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


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.


CONCLUSIONS
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.
Department of Community Health and Family Medicine, Bangalore Baptist Hospital, Hebbal, Bellary Road, Bengaluru, Karnataka, India.
Carolin Elizabeth
CE
George
Department of Community Health and Family Medicine, Bangalore Baptist Hospital, Hebbal, Bellary Road, Bengaluru, Karnataka, India.
Gift
G
Norman
Department of Community Health and Family Medicine, Bangalore Baptist Hospital, Hebbal, Bellary Road, Bengaluru, Karnataka, India.
G Venkata
GV
Ramana
Department of Community Health and Family Medicine, Bangalore Baptist Hospital, Hebbal, Bellary Road, Bengaluru, Karnataka, India.
Devashri
D
Mukherjee
Department of Community Health and Family Medicine, Bangalore Baptist Hospital, Hebbal, Bellary Road, Bengaluru, Karnataka, India.
Tata
T
Rao
Anti microbial resistance; management; urinary tract infection