Trends of antimicrobial resistance in Escherichia coli isolates from urine cultures of women in Jordan: A 10-year retrospective study


  • Mustafa Abdulkarim Alrabayah Assistant professor at The University of Jordan/ Amman.
  • Nisreen Abdel-kareem Nadi Anesthesia and Intensive Care resident at Jordan University Hospital
  • Aiman Mohammad Suleiman Anesthesia and Intensive Care resident at Jordan University Hospital
  • Ala' Mohammad Abbad Anesthesia and Intensive Care resident at Jordan University Hospital
  • Hadil Simon Ghanem Anesthesia and Intensive Care resident at Jordan University Hospital
  • Ahmad Mohammad Obeidat Anesthesia and Intensive Care resident at Jordan University Hospital
  • Maysarah Mahdi Alaqrabawi Anesthesia and Intensive Care resident at Jordan University Hospital
  • Moh'd Adnan Yousef Anesthesia and Intensive Care resident at Jordan University Hospital
  • Taima'a Ahmad Harb Anesthesia and Intensive Care resident at Jordan University Hospital
  • Isam Khair Al-Deen Bsisu Anesthesia and Intensive Care resident at Jordan University Hospital



Antimicrobial resistance, E.coli resistance, urinary tract infection, women, Jordan


Background: Urinary tract infection (UTI) is a common medical condition among women. E.coli is the most common causative organism. Appropriate understanding of the development of antimicrobial resistance over the past helps to establish efficient treatment strategies in the future. The study aims to discover antimicrobial resistance trends exhibited by E.coli strains isolated from women urine cultures over the past 10 years.

Methods: A total of 1874 affected urine samples over the years 2009 to 2018 were collectively reviewed and classified according to the response they showed to 24 different antimicrobial disks in the laboratory. Relations between time and resistance evolutionary profiles were calculated.

Results: Gentamicin (p value =0.039), Augmentin (p value =0.017), Cefoxitin (p value =0.001), Cefixime (p value =0.026) fulfilled satisfactory figures in terms of average resistance, regression of resistance, speed of resistance evolution, steadiness of performance, side effects, spectrum range and cost with high significance.

Conclusion: Drugs that showed satisfactory figures are recommended for future treatment protocols in Jordan.



Aslam B, Wang W, Arshad MI, Khurshid M, Muzammil S, Rasool MH, et al. Antibiotic resistance: a rundown of a global crisis. Infection and drug resistance. 2018;11:1645.

Cag Y, Caskurlu H, Fan Y, Cao B, Vahaboglu H. Resistance mechanisms. Annals of translational medicine. 2016;4.

Li B, Webster TJ. Bacteria antibiotic resistance: New challenges and opportunities for implantâ€associated orthopedic infections. Journal of Orthopaedic Research®. 2018;36:22-32.

Allcock S, Young E, Holmes M, Gurdasani D, Dougan G, Sandhu M, et al. Antimicrobial resistance in human populations: challenges and opportunities. Global health, epidemiology and genomics. 2017;2.

Soto SM. Role of efflux pumps in the antibiotic resistance of bacteria embedded in a biofilm. Virulence. 2013;4:223-9.

Lee C-R, Cho IH, Jeong BC, Lee SH. Strategies to minimize antibiotic resistance. International journal of environmental research and public health. 2013;10:4274-305.

Schmiemann G, Kniehl E, Gebhardt K, Matejczyk MM, Hummers-Pradier E. The diagnosis of urinary tract infection: a systematic review. Deutsches Ärzteblatt International. 2010;107:361.

PIÄ„TEK BMZ. Urinary tract infections of Escherichia coli strains of chaperone-usher system. Polish journal of microbiology. 2011;60:279-85.

Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature reviews microbiology. 2015;13:269.

Simmering JE, Tang F, Cavanaugh JE, Polgreen LA, Polgreen PM. The increase in hospitalizations for urinary tract infections and the associated costs in the United States, 1998–2011. Open forum infectious diseases: Oxford University Press; 2017.

Al-Badr A, Al-Shaikh G. Recurrent urinary tract infections management in women: a review. Sultan Qaboos University Medical Journal. 2013;13:359.

Jordan University Hospital Pharmacy Reports of Imported Drugs Quantities. Amman,Jordan: Jordan University Hospital; 2009-2018.

Brusch JL, Bavaro M, Cunha B, Tessier J. Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females Treatment & Management. Medscape Reference; 2019.

M100, Performance Standards for Antimicrobial Susceptibility Testing. West Vally Road, Suite 2500 Wayne, New Jersey, USA: Clinical and Laboratory Standards Institute; 2017.

Antimicrobial Stewardship Strategy:Formulary restriction. Toronto, ON: Queen’s Printer for Ontario: Ontario Agency for Health Protection and Promotion (Public Health Ontario); 2016.

Antimicrobial Stewardship Program strategy criteria reference guide. Toronto, ON: Queen’s Printer for Ontario: Ontario Agency for Health Protection and Promotion (Public Health Ontario); 2015.

Belyayeva M, Jeong JM. Acute Pyelonephritis. StatPearls [Internet]: StatPearls Publishing; 2019.

Minardi D, d’Anzeo G, Cantoro D, Conti A, Muzzonigro G. Urinary tract infections in women: etiology and treatment options. International journal of general medicine. 2011;4:333.

Ahmed A-fA-m, Solyman AA-k, Kamal SM. Potential host-related risk factors for recurrent urinary tract infection in Saudi women of childbearing age. International urogynecology journal. 2016;27:1245-53.

Mittal S, Kumar A, Govil N. Urinary Tract Infection: General Considerations. 2015.

Bajaj P, Singh NS, Virdi JS. Escherichia coli β-lactamases: what really matters. Frontiers in microbiology. 2016;7:417.

Fasugba O, Gardner A, Mitchell BG, Mnatzaganian G. Ciprofloxacin resistance in community-and hospital-acquired Escherichia coli urinary tract infections: a systematic review and meta-analysis of observational studies. BMC infectious diseases. 2015;15:545.

National Action Plan to Combat Antimicrobial Resistance. Hashimate Kingdom of Jordan: Ministry of Health; 2018.

Antimicrobial Resistance : National action plans. World Health Organization; 2016.

Joint Commission International Accreditation Standards for Hospitals. 5th ed. Oakbrook Terrace, Illinois 60181 US: Joint Commission International; 2014.

Jordan National Drug Formulary (JNDF). 2nd ed. Jordan: Ministry of Health; 2011.

Cho S-Y, Choi S-M, Park SH, Lee D-G, Choi J-H, Yoo J-H. Amikacin therapy for urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli. The Korean journal of internal medicine. 2016;31:156.

Hasvold J, Bradford L, Nelson C, Harrison C, Attar M, Stillwell T. Gentamicin resistance among Escherichia coli strains isolated in neonatal sepsis. Journal of neonatal-perinatal medicine. 2013;6:173-7.

Gregson DB, Matlow AG, Simor AE, Tuffnell PG, Low DE, Feld R, et al. Cotrimoxazole-resistant Escherichia coli bacteremia in neutropenic patients at a regional oncology hospital. Canadian Journal of Infectious Diseases and Medical Microbiology. 1992;3:14-8.

Leigh A. Augmentin (Amoxycillin and Clavulanic Acid) in the Treatment of Urinary Tract Infections. Scottish medical journal. 1982;27:S28-S34.

Zhang H, Kong H, Yu Y, Wu A, Duan Q, Jiang X, et al. Carbapenem susceptibilities of Gram-negative pathogens in intra-abdominal and urinary tract infections: updated report of SMART 2015 in China. BMC infectious diseases. 2018;18:493.

Niranjan V, Malini A. Antimicrobial resistance pattern in Escherichia coli causing urinary tract infection among inpatients. The Indian journal of medical research. 2014;139:945.

Chua KY, Stewardson AJ. Individual and community predictors of urinary ceftriaxone-resistant Escherichia coli isolates, Victoria, Australia. Antimicrobial Resistance & Infection Control. 2019;8:36.

Endimiani A, Perez F, Bonomo RA. Cefepime: a reappraisal in an era of increasing antimicrobial resistance. Expert review of anti-infective therapy. 2008;6:805-24.

Kapoor A, Raju S. Illustrated medical pharmacology: JP Medical Ltd; 2013.