Antimicrobial resistance pattern in urinary tract pathogens and its impact on empirical therapy in general practice

ABSTRACT

Urinary tract infections [UTI] are very common infections in the community and are usually managed through empirical treatment. The knowledge of pattern of susceptibility of pathogens at the time of establishing an empirical treatment is fundamental to avoid therapeutic failure. The aim of this study was to evaluate the prevalence of uropathogens and their resistance pattern to various antimicrobials used in the treatment of community acquired UTI in the Capital Governorate in the State of Kuwait. Data was collected retrospectively from the main primary care laboratory in the Capital Governorate. Isolates from urine samples obtained during the period from November 2002 to May 2003 were analyzed using semiquantitative culture methods, and the prevalence of the uropathogens and their resistance pattern to antimicrobial agents was studied. A total of five thousand nine hundred and ninety two urine samples were analyzed manually using semiquantitative culture methods. Of these samples 1201 were reported to be positive and uncontaminated, with female predominance [91]. Bacteria most frequently isolated were Escherichia coli [43.3%], group B streptococci [24.8%] and Klebsiella. pneumoniae [10.3%]. The resistance pattern showed that more than 60% E. coli were resistant to ampicillin, 45% to trimethoprim-sulfamethoxazole, 25% to amoxicillin-clavulanic acid and 20% to nalidixic acid, while nitrofurantoin showed a low rate of resistance [2.8%]. K. pneumoniae showed a high level of resistance to ampicillin [94%] and trimethoprim-sulfamethoxazole [23%]. Resistance to nitrofurantoin in Proteus mirabilis was [81%] and 95% in Acinetobacter. There were high numbers of streptococci isolates, especially group B that were highly susceptible to ampicillin. On the other hand, Staphylococcus aureus was resistant to ampicillin and penicillin [87.5%]. Ciprofloxacin showed high activity against Gram-negative bacilli. Resistance rates of common uropathogens to many routinely used antimicrobials appear to be rising dramatically. Continued surveillance of resistance rates among uropathogens is needed to ensure that appropriate recommendations are made for treatment of infected patients. Further studies addressing clinical and bacteriological outcome in patients are required