Increasing Antibiotic Resistance Among Isolates of Escherichia Coli Recovered from Inpatients and Outpatients in a Saudi Arabian Hospital

Objective: To study the pattern of antibiotic resistance among Escherichia coli and the trend in resistance during a 6-year period in a Saudi Arabian hospital.

Design: Retrospective in vitro surveillance study of the antibiotic susceptibility pattern among E. coli isolates recovered from outpatients and from inpatients.

Setting: A general hospital in Saudi Arabia.

Patients: All patients with a culture positive for E. coli during a 6-year study period.

Results: A statistically significant increase in antibiotic resistance was observed among outpatient and inpatient isolates of E. coli. Inpatient isolates were more likely to be resistant to antimicrobial agents. Among isolates from outpatients, 50% were resistant to ampicillin, 33% were resistant to trimethoprim-sulfamethoxazole (TMP-SMZ), and 14% were resistant to ciprofloxacin. Among isolates from inpatients, 63% were resistant to ampicillin, 44% were resistant to TMP-SMZ, and 33% were resistant to ciprofloxacin. There was a low rate of resistance to imipenem (0.3% of isolates), amikacin (2%), and nitrofurantoin (2.4%-6.5%). Resistance to ceftazidime was detected in 9% of outpatient isolates and 17% of inpatient isolates. Multidrug resistance was defined as resistance to 2 or more classes of antibiotics. Multidrug resistance was detected in 2.0%-28.1% of outpatient isolates and 7.4%-39.6% of inpatient isolates, depending on the combination of antimicrobials tested. More isolates were resistant to ampicillin plus TMP-SMZ than to any other combination of antimicrobials.

Conclusion: The prevalence of antibiotic resistance among outpatient and inpatient E. coli isolates increased during the study period. The rates of antibiotic resistance were statistically significantly higher among inpatient isolates, compared with outpatient isolates. These findings call for wiser use of antibiotics and continued surveillance of antibiotic resistance.