An Epidemic of Urinary Tract Infections?

Community-acquired urinary tract infections occur mostly in women, are generally caused by Escherichia coli, and are among the most common bacterial infections. For the past two decades, trimethoprim–sulfamethoxazole or trimethoprim alone has been used widely as empirical therapy for E. coli urinary tract infection. However, in the United States, resistance to trimethoprim–sulfamethoxazole among E. coli isolates from persons with community-acquired urinary tract infections has increased substantially over the past decade, with a prevalence that now exceeds 20 percent in many parts of the country.1 The prevalence of such resistance is substantially higher in the West (22 percent) than in the . . .