Surveillance Epidemiology and frequency of resistance among pathogens causing urinary tract infections in 1,510 hospitalized patients: A report from the SENTRY Antimicrobial Surveillance Program (North America) D. Mathai a , R. N. Jones a, *, M. A. Pfaller a , The SENTRY Participant Group North America b a University of Iowa College of Medicine, Iowa City, IA, USA b The JONES Group/JMI Laboratories, 345 Beaver Kreek Centre, Suite A, North Liberty, IA, USA Abstract Bacterial urinary tract infections (UTIs) are an important cause of septicemia resulting in high mortality rates, prolonged hospital stays and increased healthcare costs. Periodic reviews of pathogen frequency and susceptibility patterns impact on appropriate antimicrobial usage, leading to more effective prescribing practices. As part of the SENTRY Antimicrobial Surveillance Program (SENTRY, 1998), participants collected 50 consecutive UTI pathogens from patients hospitalized in 31 medical centers (26 in the United States and five in Canada) and forwarded subcultures to the coordinating center. Thirty-four antimicrobial agents were tested including two investigational compounds (quinupristin/dalfopristin [Q/D], gatifloxacin). The rank order of the 32 species identified during the study was: Escherichia coli (46.9%)  Enterococcus spp. (12.8%)  Klebsiella spp. (11.0%)  Pseudomonas aeruginosa (7.5%)  Proteus mirabilis (5.0%)  coagulase-negative staphylococci (CoNS; 3.4%). This pathogen rank order did not change from 1997 to 1998, but resistance patterns changed. Clonal spread of confirmed extended spectrum -lactamase-producing strains was not observed, but co-resistance was elevated for aminoglycosides, tetracyclines, sulfonamides, and fluoroquinolones. P. aeruginosa was most susceptible to amikacin (97.3%)  pipera- cillin  tazobactam (92.0 –95.6%)  cefepime = imipenem (91.2%)  ceftazidime (85.8%). Fluoroquinolone resistance was greater in P. aeruginosa (24.8 –39.8%)  P. mirabilis (5.3–13.3%)  Enterobacter spp. (6.7– 8.9%)  Klebsiella spp. (4.2–7.8%)  E. coli (3.0 –3.8%). Only 5% of enterococci were resistant to vancomycin. These results emphasize the need for continued surveillance studies for common infections which establish baseline resistance patterns by geographic areas, and have the potential to detect epidemics or direct local epidemiologic interventions. © 2001 Elsevier Science Inc. All rights reserved. 1. Introduction Urinary tract infections (UTIs) constitute the most prev- alent group of bacterial infection seen in domiciliary care settings in the United States (US), with over 7 million additional clinic visits annually (Patton et al., 1991). A fifth of the residents in nursing homes also have significant (non-catheter related) bacteriuria (Nicolle et al., 1996), with estimates of 1 to 8% of such patients needing transfer to hospitals. Up to 25% of patients already hospitalized with other medical and surgical conditions require endourologi- cal interventions (usually catheters) that could result in a nosocomial infection (Rosser et al., 1999). Among the hos- pitalized patients (constituting over 1.5 million hospital case records), and in particular the elderly subset, UTIs are the cause of over half of the bacteremic episodes and are asso- ciated with a high (16 –23%) case fatality rate, prolonged stay, and added health care costs (Bishara et al., 1997; Eykyn, 1998; Jarvis, 1996; Paradisi et al., 1998; Platt et al., 1982). In recent years, the etiologies of UTI cases and their antimicrobial susceptibility patterns have been changing in these patient care settings and in various geographic regions (Bronsema et al., 1993; Maniatis et al., 1997; Vromen et al.,1999; Weber et al., 1997). During a five year interval (1992 through 1996) at a single institution in the US, Esch- erichia coli and Staphylococcus saprophyticus were the causative pathogens in 90% of acute uncomplicated cystitis in females aged 18 to 50 years attending outpatient clinics or emergency departments in a managed care setting (Gupta et al., 1999). Microbial resistance to trimethoprim-sulfame- thoxazole (TMP-SMX) doubled in E. coli from 9 to more than 18%, and in all other uropathogens from 8 to 16% during the same period. In surveys of North and Latin * Corresponding author. Tel.: +1-319-665-3370; fax: +1-319-665- 3371. E-mail address: Ronald-jonesgr.com (R.N. Jones). www.elsevier.com/locate/diagmicrobio Diagnostic Microbiology and Infectious Disease 40 (2001) 129 –136 0732-8893/01/$ – see front matter © 2001 Elsevier Science Inc. All rights reserved. PII: S0732-8893(01)00254-1