Urinary tract infections, antibiotic resistance and sales of antimicrobial drugs--an observational study of uncomplicated urinary tract infections in Icelandic women

OBJECTIVES: To analyse the antimicrobial susceptibility pattern of bacteria causing symptomatic but otherwise uncomplicated lower urinary tract infections (UTI) in primary health care and the sales of antimicrobial drugs. SETTING: Primary health care in Akureyri District, Northern Iceland, with about 17400 inhabitants. PATIENTS: A total of 516 episodes of symptomatic but otherwise uncomplicated lower UTI in women 10 to 69 years of age. MAIN OUTCOME MEASURES: Number of verified UTI, bacterial species, antimicrobial susceptibility pattern, and total sales of antimicrobial drugs. RESULTS: Escherichia coli was by far the most common cause of UTI (83%), followed by Staphylococcus saprophyticus (7%). Infections caused by E. coli resistant to ampicillin accounted for 36% of cases, with the corresponding figures for sulfafurazol being 37%, cephalothin 45%, trimethoprim 13% and mecillinam 14%. Only 1% of the strains were resistant to nitrofurantoin. The total use of antimicrobial drugs was 17.4 DDD/1000 inhabitants/day. CONCLUSIONS: The resistance of bacteria causing uncomplicated UTI to common antimicrobials is high and must be taken into account when selecting treatment strategies. High consumption of antibiotics in the community indicates possible association.