الفهرس 
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Abstract
Summary and conclusion
After notifying the role of fluoroquinolones in UTIs caused by E. coli, the present study is undertaken to study resistance towards urinary E. coli with various generations of fluoroquinolones and also to assess sensitivity pattern of other drugs in place of fluoroquinolones resistant E. coli urinary tract infections with an objective to define appropriate intervention strategies to be applied inpatient care and management.
This study was carried out in the Clinical Pathology Department, faculty of medicine, Sohag university hospital. In this study we performed complete blood count, creatinine, urea, urine analysis and urine culture and sensitivity.
E.coli was isolated from 100 patient (71%) of all patients complaining of UTI with positive urinary culture, they are considered our study or case group.
By studying prevalence of Antibiotic resistance of E.coli isolates reveals that Fluoroquinolones show sensitivities of 42-46%; being higher among 1st generation (ciprofloxacin; 46%); and lower among the 3rd and 4th generations (Gatifloxacin and Moxifloxacin; 42%). Also Nitrofurantoin has the highest sensitivity of 87%. This is followed by meropenem (67%). Ampicillin shows sensitivity in only 6% of cases.
Regarding drug sensitivity in out & inpatients, we find that all generations of fluoroquinolones show highly significant resistance ratios among inpatients compared to outpatients. Meropenem show resistance more in inpatients than outpatients, with significant difference ,Ampicillin and Nitrofuratoin show non significant difference.
IN CONCLUSION
The present study shows an increased fluoroquinolone resistance among uropathogenic E. coli isolates mainly in hospital admitted patients.
RECOMMENDATIONS
We recommend:
1. Close attention to monitor fluoroquinolone susceptibility patterns and the association of multidrug resistance with fluoroquinolone resistance in isolates of E. coli and other bacteria causing urinary tract infections and other infections.
2. The increased prescription of fluoroquinolones as first-line therapy for common infections such as cystitis will facilitate the emergence of resistance to this class of compounds and promote the emergence of multidrug-resistant strains and, therefore, should be discouraged as it will undermine the efficacy of fluoroquinolones to treat more-serious infections.
3. Fluoroquinolone- sparing agents should be given higher priority than fluoroquinolones in the treatment of cystitis .
4. Continued surveillance of urinary tract isolates of E. coli and other pathogens is important, and appropriate clinical use of fluoroquinolones is imperative as they become more widely prescribed.
5. Other large-scale studies are recommended to reflect the resistance in fourth generation of fluoroquinolones more than first generation.
6. Further research into the molecular basis of FQ resistance could lead to new therapeutic strategies for FQ-resistant E. coli.