Treatment of uncomplicated symptomatic urinary tract infections: Resistance patterns and misuse of antibiotics

Abstract

Introduction:Uncomplicated but symptomatic urinary tract infections (UTIs) are a common problem seen in practice. The study was undertaken to assess the most common pathogens responsible for uncomplicated symptomatic UTIs and the antimicrobial resistance pattern in a hospital in Bangalore. The study also explores the issue of antibiotic usage for these patients.Materials and Methods:The study was conducted in the Medicine department of a tertiary hospital in Bangalore. In all, 196 patients presented with symptoms of UTI. Bacterial growth was determined by standard microbiology techniques on freshly voided mid-steam urine samples collected from recruited patients. Patients’ demographic data, urine culture results, resistance rates to antimicrobial agents and prescribed empiric antimicrobial therapy were analyzed.Results:The prevalence of UTI was 32.1%; majority (67.9%) of the symptomatic did not have UTI based on culture report. Gram-negative bacteria constituted the largest group with a prevalence of 84.1% (53/63), with Escherichia coli being the most common (70%) uropathogen. Gram-negative isolates showed high level of sensitivity to amikacin (90.6%) and nitrofurantoin (77.4%). Most of the gram-positive organisms were susceptible to nitrofurantoin (70%) and gentamicin (50%). Uropathogens isolated demonstrated high resistance to cotrimoxazole, fluoroquinolones, and beta-lactam antibiotics. It was found out that 30.1% of the patients were wrongly managed of which 14.7% were over treated.Conclusion:UTI can be over diagnosed and over treated on the basis of clinical signs, symptoms and urine microscopy. In the era of emerging anti-microbial resistance, effective counseling and delay in antibiotic initiation or empirical therapy with a short course of nitrofurantoin is highly recommended. Empirical therapy guidelines should be updated periodically to reflect changes in antimicrobial resistance of uropathogens.

Anti-Microbial Resistance in Agents Causing Urinary Tract Infections

“…In a study conducted in India, it was observed that frequency rate for E.coli was 69.8% followed by Klebsiella to be 7.9%, 4.8% for Staphylococcus, 4.8% for Pseudomonas, 4.8% for Enterococcus and 1.6% for MRSA. (12) These results were comparable to our observations…”

Lactobacilli and Clove Essential Oil Against Menace of E.COLI: A Possible Solution for Antibiotic Resistance

“…[26] The problems further worsen due to wrong management of the infection and/or over treatment. [13] Another revealing study showed 96% (4% gram positives) of total isolated microbes from UTI cases to be gram negative bacteria, among which E.coli was most prevalent. Upon antibiotic sensitivity testing of the isolates by disc-diffusion method with thirteen mechanistically different antibiotics, the gram negatives showed more resistance towards these antibiotics as compared to gram positive bacteria.…”

“…[12] Another study done in medicine department at a tertiary hospital in Bangalore reported that gram negative bacteria constitute the largest group causing UTI (prevalence = 84.1%) with E.coli being the commonest (70%) uro-pathogen. [13] Problems associated with available treatment regime for E.coli infection: Apart from maintenance of adequate rehydration as primary treatment regime in case of E.coli diarrhea, a number of other treatment options are available for diverse range of pathogenic E.coli like antibiotic administration in case of extra-intestinal infections. [14] β-lactam antibiotics have been successfully used in such cases [15,16] [17] Emperical therapy failures are also common due to emergence of extended spectrum β-lactamases.…”

“…[6] High resistance to cotrimoxazole, β-lactam antibiotics, fluoroquinolones and 3 rd generation cephalosporins has also been noted in some studies. [12,13] Most of these bacteria have now developed resistance to the β-lactam drugs by producing Extended Spectrum β-Lactamase (ESBL) enzymes. [18] There has been an increase in the resistance towards fluoroquinolones, trimethoprim and cephalosporins among urinary tract infection cases in recent years, which is quite worrisome.…”

Molecular and Imaging Diagnostic Techniques for Urinary Tract Infections: Modern Approaches

“…Urinary tract infections are the most common diseases encountered in the practice of medicine today [2], major cause of patient death and health care expenditure for all age groups, and it is estimated to account for more than seven million clinic visits and more than one million hospital admissions per year. The total cost of urinary tract infections to the United States health care system in 2000 was approximately 3.5 billion dollars.…”