Regional community-acquired urinary tract infections in Israel: diagnosis, pathogens, and antibiotic guidelines adherence: a prospective study.
BACKGROUND
The identification and treatment of hospitalized patients with community-acquired urinary tract infections (CAUTI) may be a challenge. The pathogens causing the infection and their relative proportions vary geographically and with time. This observational prospective study had three primary goals: (1) to estimate the likelihood of diagnosis of CAUTI upon admission; (2) to evaluate adherence to the institutional recommendations; (3) to assess the compatibility of the current local antibiotic recommendations with a pathogen's distribution and with its drug sensitivities.


RESULTS
Two hundred and twenty-three patients with positive urinary cultures fulfilling criteria for CAUTI were studied. Only 54 (24.2%) were diagnosed as having a urinary tract infection upon admission. Approximately 90% of the patients, who were correctly diagnosed, received the institutional recommended antibiotic therapy (ofloxacin or cefuroxime). Gram-negative intestinal flora comprised 86.1% (192 patients) of the causative microorganisms. Of these, 20.3% of the pathogens demonstrated resistance to ofloxacin and 19.8% to cefuroxime. The prevalence of Escherichia coli, the most common pathogen of UTI, significantly declined in the current study, from 70.5% in 1991 to 56% in 2000.


CONCLUSIONS
We observed a low sensitivity in diagnosing community-acquired urinary tract infections upon admission. In patients correctly diagnosed, the use of recommended antibiotics was high. A substantial percentage of the pathogens were resistant to the recommended antibiotics. This study stresses the need for frequent re-evaluation of the prevalence of pathogens involved in regional community-acquired urinary tract infections and the adjustment of the empirical first-line treatment accordingly.
Nesher
L
L
Department of Internal Medicine, Soroka Medical Center and Ben-Gurion University, Box 151, Beer Sheva 84101, Israel. nesherke@bgu.ac.il
Novack
V
V
Riesenberg
K
K
Schlaeffer
F
F
D000368:Aged; D000892:Anti-Infective Agents, Urinary / Q000494:pharmacology / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D019983:Guideline Adherence; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology
D000892:Anti-Infective Agents, Urinary