Are fluoroquinolones still viable for empirical UTI treatment? Evidence from southeastern Brazil
Abstract
Urinary tract infections frequently require empirical antimicrobial therapy, although increasing fluoroquinolone resistance may limit their use. This retrospective cross-sectional study evaluated local susceptibility patterns and factors associated with resistance in urine cultures from outpatients attending a university hospital in southeastern Brazil during 2024. Of 1,958 cultures, 418 (21.35%) showed significant bacterial growth. Escherichia coli was the predominant pathogen (48.3%), followed by Klebsiella spp. (17.9%). Resistance to ciprofloxacin and levofloxacin was 33.1% and 25.0%, respectively, while ciprofloxacin resistance reached 37.6% among E. coli isolates. Increasing age remained independently associated with fluoroquinolone resistance after adjustment for sex. These findings indicate that local resistance rates exceed recommended thresholds for empirical therapy, reinforcing the need for periodic protocol review, microbiological surveillance, and antimicrobial stewardship.
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