Comparison of empirical antibiotics used with microbiological sensitivity pattern among patients admitted with urinary tract infection
Keywords:Urinary Tract Infection, Empirical Antibiotics, Antibiotic resistance, microbiological sensitivity.
Background: Symptomatic Urinary tract infection (UTI) is among the most common infection described in hospital settings. Inappropriate use of antibiotics initiated before the laboratory results of urine culture contribute to increasing resistance to antibiotics in uropathogens. Awareness of the disease, knowledge of the spectrum of antibiotics and common complication of UTI will help to reduce morbidity and mortality. This study compares common empirical antibiotics used with their clinical outcomes and microbiological sensitivity pattern among patients admitted with UTI in a tertiary care hospital.
Methods: It is a cross sectional study conducted in inpatients of Pushpagiri medical college, Thiruvalla from January 2017 – June 2018. Assuming that 50% of organisms will show sensitivity to empirical antibiotic therapy with a relative precision of 20% and alpha error of 5 %. Sample size is calculated as 100. Those patient satisfying the inclusion criteria was recruited into the study after obtaining informed consent till the sample size attained. Symptoms on the day of admission was assessed using the questionnaire for Clinical profile. Primary outcome was matching of empirical antibiotics with culture and sensitivity pattern. Secondary outcomes were Symptom resolution on third day with empirical antibiotics and profile organisms causing UTI.
Results: Majority of the population belonged to 61-80 year of age (57%). The study population had 44 percent male and 56 females.72 percent of total population was diabetic. The most common antibiotic used to treat empirically was piperacillin –tazobactum accounting for 47.2 percent followed by ceftriaxone 45 percent. Others contributed less than 8 percent.75 percent of empirical antibiotics matched with culture and sensitivity report in the study population.The most common organisms found was Escherichia coli (61%) followed by Klebsiella pneumonia(15 %) The most common resistant organism was E Coli followed by Klebsiella pneumonia. Esbl resistance was encountered in 28 cases and carbepenamase resistance in 2 percent cases. 27 percent of diabetic patient had resistant organism infection in urine. Symptoms of urinary tract infections were better resolved when empirical antibiotics used had matched microbiological sensitivity pattern.
Conclusions: After the age of 60 year UTI occurred almost equal in male and females There was only 75 percent agreement with empirical antibiotics and culture sensitivity report. Resistant organism were common in the diabetic population. Most common organism encountered in symptomatic UTI is E coli. Symptomatic resolution occurred in majority of cases where the empirical antibiotic was sensitive than compared to resistant case. Some of the resistant cases had symptomatic resolution possibly explained by the in vivo sensitivity. As the agreement with empirical antibiotics became low, hospital antibiotic policies must reviewed and changed according to resistance pattern and type of organism that is locally prevalent
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