Risk factors for fluoroquinolone-resistant Escherichia coli in adults with community-onset febrile urinary tract infection

Results: Of 787 consecutive patients, 420 had E. coli-positive urine cultures. Of these, 51 (12%) were fluoroquinolone resistant. Independent risk factors for fluoroquinolone resistance were urinary catheter [odds ratio (OR) 3.1; 95% confidence interval (CI) 0.9 –11.6], recent hospitalization (OR 2.0; 95% CI 1.0 –4.3) and fluoroquinolone use in the past 6 months (OR 17.5; 95% CI 6.0 –50.7). Environmental factors (e.g. contact with animals or hospitalized household members) were not associated with fluoroquinolone resistance. Of fluoroquinolone-resistant strains, 33% were resistant to amoxicillin/clavulanate and 65% to trimethoprim/ sulfamethoxazole; 14% were extended-spectrum b-lactamase (ESBL) positive compared with ,1% of fluoroquinolone-susceptible isolates. Conclusions: Recent hospitalization, urinary catheter and fluoroquinolone use in the past 6 months were independent risk factors for fluoroquinolone resistance in community-onset febrile E. coli UTI. Contact with animals or hospitalized household members was not associated with fluoroquinolone resistance. Fluoroquinolone resistance may be a marker of broader resistance, including ESBL positivity.