Changing trends in frequency and antimicrobial resistance of urinary pathogens in outpatient clinics and a hospital in Southern Israel, 1991–1995

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Abstract
In order to monitor changes in the frequency and antimicrobial resistance of urinary pathogens over several years, urinary cultures received from outpatient clinics and from a hospital during a period of one month each in 1991 and 1995 were analyzed at a clinical microbiology laboratory. In 1991 and 1995, 1366 and 1534 significant monomicrobic cultures respectively were reviewed. The frequency ofEscherichia coli dropped significantly in the outpatient clinics from 70.5% to 61.2% (pProteus mirabilis, Morganella morganii, Pseudomonas aeruginosa and other gram-negative bacteria also decreased, but the frequency ofKlebsiella spp. andEnterobacter spp. increased from 2.6% to 5.8% (pEnterobacter spp. (pEscherichia coli andMorganella morganii declined from 1991 to 1995, whereas the frequency ofPseudomonas aeruginosa (p=0.001),Acinetobacter spp. (pKlebsiella spp.,Proteus mirabilis and other gram-negative rods increased considerably. The frequency of gram-positive aerobic bacteria rose markedly in outpatient specimens from 6.1% to 13.5% (pEscherichia coli to gentamicin and ciprofloxacin (p<0.0001) was detected in outpatient isoates. In the hospital, gram-negative urinary pathogens demonstrated increased resistance to ampicillin (p=0.042), cefuroxime (p=0.005), gentamicin (p=0.002) and ciprofloxacin (p<0.0001) during the study period. The changing etiology of urinary tract infections and the increasing resistance of organisms indicate that periodic monitoring and possibly also modification of empirical therapy are required.