Resistance patterns of gram negative bacteria in urinary tract infections and efficacy of empirical treatment in noncomplicated cases: Retrospective cohort study of 2180 women
Keywords:Antimicrobial resistance, Empirical therapy, Urinary tract infections, Escherichia coli, Klebsiella spp
Aim: Community and hospital acquired urinary tract infections (UTI) are the most common bacterial infections in all age groups. In this study, the women diagnosed UTI, which complicated and uncomplicated, were referred to outpatient clinics between 2011 and 2015 were selected. The suitability of empirical antimicrobial therapy prescribed with resistance patterns of Gram negative bacteria isolated from these patients was investigated.
Methods: UTI complaining and urine culture ≥10⁵ cfu / ml of bacteria that women aged 18-65 were comprised the study group. HIS (Hospital Information System Software) was scanned for these patients and uncomplicated and complicated UTI distinction was made according to the criteria set by Infectious Diseases Society of America (IDSA, 2016). Of the 2180 patients studied, 836 were complicated and 896 were noncomplicated. Identification of Gram negative isolates in urine culture; Conventional methods and Matrix-Assisted Laser Desorption and Ionization Time-Of-Flight Mass Spectrometry (MALDI-TOF MS), (Biotyper, Bruker, Germany) systems were used. The antimicrobial susceptibilities of the isolated strains from 2011 to 2014 were determined according to the Clinical Laboratory Standards Institute (CLSI) and the isolated strains in 2015 were determined according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST).
Results: The distribution of 2180 female patients (18 to 65 years old) was urology polyclinic (68%), family medicine, infectious disease and physical medicine and rehabilitation polyclinics (19.1%), and emergency medicine polyclinic (12.6%). E. coli (84%), K. pneumonia / oxytoca (7%) and Enterobacter spp (2.6%) were the most frequently detected agents in the uncomplicated UTIs, while complicated UTI E. coli (91%), K. pneumonia / oxytoca (5.7%) and P. aeruginosa (1%) were found to be the first, second and third in the patients. Quinolones were prescribed 18.2%, phosphomycin 16.7%, nitrofurantoin 15.6%, nitrofurantoin and phosphomycin combined 16.3%, second generation oral cephalosporins 9.6% and third generation oral cephalosporins 10.7%. Resistance to quinolones, the most commonly prescribed antibiotic, was found in 19% of E. coli, 21% of Klebsiella spp., 13% of Enterobacter spp. and 9% of Proteus spp.
Conclusion: When these prescriptions were compared with the results of antimicrobial susceptibility, it was observed that 38 (14%) were incompatible with the sensitivity results. It was found that 42% of cefuroxime prescriptions, 28% of quinolone prescriptions and 17% of ceftriaxone prescriptions were incompatible with the antibiogram results.
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