The evaluation of the common pathogenic microorganisms in uncomplicated urinary tract infections and the antibiotic susceptibilities in daily practice

Abstract

Objective: To evaluate the frequency of the causative pathogens for the uncomplicated urinary tract infections, the efficacy of antimicrobial agents and the antimicrobial resistance of common pathogens.Materials and methods: The culture-antibiogram results of patients with probable uncomplicated urinary tract infections were retrospectively analysed. Three urine samples were routinely collected by the mid-stream “clean catch” method. The samples were tested microbiologically by standard procedures. Antibiotic susceptibility was analysed by Kirby-Bauer technique.Results: 2850 urine cultures were analysed. The most commonly isolated pathogen was E. Coli %66.4 . E.Coli most commonly had antibiotic resistance for ampicillin 63.2% and amoxicillin clavulanat 58.1% ; but all E. Coli samples were susceptible for Carbapenems. Vancomycin resistance was not found in Enterococcus spp and Nitrofurantoin was the most effective antibiotic against this group. All Staphilococcus spp. were susceptible for Vancomycin and Teicoplanin and the resistance rate of Methicillin was 33.3%. All of Streptococcus spp. had susceptibility for Penicillin and the other susceptible antibiotics were Levofloxacin 95.4% and Cefotaxime 93.9% . Tetracycline resistance in this group were 75.1%.Conclusion: The most common ethiologic pathogene in uncomplicated UTI is E.Coli 66.4% . The conventional antibiotics for UTI are less effective and the treatment commonly starts without any results of urine culture

Keywords

• Urinary tract infection,ethiologic agents,antibiotic susceptibility,conventional management

Güncel pratikte komplike olmamış idrar yolu enfeksiyonlarında sık karşılaşılan etken mikroorganizmalar ve antibiyotik duyarlılıklarının değerlendirilmesi

Abstract

Amaç: Komplike olmamış üriner enfeksiyonlarda saptanan etken mikroorganizmaların sıklığını, antimikrobiyal ajanların enfeksiyon etkenlerine karşı etkinliğini ve sık rastlanan patojen mikroorganizmaların antibiyotik rezistanslarını değerlendirmek.Gereç ve yöntem: Komplike olmamış idrar yolu enfeksiyonu şüphesi olan hastaların idrar kültürleri retrospektif olarak incelendi. Orta akım temiz yakalama tekniği kullanılarak üç idrar örneği rutin olarak toplandı. Alınan örnekler, standart mikrobiyolojik prosedürler kullanılarak test edildi. Antibiyotik duyarlılığı, KirbyBauer tekniği kullanılarak analiz edildi.Bulgular: 2850 idrar kültürü değerlendirildi. En sık izole edilen etken patojen mikroorganizma E. Coli idi %66.4 . E. Coli’ nin en sık direnç gösterdiği antibiyotikler ampisilin 63.2% ve amoksisilin klavulonat 58.1% idi; fakat tüm E. Coli örnekleri karbapeneme duyarlı idi. Enterokok grubunda vankomisin rezistansı bulunmazken; bu grupta nitrofurantoinin en etkili antibiyotik idi. Tüm stafilokok grubu vankomisin ve teikoplanine duyarlı iken bu gruptaki metisilin direnci sıklığı 33.3% olarak bulundu. Streptokokların tümü penisilinin yanısıra levofloksasin 95.4% ve sefotaksime de 93.9% duyarlı idi. Bu grupta tetrasiklin rezistans oranı 75.1% olarak saptandı.Sonuçlar: Komplike olmamış idrar yolu enfeksiyonlarında en sık saptanan etken patojen mikroorganizma E. Coli’dir 66.4% . Üriner enfeksiyonlarda genelde idrar kültürü sonucu olmadan tedaviye başlandığından antibiyotiklerin etkisi daha az olmaktadır

Keywords

• Üriner sistem enfeksiyonu,etyolojik ajanlar,antibiyotik duyarlılığı,geleneksel tedavi

References

1. Ronald AR, Pattulo MS. The natural history of urinary in- fection in adults. Med Clin North Am; 75: 299- 312, 1991.
2. Gebre-Selassie S. Asymptomatic bacteriuria in pregnancy: epidemiological, clinical and microbiological approach. Ethiop Med J; 36: 185- 92, 1998.
3. Liperky BA. Urinary tract infection in men: epidemiology, pathophysiology, diagnosis and treatment. Ann Intern Med; 111:138-50,1989.
4. Tambyah PA, Maki DG. Catheter associated urinary tract infection is rarely symptomatic; a prospective study of 1497 catheterized patients. Arch Int Med; 160:678-82,2000.
5. Susan A. Mehnert- Kay. Diagnosis and Management of Uncomplicated Urinary Tract Infections. American Family Physician; 72(3): 451- 456,2005.
6. Soraya S Andrade, Helio S Sader, Ronald N Jones, Andrea S Pereira, Antônio CC Pignatari, Ana C Gales. Increased re- sistance to first-line agents among bacterial pathogens iso- lated from urinary tract infections in Latin America:time for local guidelines?. Mem Inst Oswaldo Cruz, Rio de Ja- neiro; 101(7): 741- 748,2006.
7. Van Nostrand JD, Junkins AD, Bartholdi RK. Poor predic- tive ability of urinalysis and microscopic examination to detect urinary tract infection. Am J Clin Pathol; 113: 709- 13,2000.
8. New CH. Urinary tract infection. Am J Med; 4A(suppl): 63- 70,1992.

9. Srinivasa H, Parija SC, Bhattacharya S, Sehgal R. Incidence of ciprofloxacin resistance in urinary isolates Eastern Ne- pal. J Comm Dis; 31:45-7,1999.
10. Navaneeth BV, Belwadi S, Suganthi N. Urinary pathogens’ resistance to common antibiotics: a retrospective analysis. Trop Doct; 32: 20- 2, 2002.
11. Iqbal J, Rahman M, Kabir MS, Rahman M. Increasing cip- rofloxacin resistance among prevalent urinary tract bac- terial isolates in Bangladesh. Jpn J Med Sci Biol; 50: 241- 50,1997.
12. Sharafian M, Karimi A, Tabatabaei SR, Anvaripour N. Microbial sensitivity pattern in urinary tractinfections in children:Asingle center experience of 1,177 urine cultures. Jpn.J.Infect.Dis.; 59: 380- 382,2006.
13. Abu Shaqra Q. Occurrence and antibiotic sensitivity of Enterobacteriaceae isolated from a group of Jordanian pa- tients with community acquired urinary tract infections. Cytobios; 101: 15- 21,2000.
14. Jones RN, Kugler KC, Pfaller MA, Winokur PL. Charac- teristics of pathogens causing urinary tract infections in hospitals in North America: results from the SENTRY An- timicrobial Surveillance Program, 1997. Diagn Microbiol Infect Dis; 35: 55- 63,1999.
15. Lomberg H, Hanson LA, Jacobsson B. Correlation of Pblood group,vesicoureteral reflux, and bacterial attach- ment in patients with recurrent pyelonephritis. N Engl J Med; 308: 1189- 92,1983.
16. Das R N, Chandrashekhar T S, Joshi H S, Gurung M, Shrestha N, Shivananda P G. Frequency and susceptibility profile of pathogens causing urinary tract infections at a tertiary care hospital in western Nepal Singapore Med J; 47(4) : 281,2006.
17. Allen UD, MacDonald N, Fuite L, Chan F, Stephens D. Risk factors for resistance to “first-line” antimicrobials among urinary tract isolates of Escherichia coli in children. CMAJ; 160: 436- 40,1999.
18. Hummers-Pradier E, Koch M, Ohse AM, Heizmann WR, Kochen MM: Antibiotic rezistance of urinarypathogens in female general practice patients. Scand J Infect Dis.; 37: 256- 61,2005.
19. Farrell DJ, Morrissey I, De Rubeis D, Robbins M, Felm- ingham D: A UK multicentere study of the antimicrobial susceptibility of bactyerial pathogens causing urinary tract infection. J Infect.; 46: 94- 100,2003.
20. Kahlmeter G; ECO.SENS. An international survey of the antimicrobial susceptibility of pathogens from uncompli- cated urinary tract infections: the ECO.SENS Project. J An- timicrob Chemother; 51: 69- 76, 2003.