Which antibiotics should we prefer empirical treatment of urinary tract infections in elderly patients?

Abstract

Aim: Urinary tract infection (UTI) is a major cause of mortality and morbidity in elderly patients. In this cross-sectional study, we aimed to determine the frequency and antibiotic resistance profile of the bacteria causing UTI and contribute to the empirical treatment options in elderly patients.

Methods: This study included urine culture results from 347 elderly outpatients who were referred to Karabuk Training and Research Hospital between January 2018 and June 2019. The identification and antibiotic susceptibilities of microorganisms were determined using the BD-Phoenix 100 fully automated system, and the extended-spectrum beta-lactamase (ESBL) positivity was analyzed using the combined disk diffusion method. The results were retrospectively analyzed. 

Results: The most common pathogens were Escherichia coli (58%), Enterococcus spp. (18%) and Klebsiella pneumoniae (11%). The rate of resistance to ampicillin, amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole (TMP-SMX), cefixime, and ciprofloxacin, which are oral antibiotics used in the treatment of UTI, was between 30% and 70%. The rate of resistance to nitrofurantoin was 3%. The gentamicin and piperacillin-tazobactam resistance were 12% and 9%, respectively. The ESBL positivity for E. coli and K. pneumoniae were 29% and 49%, respectively (P=0.03).

Conclusion: The rates of resistance to oral antibiotics such as ampicillin, amoxicillin-clavulanic acid, TMP-SMX, cefixime, and ciprofloxacin, which are used treatment of UTI, were more than 20%. Therefore, these antibiotics should not be used in the empirical treatment of UTI. Instead, nitrofurantoin may be preferred in the empirical treatment of uncomplicated UTI, or gentamicin and piperacillin-tazobactam, which are parenteral antibiotics that may be used depending on the patient’s clinical condition.

Keywords

• Antibiotics,Enterococcus species,Escherichia coli,Nitrofurantoin,Ciprofloxacin,Urinary tract infection

Yaşlı hastalarda üriner sistem infeksiyonlarının ampirik tedavisinde hangi antibiyotikleri tercih etmeliyiz?

Öz

Amaç: Üriner sistem infeksiyonları (ÜSİ) yaşlı hastalarda önemli bir mortalite ve morbidite nedenidir. Bu kesitsel çalışmada yaşlı hastalarda toplum kaynaklı ÜSİ etkenlerinin sıklığını ve antibiyotik direnç profilini belirleyerek ampirik tedavi seçimine katkıda bulunmayı amaçladık.

Yöntemler: Ocak 2018 - Haziran 2019 tarihleri arasında Karabük Eğitim ve Araştırma Hastanesi’ne ayaktan başvuran 347 yaşlı hastanın idrar kültür sonuçları çalışmaya dahil edilmiştir. Mikroorganizmaların identifikasyonu ve antibiyotik duyarlılıkları BD-Phoenix (Becton-Dickinson, MD,USA) tam otomatize sistem ile, genişlemiş spektrumlu beta-laktamaz varlığı (GSBL) ise kombine disk difüzyon yöntemi ile araştırılmıştır. Sonuçlar retrospektif olarak incelenmiştir. 

Bulgular: En sık izole edilen patojenler Escherichia coli (%58), Enterococcus spp (%18) ve Klebsiella pneumoniae (%11) idi. Üriner infeksiyon tedavisinde kullanılan oral antibiyotiklerden ampisilin, amoksisilin-klavulanik asit, trimethoprim-sulfametoksazol (TMP-SMX), sefiksim ve siprofloksasine direnç %30-70 arasında idi. Nitrofurantoin direnci ise %3 idi. Gentamisine %12 ve piperasilin-tazobaktama ise %9 oranında direnç saptandı. GSBL pozitifliği ise E.coli‘de % 29 iken, K. pneumoniae suşlarında %49 idi (P=0.03).

Sonuç: Üriner sistem infeksiyonlarının tedavisinde kullanılan oral antibiyotiklerden ampisilin, amoksisilin-klavulanik asit, TMP-SMX, sefiksim ve siprofloksasine %20’nin üzerinde direnç saptanmıştır. Bu nedenle ÜSİ’ nın ampirik tedavisinde bu antibiyotikler kullanılmamalıdır. Onun yerine komplike olmayan ÜSİ’ da nitrofurantoin, parenteral antibiyotiklerden ise gentamisin ve piperasilin-tazobaktam hastanın klinik durumuna göre tercih edilebilir.

Anahtar Kelimeler

• Antibiyotik,Enteroccus türleri,Escherichia coli,Nitrofurantoin,Siprofloksasin,Üriner sistem infeksiyonları

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