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Urinary Tract Infection

The standard cystitis antibiotic worked in 58.4 percent of Korean cases. In recurrent cystitis, 59.8 percent of isolates were resistant to it

National surveillance of 885 patients puts numbers on a drug most people are still prescribed first. Fosfomycin was 94.9 percent effective. Ciprofloxacin was closer to a coin toss.

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In short

In the 2023 Korean Antimicrobial Resistance Monitoring System surveillance of 885 patients with uncomplicated cystitis, run by the Korean Association of Urogenital Tract Infection and Inflammation, Escherichia coli was the commonest uropathogen at 75.1 percent (654 of 871) and susceptibility was 94.9 percent to fosfomycin, 90.5 percent to nitrofurantoin, 83.6 percent to cefotaxime, 100.0 percent to ertapenem and only 58.4 percent to ciprofloxacin — while fluoroquinolone resistance reached 59.8 percent in recurrent cystitis, 44.9 percent in postmenopausal patients and 47.4 percent in tertiary hospitals, with recurrence (odds ratio 2.37, 95% CI 1.44 to 3.92) and postmenopausal status (OR 1.96, 95% CI 1.38 to 2.77) independently associated with it.

Key takeaways

  • 885 patients with uncomplicated cystitis were captured in Korea's national antimicrobial resistance surveillance for 2023, with a mean age of 56.4 years.
  • 530 patients (61.1 percent) were postmenopausal and 102 (11.5 percent) had recurrent cystitis.
  • Escherichia coli was the commonest uropathogen, at 654 of 871 isolates (75.1 percent).
  • Susceptibility was 94.9 percent to fosfomycin, 90.5 percent to nitrofurantoin, 83.6 percent to cefotaxime and 100.0 percent to ertapenem.
  • Susceptibility to ciprofloxacin was 58.4 percent, and fluoroquinolone resistance reached 59.8 percent in recurrent cystitis.
  • Extended-spectrum beta-lactamase positivity was 13.7 percent overall, rising to 24.7 percent in recurrent cystitis and 23.1 percent in tertiary hospitals.
  • Recurrent cystitis (OR 2.37) and postmenopausal status (OR 1.96) were each independently associated with fluoroquinolone resistance.

A fluoroquinolone is still what many women with cystitis are handed, on the reasoning that it is convenient, well absorbed and reliably effective. The first two remain true in Korea. The third has stopped being true.

58.4%

of uropathogens from Korean patients with uncomplicated cystitis were susceptible to ciprofloxacin in 2023 national surveillanceYu SH et al., Investigative and Clinical Urology, 2025

What still works

The contrast inside the same dataset is what makes the number actionable rather than merely alarming. Fosfomycin came in at 94.9 percent and nitrofurantoin at 90.5 percent — both oral, both narrow-spectrum, both designed for exactly this infection. Cefotaxime was 83.6 percent and ertapenem 100.0 percent, though those are injectable and belong to a different tier of decision.

So this is not a study about running out of options. It is a study about the ranking of the options being out of date. The drug with the worst susceptibility in this survey is the one with the strongest habit behind it.

The patients where it fails most

Fluoroquinolone resistance was 59.8 percent in recurrent cystitis, 44.9 percent in postmenopausal patients and 47.4 percent in tertiary hospitals. Recurrence carried an odds ratio of 2.37 for resistance and postmenopausal status 1.96, both independently.

What surveillance of this size can and cannot say

885 patients is a substantial national sample for a single year and a small one for subgroup analysis — the recurrent cystitis group is 102 people, and its 59.8 percent figure carries the uncertainty that follows from that. The data are also drawn from participating centres rather than from every clinic in the country, and tertiary hospitals, where resistance ran highest, are over-represented relative to where most cystitis is actually treated.

The system is designed to be repeated, which is its point. A single year's resistance figure is a snapshot; the value of continuous surveillance is the trend it will produce, and the 2023 snapshot is the baseline against which the next one gets read.

Sources

  1. 1

    Yu SH, Jung SI, Lee SJ, Oh MM, Choi JB, Choi CI, Kim YJ, Park DJ, Bae S, Min SK

    Nationwide surveillance of antimicrobial resistance for uncomplicated cystitis in 2023: Conducted by the Korean Association of Urogenital Tract Infection and Inflammation

    Investigative and Clinical Urology 2025;66(2):161-171

    doi:10.4111/icu.20240302 · PMID:40047130

    https://doi.org/10.4111/icu.20240302