between community- and hospital-acquired infections. Our data suggest that fluoroquinolones, co-amoxiclav and first- and second-generation cephalosporins can still be used for empiric treatment in many local settings, but clinicians should be alert to the risk of treatment failure. With the withdrawal of nitrofurantoin from the local market, other oral antibiotic options are limited, and fosfomcyin may become increasingly important. Given their sustained high susceptibility rates, aminoglycosides should be considered to treat pyelonephritis more often. Judicious use of laboratory testing is advised and further research and surveillance is warranted.
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