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Evaluating antimicrobial effectiveness in acute uncomplicated cystitis: A retrospective single-center study
Takuhisa Nukaya1, Kiyohito Ishikawa1, Ryoichi Shiroki1
1Department of Urology Fujita Health University School of Medicine Nagoya Aichi Japan.
Journal of General and Family Medicine
|September 4, 2025
Summary
Beta-lactam/beta-lactamase inhibitor combinations show highest effectiveness for acute uncomplicated cystitis (AUC) treatment. This is especially true for fluoroquinolone-resistant E. coli infections, offering a promising therapeutic option.
Area of Science:
- Urology
- Infectious Diseases
- Pharmacology
Background:
- Acute uncomplicated cystitis (AUC) is a common urinary tract infection.
- Antimicrobial therapy is the standard treatment for AUC.
- Increasing prevalence of fluoroquinolone (FQ)-resistant Escherichia coli poses a therapeutic challenge.
Purpose of the Study:
- To evaluate the real-world effectiveness of antimicrobial treatments for AUC caused by E. coli.
- To assess treatment outcomes in the context of rising FQ resistance.
Main Methods:
- Retrospective cohort study of 730 AUC patients treated at Minami Cooperative Hospital (April 2016 - December 2020).
- Analysis of E. coli detection rates and antimicrobial resistance patterns, including levofloxacin (LVFX) resistance.
- Comparison of clinical effectiveness across different antimicrobial classes: beta-lactam/beta-lactamase inhibitor (BL/BLI) combinations, cephalosporins (CPs), FQs, and sulfamethoxazole-trimethoprim (ST).
Main Results:
- E. coli was detected in 73.4% of patients; 26.7% exhibited LVFX-resistant strains.
- LVFX-resistant E. coli was associated with older age (≥55 years) and recurrent infections.
- BL/BLI combinations demonstrated the highest overall effectiveness (94.7%) and were most effective against LVFX-resistant E. coli (100%).
- Effectiveness of other agents varied: FQs showed lower efficacy against resistant strains (50%).
Conclusions:
- Beta-lactam/beta-lactamase inhibitor combinations are highly effective for AUC treatment.
- These combinations represent a superior therapeutic option, particularly for infections involving FQ-resistant E. coli.
- Clinical guidelines should consider the efficacy of BL/BLI combinations in AUC management.
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