Treatment Of Community-acquired Urinary Tract Infections Research Articles

Relooking at Nitrofurantoin as drug of choice for empiric treatment of community acquired uncomplicated urinary tract infections: An effective and economic treatment option

Introduction: Urinary tract infections (UTI) caused by multidrug resistant bacteria necessitate the use of broad spectrum expensive antibiotics, which enhance antibiotic pressure. It would be ideal to look at older less commonly prescribed antibiotics like nitrofuratoin and assess its sensitivity for treatment of community acquired UTIs. Nitrofurantoin has been used successfully for prophylaxis and treatment of acute lower UTIs in adults, children and pregnant women. Aim & objectives: This study aims to assess the in-vitro sensitivity of common uropathogens to nitrofurantoin including ESBL producers. Materials and methods : Urine culture and bacterial identification was by standard tests and antibiotic sensitivity was assessed by Kirby Bauer disc diffusion method. ESBL producers were identified by CLSI recommended double disk synergy test. Results: 226 (29.89) % of 756 urine samples showed significant bacteruria, of which 122 (53.98%) were E.coli , 32 (14.15%) K.pneumoniae , 23 (10.17%) P.aeruginosa , 14 (6.19%) Enterococcus spp., 12 (5.30%) Acinetobacter spp, 10 (4.42%) S.saprophyticus and 5 (2.3%) were Candida species. 111/122 (90.98%) of E.coli were sensitive to nitrofurantoin, of which 40 were ESBL producers. 37/40 (92.5%) ESBL producing E.coli and all isolates of S.saprophyticus and Enterococcus spp. were sensitive to nitrofurantoin. Conclusions: Nitrofurantoin is an oral antibiotic with minimal adverse effects, having high in-vitro sensitivity against common community acquired uro-pathogens and is reasonably priced. Hence there is a need to reconsider nitrofurantoin as drug of choice for treatment of community acquired uncomplicated lower UTIs. This could ease the antibiotic pressure, off oral cephalosporins and fluoroquinolones which are currently overused in the community

Antimicrobial susceptibility profile of uropathogens in Maluti Adventist Hospital patients, 2011

BackgroundUrinary tract infections (UTIs) are amongst the most common infections encountered globally and are usually treated empirically based on bacterial resistance to antibiotics for a given region. Unfortunately in Lesotho, no published studies are available to guide doctors in the treatment of UTIs. Treatment protocols for Western countries have been adopted, which may not be applicable for this region.AimTo determine the antimicrobial susceptibility profile of uropathogens in outpatients at the Maluti Adventist Hospital.SettingThe study was conducted at the outpatient department of the Maluti Adventist Hospital in Mapoteng, Lesotho.MethodsThis was a prospective cross-sectional study using consecutive sampling of patients with clinical symptoms of UTI. Midstream urine samples were screened through chemistry and microscopy, then positive urine samples were cultured. The isolated uropathogens underwent antimicrobial susceptibility testing and inclusion continued until 200 culture samples were obtained. Descriptive statistics were used in the data analysis.ResultsThe top five cultured uropathogens were Escherichia coli (61.5%), Staphylococcus aureus (14%), Pseudomonas species (6.5%), Enterococcus faecalis (5.5%) and Streptococcus agalactiae (5%). The isolated uropathogens showed low sensitivity to cotrimoxazole (32.5% – 75.0%) and amoxicillin (33.2% – 87.5%) and high sensitivity to ciprofloxacin (84.0% – 95.1%) and nitrofurantoin (76.9% – 100%)ConclusionIn the Maluti setting, cotrimoxazole and amoxicillin should be avoided as first-line drugs for the empirical treatment of community-acquired UTI. We recommend the use of nitrofurantoin as first choice.

Risk Factors for Community-Acquired Urinary Tract Infections Caused by ESBL-Producing Enterobacteriaceae –A Case–Control Study in a Low Prevalence Country

Community-acquired urinary tract infection (CA-UTI) is the most common infection caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, but the clinical epidemiology of these infections in low prevalence countries is largely unknown. A population based case-control study was conducted to assess risk factors for CA-UTI caused by ESBL-producing E. coli or K. pneumoniae. The study was carried out in a source population in Eastern Norway, a country with a low prevalence of infections caused by ESBL-producing Enterobacteriaceae. The study population comprised 100 cases and 190 controls with CA-UTI caused by ESBL-producing and non-ESBL-producing E. coli or K. pneumoniae, respectively. The following independent risk factors of ESBL-positive UTIs were identified: Travel to Asia, The Middle East or Africa either during the past six weeks (Odds ratio (OR) = 21; 95% confidence interval (CI): 4.5–97) or during the past 6 weeks to 24 months (OR = 2.3; 95% CI: 1.1–4.4), recent use of fluoroquinolones (OR = 16; 95% CI: 3.2–80) and β-lactams (except mecillinam) (OR = 5.0; 95% CI: 2.1–12), diabetes mellitus (OR = 3.2; 95% CI: 1.0–11) and recreational freshwater swimming the past year (OR = 2.1; 95% CI: 1.0–4.0). Factors associated with decreased risk were increasing number of fish meals per week (OR = 0.68 per fish meal; 95% CI: 0.51–0.90) and age (OR = 0.89 per 5 year increase; 95% CI: 0.82–0.97). In conclusion, we have identified risk factors that elucidate mechanisms and routes for dissemination of ESBL-producing Enterobacteriaceae in a low prevalence country, which can be used to guide appropriate treatment of CA-UTI and targeted infection control measures.