Abstract
BackgroundIn Bangladesh, treatment for urinary tract infection has become increasingly difficult due to antibiotic resistance. In addition, the prescription of age and gender-specific drugs is still far from being practiced in Bangladesh. We are examining trends of antibiotic resistance per age and gender in patients with urinary tract infection (UTI) caused by the most frequent agent, Escherichia coli. MethodsWe determined the resistance of 1663 E. coli isolates obtained from urine cultures. A sensitivity study using the Kirby-Bauer method was carried out to identify the antibiotic resistance trends. ResultsImipenem with 1.9% resistance of all isolates found to be the lowest percentage of resistance. Meropenem (2.8%), amikacin (2.8%), colistin (2.9%), and nitrofurantoin (15.8%) showed low resistance percentages. The sensitivity analysis suggests that age and gender (area under curve = 0.67) should be taken into consideration to prescribe amikacin. The increasing odds ratios (OR) by age groups suggest that amikacin is a less effective agent for older patients with UTIs. Moreover, nitrofurantoin (OR = 1.45, 95% confidence interval (CI) = 1.07–1.95) and colistin (OR = 2.09, CI = 1.13–3.76) were less effective against isolates obtained from males compared to isolates obtained from females. Meropenem was effective against bacteria obtained from all age groups and genders. On the other hand, efficacy of imipenem was lower in isolates obtained from adults older than 40 years (OR: 0.44 for < = 18 years, OR = 0.47 for 19–40 years, OR = 0.86 for 41–60 years; reference: > = 61 years). ConclusionIn Bangladesh, meropenem, imipenem, amikacin, colistin, and nitrofurantoin are suitable therapeutic alternatives against urinary tract pathogens. Among the oral agents, amikacin, colistin, and nitrofurantoin should be prescribed, taking consideration of age and gender. These results will assist physicians in prescribing effective primary care antibiotics for UTI patients and encouraging the implementation of health policies for a safe prescription of antibiotics.
Highlights
Urinary tract infections (UTIs) are among clinical practice's most common and recurrent bacterial infections and account for one-third of all community-acquired or nosocomial infections [1]
UTI patients within the age group less than or equal to 18 years were 71% less resistant to amikacin compared to the patients of the age group 60 þ years (OR 1⁄4 0.29, Confidence Interval (CI) 1⁄4 0.084–0.763)
Our study shows the distribution of antibiotic resistance among E. coli isolates obtained from UTI cases in Bangladesh, considering age and gender of the patients
Summary
Urinary tract infections (UTIs) are among clinical practice's most common and recurrent bacterial infections and account for one-third of all community-acquired or nosocomial infections [1]. One of the most important advances in modern medicine was the discovery of antibiotics, but their availability and expanded use slowly lead to microbial resistance for patients [3] From the literature, it appears that about 15% of all prescription antibiotics are used to treat UTI [4]. We are examining trends of antibiotic resistance per age and gender in patients with urinary tract infection (UTI) caused by the most frequent agent, Escherichia coli. Conclusion: In Bangladesh, meropenem, imipenem, amikacin, colistin, and nitrofurantoin are suitable therapeutic alternatives against urinary tract pathogens. Amikacin, colistin, and nitrofurantoin should be prescribed, taking consideration of age and gender These results will assist physicians in prescribing effective primary care antibiotics for UTI patients and encouraging the implementation of health policies for a safe prescription of antibiotics
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