Mapping antimicrobial susceptibility of community-acquired uropathogenic Escherichia coli across low, middle and high-income countries highlights significant differences: insights for empiric treatment

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Rizvi, Meher and Khan, Maria and Al-Jardani, Amina Khalfan and Al-Abri, Seif Salem and Ghoshal, Ujjala C. and Jabri, Zaaima Al and Ahanjan, Mohammad and Mamari, Azza Al and Shizawi, Nawal Al and Sami, Hiba and Balkhair, Abdullah A.S. and Shaukat, Adila and Alkharusi, Alwarith Nasser Salem and Almahrouqi, Abdulrahman and Hassan, Afreenish and Kumar, Ajay and Saki-Malehi, Amal and Gul, Amina and Singh, Ashima and Shidhani, Asma Said Hamed Al and Siddiqui, Areena Hoda and Poojary, Aruna Ananda and Rashdi, Azza Al and Langford, Bradley J. and Stepanskyi, Dmytro O. and Dolatabadi, Abbas and Al-Maani, Amal Saif and Mufarji, Aisha Al and AlRisi, Elham and Kapoor, Garima and Princess, Isabella and Lawati, Hawra Al and El-Tahir, Hatim Ali and Sidairi, Hilal Al and Iskandar, Katia A. and Masters, Ken and Al-Busaidi, Ibrahim Khalaf Hamdan and Al-Yazidi, Laila S. and Nasrin, Mahfuza and Subhi, Mahmood Salim Al and Sengupta, Mallika and Khandait, Manisha and Tamtami, Nada Khalfan Al and Siyabi, Nada Khafan Al and Kindi, Nawal Al and Luthfee, Nazla and Shreshtha, Neha and Al Riyami, Nihal M. and Busaidi, Noora Hilal Ali Al and Goel, Nupur and Ishchenko, Oksana V. and Taher, Omnia Mohamed Elnabawy Ahmed and Jena, Pragnya Paramita and Ekadashi, Rajni Sabharwal and Al Zadjali, Razan and Kanungo, Reba and Abolghasemi, Sara and Maqbali, Salima Al and Banerjee, Sayantan and Yaqoob, Shadma and Sali, Shahnaz and Khan, Shafqat Husnain and Malhotra, Shalini and Hughes, Stephen J. and Shaukat, Sundas and Atif, Syed Mohammed and Patwardhan, Vrushali Vishwas and Dougnon, Victorien Tamègnon and Khan, Wahid and Wali, Walid and Muharrmi, Zakariya Al and Basit, Zeeshana and Choudhury, Jasashree and Pravalina, Rachita and John, Keith H.St and Singh, Sanjeev K. and Sarman, Singh and Taneja, Neelam K. and Sardana, Raman and Ghafur, Abdul K. and Kapoor, Pawan and Soman, Rajeev N. and Abri, Rashid Al (2025) Mapping antimicrobial susceptibility of community-acquired uropathogenic Escherichia coli across low, middle and high-income countries highlights significant differences: insights for empiric treatment. IJID Regions, 16. ISSN 27727076

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Abstract

Objectives: Rising antimicrobial resistance (AMR) in Escherichia coli urinary tract infections (UTI) poses a global challenge. Evidence-based treatment of cystitis requires local resistance data. The DASH to Protect Antibiotics (https://dashuti.com/), a multi-regional group, supports centers in generating and sharing focused antibiograms to guide stewardship in community UTIs. This multi-country study aimed to describe antimicrobial susceptibility patterns of community-acquired E. coli isolates in low, middle, and high-income countries (LMICs and HICs). Methods: The study was conducted in 37 representative centers across 13 countries in Asia (Middle East and Indian Subcontinent), Africa, Europe, and North America. A rigorous comparative analysis of the antimicrobial susceptibility of E. coli isolated from cases of simple cystitis presenting in outpatient or emergency departments was carried out. The impact of gross domestic product, climate, and population density per km<sup>2</sup> on E. coli susceptibility profile was analyzed using the Kruskal-Wallis test and two-way analysis of variance. Results: Antimicrobial susceptibility varied significantly between LMICs and HICs, with nitrofurantoin (89) and fosfomycin (96) emerging as empiric choices globally. Across most centers, susceptibility to other oral antimicrobials was low: co-trimoxazole <60, amoxicillin-clavulanic acid <70, first-generation cephalosporins <50, fluoroquinolones <60. Injectable antibiotics fared better: piperacillin-tazobactam >70, amikacin and meropenem >80. Higher susceptibilities were noted in countries with high gross domestic product (P < 0.001) and humidity (P = 0.002). Conclusion: Marked geographical differences in E. coli susceptibility patterns support the need for localized antibiograms and tailored empirical therapy. This study reinforces the utility of nitrofurantoin and fosfomycin as first-line agents and discourages the use of fluoroquinolones and third-generation cephalosporins. © 2025 Elsevier B.V., All rights reserved.

Item Type: Article
Additional Information: Cited by: 0
Subjects: Immunology and Microbiology > Microbiology
Divisions: Medicine > Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Salem > Medicine
Depositing User: Unnamed user with email techsupport@mosys.org
Last Modified: 14 Oct 2025 18:03
URI: https://vmuir.mosys.org/id/eprint/65

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