Uropathogen profiles and antimicrobial resistance

Published Date: 19th July 2016

Publication Authors: McCabe JE

INTRODUCTION & OBJECTIVES

Urinary tract infections are a core aspect of urological practice and occupy a large component of infections treated in primary care. The rise of antimicrobial resistance poses a challenge to clinical practice and raises the morbidity and mortality from urinary tract infections. The volume of urinary tract infections, coupled with the short duration of appropriately treated infections, means that the vast majority will be treated empirically. We analysed the profile of urinary tract pathogens in the North West of England to guide empirical prescribing of antimicrobial agents, as well as evaluate the prevalence of resistant organisms.

MATERIAL & METHODS

We carried out retrospective analysis over a three months period of all positive urine microbiology specimens within a district general hospital, giving a total of 11094 individual patients (2237 male, 8857 female). We divided the patients using the referring speciality, grouping Primary care, Medicine, Surgery (excluding Urology), Urology, Obstetrics & Gynaecology, and Paediatrics, as well as analysis of the overall microbiology samples. The prevalence of causative bacteria was evaluated by speciality and evaluated for resistance to common antimicrobial agents. We also compared samples from Urological patients to the overall sample results to assess whether urological patients require different empirical treatment.

RESULTS

Resistance to commonly used antimicrobial agents was higher than anticipated throughout the patient groups. Overall resistance to trimethoprim resistance was 31.3%, cefalexin was 18.87%, nitrofurantoin resistance was 14.36% and amoxicillin resistance was 49.6% and ciprofloxacin resistance was 22.8%. Student T test analysis indicated that urological patients have statically significant higher resistance rates (p<0.0004). Comparison of male and female patients with Student's T Test found statically different rates of resitance (p=0.002).

CONCLUSIONS

Common antibiotics used in the treatment of urinary tract infections, such as amoxicillin, cefalexin, trimethoprim and nitrofurantoin have now developed such high resistant rates that they can no longer be advocated as empirical treatments in the North West of England. Worryingly, resistance to ciprofloxacin is also rising, with levels currently at 18.8% across all patients and 30% in urology patients, which will limit the options for oral antimicrobials in the future. The higher resistance encountered in urology patients is likely to be due to be due to a combination of accumulating difficult and resistant cases, and patients likely to have been treated to multiple antibiotics prior to referral to urology services. These results dictate a change in current prescribing recommendations; closer liaison with primary care to set effective regional guidelines for the treatment of urinary tract infections.

Iskander, M; McCabe, JE. (2014).  Uropathogen profiles and antimicrobial resistance in North West England . European Urology Supplements. 13 (1), e674.

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