title: Adherence to Hospital Antibiotic Policy for Treatment of Escherichia coli ESBL in Urine.
abstract: BACKGROUND
  Escherichia coli are the most common uropathogen worldwide accounting for 80% of the Urinary Tract Infections (UTIs). Nosocomial infections caused by Multi-drug resistant Gram negative bacteria expressing Extended Spectrum β Lactamase enzyme, pose a serious therapeutic challenge to clinicians due to limited therapeutic options. Stringent adherence to Hospital Antibiotic Policy in treating Urinary Escherichia coli ESBLs is a borne necessity.
  
  
  OBJECTIVE
  A clinical audit was undertaken in the form of a cross-sectional study to evaluate the compliance on appropriate antibiotic prescription and strict adherence to Hospital Antibiotic Policy for therapeutic management of the patients infected with urinary Escherichia coli ESBL producers.
  
  
  METHODS
  A cross-sectional medical audit on adherence to treatment of Escherichia coli ESBL producers from in-patients diagnosed to have urinary tract infections for a duration of 7 months was conducted as a prospective study. Clinical data, culture and sensitivity reports of the patient diagnosed with urinary Escherichia coli ESBLs were compared with the treatment chart to ensure strict adherence to hospital antibiotic policy for appropriate therapy by physicians. Data were analysed using IBM SPSS version 20 software.
  
  
  RESULTS
  The incidence of uncomplicated cystitis, pyelonephritis and complicated pyelonephritis cases were 65.24% (107 out of 164), 20.7% (34 out of 164) and 14.02% (23 out of 164) respectively. Resistance to individual fluoroquinolones like norfloxacin, ciprofloxacin and ofloxacin were found to be 60%, 59% and 47.5% respectively. As per hospital antibiotic policy, fluoroquinolones were prescribed in only 23% of the patients for the treatment of urinary Escherichia coli ESBLs.
  
  
  CONCLUSIONS
  Irrational utilization of antibiotics and non-adherence to antibiotic policy could have been the significant risk factors for drug resistance. Optimized antibiotic use, Microbiology laboratory support and periodic antibiotic audit led by effective infection control team would hasten the development of drug resistance.
authors.affiliation: Assistant Professor, Department of Microbiology, Karpagam Faculty of Medical Sciences & Research , Pollachi Main Road, Othakalmandapam, Coimbatore, India .
authors.forename: R
authors.initials: R
authors.lastname: Someshwaran
authors.affiliation: Tutor, Department of Microbiology, Karpagam Faculty of Medical Sciences & Research , Pollachi Main Road, Othakalmandapam, Coimbatore, India .
authors.forename: K Gnana
authors.initials: KG
authors.lastname: Prakash
authors.affiliation: Assistant Professor, Department of Microbiology, Karpagam Faculty of Medical Sciences & Research , Pollachi Main Road, Othakalmandapam, Coimbatore, India .
authors.forename: Shreeram A
authors.initials: SA
authors.lastname: Deshpande
authors.affiliation: Professor and HOD, Department of Microbiology, Karpagam Faculty of Medical Sciences & Research , Pollachi Main Road, Othakalmandapam, Coimbatore, India .
authors.forename: Anbu N
authors.initials: AN
authors.lastname: Aravazhi
keywords: Drug resistance; Fluoroquinolones; Medical audit; Morbidity and mortality; Rational antibiotic use; Treatment outcome