Background/Purpose:

Rheumatoid arthritis (RA) is a chronic autoimmune disease that requires chronic immunosuppressive treatment. Urinary tract infections (UTI) are common among patients with RA. It has been suggested that hydroxichloroquine (HCQ), a drug used in the treatment of RA, may have antimicrobial activity and induce selective resistance to fluoroquinolones in bacterial species. However, this has not been well established.

To evaluate the association between use of HCQ and development of fluoroquinolone resistance in Escherichia coli among patients with RA and UTI.

Methods:

Retrospective case-control study. We evaluated 225 patients with RA and UTI. Cases were defined as patients receiving HCQ, and controls as those receiving a different treatment. Demographics and clinical features were assessed, and laboratory data was obtained from urine cultures and antibiotic susceptibility tests. Univariate and multivariate analyses were performed.

Results:

There were 112 subjects in the HCQ group and 113 controls. The mean±SD age in the HCQ group and controls was 51 ± 15.66, and 60 ± 15.35 years, respectively. Duration of RA was 12± 8.67 and 17± 9.48 years in the HCQ and control groups, respectively. Overall, 61% of patients received methotrexate, 50% HCQ, and 29% prednisone. Class I/II functional status was observed in 63% of patients, and class III/IV in 37%. Resistance to ciprofloxacin was found in 102 (45%) patients overall, and it was less common among the HCQ group compared with controls, although the difference was not statistically significant (43% vs. 48%, p-value = 0.458). The factors associated with resistance to ciprofloxacin in univariate analysis were: UTI within the last six months, previous antibiotic use, diabetes mellitus, and RA functional status. In logistic regression analysis, RA functional status class and previous antibiotic use were the only significant independent predictors of fluoroquinolone resistance.

Conclusion:

Resistance to ciprofloxacin is common among patients with RA and UTI. We found no evidence that the use of HCQ is associated with fluoroquinolone resistance in patients with RA and Escherichia coli UTI. RA functional status class III/IV was a significant independent predictor of fluoroquinolone resistance.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fluoroquinolone-resistance-in-escherichia-coli-urinary-tract-infections-among-patients-with-rheumatoid-arthritis-does-use-of-hydroxichloroquine-matter/