The systematic Review of Quinolones Resistance of Escherichia coli Isolated from Urinary Tract Infections in Iran over the Last Ten Years (2001-2011)

Abstract

Aims: Urinary tract infection (UTI) is one the most common bacterial infection and Escherichia coli (E. coli) has been isolated from the majority of UTI cases. On the other hand, the rate of UTIs caused by quinolones resistant E. coli is increasing worldwide. We aimed to perform a systematic review of quinolones resistance of E. coli isolated from urinary tract infections in Iran over last ten years. Methodology: In this study the data of 53 cross-sectional studies from 2001 to 2011 on quinolones resistance of E. coli isolated from UTIs in 22 cities of Iran was collected. The data was statistical analyzed using SPSS version 18 and Stata software. Results: Of 53 studies, 44, 41, 8 and 6 studies tested ciprofloxacin, nalidixic acid, norfloxacin and ofloxacin, respectively. Majority of studies, 31(58.5%), was done on out-patients. For susceptibility testing of isolates, 49 and 4 of studies used disk diffusion and E test method, respectively. Forty six of studies (86.8%) used mid-stream urinesample, while the rest used other methods for sampling including catheter, suprapubic aspiration and urine bag. Overall resistance for nalidixic acid, ciprofloxacin, norfloxacin and ofloxacin were 42.3%, 28.2%, 48.5% and 24.1%, respectively. The results of most studies were significantly heterogenic (P<0.001). Conclusion: Results indicated the resistance to quinolones including ciprofloxacin, norfloxacin and nalidixic acid is quite high. Given the increased resistance to these drugs, urine culture and antimicrobial susceptibility testing are essential for the treatment of UTIs.