Comparison of empirical antibiotics used with microbiological sensitivity pattern among patients admitted with urinary tract infection
DOI:
https://doi.org/10.18203/2320-6012.ijrms20210425Keywords:
Urinary Tract Infection, Empirical Antibiotics, Antibiotic resistance, microbiological sensitivity.Abstract
Background: Symptomatic Urinary tract infection (UTI) is among the most common infection described in hospital settings. Inappropriate use of antibiotics initiated before the laboratory results of urine culture contribute to increasing resistance to antibiotics in uropathogens. Awareness of the disease, knowledge of the spectrum of antibiotics and common complication of UTI will help to reduce morbidity and mortality. This study compares common empirical antibiotics used with their clinical outcomes and microbiological sensitivity pattern among patients admitted with UTI in a tertiary care hospital.
Methods: It is a cross sectional study conducted in inpatients of Pushpagiri medical college, Thiruvalla from January 2017 – June 2018. Assuming that 50% of organisms will show sensitivity to empirical antibiotic therapy with a relative precision of 20% and alpha error of 5 %. Sample size is calculated as 100. Those patient satisfying the inclusion criteria was recruited into the study after obtaining informed consent till the sample size attained. Symptoms on the day of admission was assessed using the questionnaire for Clinical profile. Primary outcome was matching of empirical antibiotics with culture and sensitivity pattern. Secondary outcomes were Symptom resolution on third day with empirical antibiotics and profile organisms causing UTI.
Results: Majority of the population belonged to 61-80 year of age (57%). The study population had 44 percent male and 56 females.72 percent of total population was diabetic. The most common antibiotic used to treat empirically was piperacillin –tazobactum accounting for 47.2 percent followed by ceftriaxone 45 percent. Others contributed less than 8 percent.75 percent of empirical antibiotics matched with culture and sensitivity report in the study population.The most common organisms found was Escherichia coli (61%) followed by Klebsiella pneumonia(15 %) The most common resistant organism was E Coli followed by Klebsiella pneumonia. Esbl resistance was encountered in 28 cases and carbepenamase resistance in 2 percent cases. 27 percent of diabetic patient had resistant organism infection in urine. Symptoms of urinary tract infections were better resolved when empirical antibiotics used had matched microbiological sensitivity pattern.
Conclusions: After the age of 60 year UTI occurred almost equal in male and females There was only 75 percent agreement with empirical antibiotics and culture sensitivity report. Resistant organism were common in the diabetic population. Most common organism encountered in symptomatic UTI is E coli. Symptomatic resolution occurred in majority of cases where the empirical antibiotic was sensitive than compared to resistant case. Some of the resistant cases had symptomatic resolution possibly explained by the in vivo sensitivity. As the agreement with empirical antibiotics became low, hospital antibiotic policies must reviewed and changed according to resistance pattern and type of organism that is locally prevalent
References
Flores-Mireles A, Walker J, Caparon M, Hultgren S. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13(5):269-84.
Barber A, Norton J, Spivak A, Mulvey M. Urinary tract infections: current and emerging management strategies. Clin Infect Dis. 2013;57(5):719-24.
Hooton TM. Uncomplicated urinary tract infection. New Engl J Med. 2012;366(11)1028-37.
Nielubowicz GR, Mobley HL. Host-pathogen interactions in urinary tract infection. Nature Rev Urol. 2010;7:430-41.
Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clinical infectious diseases. 2005;40(5):643-54.
Arinzon Z, Shabat S, Peisakh A, Berner Y. Clinical presentation of urinary tract infection (UTI) differs with aging in women. Arch Gerontol Geriatr. 2012;55(1):145-7.
Kronenberg A, Bütikofer L, Odutayo A, Mühlemann K, da Costa BR, Battaglia M, et al. Symptomatic treatment of uncomplicated lower urinary tract infections in the ambulatory setting: randomised, double blind trial. BMJ. 2017;359:j4784.
Gupta K, Barbara W. Urinary Tract Infections, Pyelonephritis and Prostatitis. In: Braunwald E, Kasper D, Hauser S, Longo D, Jameson J, Loscalzo J. Harrison’s Principles of Internal Medicine. 19th Edn. McGraw-Hill Publication; 2015:861-868.
Cotter M, Donlon S, Roche F, Byrne H, Fitzpatrick F. Healthcare-associated infection in Irish long-term care facilities: results from the First National Prevalence Study. J Hosp Infect. 2012;80(3):212-6.
Curns AT, Holman RC, Sejvar JJ, Owings MF, Schonberger LB. Infectious disease hospitalizations among older adults in the United States from 1990 through 2002. Arch Intern Med. 2005;165(21):2514-20.
Rowe TA, Juthani-Mehta M. Urinary tract infection in older adults. Aging Health. 2013;9(5):519-28.
Gale J. India’s Diabetes Epidemic Cuts Down Millions Who Escape Poverty. Bloomberg. 2010. Available from: https://www.bloomberg.com/news/articles/2010-11-07/india-s-deadly-diabetes-scourge-cuts-down-millions-rising-to-middle-class. Accessed on 8 June 2012.
Nitzan O, Elias M, Chazan B, Saliba W. Urinary tract infections in patients with type 2 diabetes mellitus: review of prevalence, diagnosis, and management. Diabetes Metab Syndr Obes. 2015;8:129-36.
Pallett A, Hand K. Complicated urinary tract infections: practical solutions for the treatment of multiresistant Gram-negative bacteria. J Antimicrob Chemother. 2010;65(3)iii25-33.
Wells WG, Woods GL, Jiang Q, Gesser RM. Treatment of complicated urinary tract infection in adults: combined analysis of two randomized, double-blind, multicentre trials comparing ertapenem and ceftriaxone followed by appropriate oral therapy. J Antimicrob Chemother. 2004;53(2):ii67-74.
Behzadi P, Behzadi E, Yazdanbod H, Aghapour R, Cheshmeh AM, Omran SD. A survey on urinary tract infections associated with the three most common uropathogenic bacteria. Maedica (Buchar). 2010;5(2):111-5.
Aswani SM, Chandrashekar UK, Shivashankara KN, Pruthvi BC. Clinical profile of urinary tract infections in diabetics and non-diabetics. Australas Med J. 2014;7(1):29.
