journal article Open Access Jul 03, 2023

The Appropriateness of Empirical Antimicrobial Treatment of Uncomplicated Urinary Tract Infection in Adult Female Patients in Jazan Region, Saudi Arabia

Clinics and Practice Vol. 13 No. 4 pp. 743-752 · MDPI AG
View at Publisher Save 10.3390/clinpract13040067
Abstract
Introduction: Uncomplicated urinary tract infection (uUTI) is one of the most prevalent bacterial infections in clinical practice. Empirical treatment is used commonly; thus, knowledge of the local antimicrobial susceptibility pattern is crucial to avoid the growing antibiotic resistance. Purpose: The aim of this study is to evaluate the effectiveness of the empirical treatment of uUTI and determine the susceptibility pattern for common uUTI causative microorganisms at outpatient clinics in hospitals in the Jazan region. Method: This is a prospective observational study of 120 patients with uncomplicated urinary tract infections attending internal medicine outpatient clinics in Al-Hayat Jazan hospital, Saudi Arabia, from September 2021 to January 2023. Results: In total, 120 patients were included in the study. The mean age of the participants was 48.53 ± 9.29. Risk factors for UTI were found in 57.5%, and type 2 diabetes mellitus (DM) was the major risk factor (27.5%). The most common causative microorganism was Escherichia coli (E. coli) (87.5%), followed by Klebsiella pneumoniae (5%), Staphylococcus aureus, Enterobacter spp., and Enterococcus spp. (2.5%). Nitrofurantoin was the most effective antimicrobial agent (sensitivity rate of 91.7%) against all microorganisms, followed by Ciprofloxacin (75%). Conclusions: This study concluded that nitrofurantoin and Ciprofloxacin are suitable empirical treatments for uncomplicated urinary tract infection in the Jazan region, and increased resistance against trimethoprim/sulphamethoxazole (TMPSMX) and cefaclor was observed; thus, empirical therapy with these agents should be reconsidered in local guidelines. Wide surveillance research is necessary to monitor effective empirical therapies and to evaluate the regional antimicrobial susceptibility pattern.
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References
47
[1]
Patel "Causative agents of urinary tract infections and their antimicrobial susceptibility patterns at a referral center in Western India: An audit to help clinicians prevent antibiotic misuse" J. Fam. Med. Prim. Care (2019) 10.4103/jfmpc.jfmpc_203_18
[2]
Bonkat, G., Pickard, R., Bartoletti, R., Bruyere, F., Geerlings, S.E., and Wagenlehner, F. (2017). EAU Guidelines on Urological Infections, European Association of Urology. Available online: http://www.uroweb.org/wp-content/uploads/19-Urological-infections_2017_web.pdf.
[4]
Does This Woman Have an Acute Uncomplicated Urinary Tract Infection?

Stephen Bent

JAMA 2002 10.1001/jama.287.20.2701
[5]
Colgan "Diagnosis and treatment of acute uncomplicated cystitis" Am. Fam. Phys. (2011)
[6]
Marsh "Analysis of urine-specific antibiograms from veterans to guide empiric therapy for suspected urinary tract infection" Diagn. Microbiol. Infect. Dis. (2019) 10.1016/j.diagmicrobio.2019.114874
[7]
Gupta "Managing uncomplicated urinary tract infection—Making sense out of resistance data" Clin. Infect. Dis. (2011) 10.1093/cid/cir637
[8]
Williams "Antimicrobial resistance in Escherichia coli causing urinary tract infections in Costa Rica: A clinical dilemma" Int. J. Antimicrob. Agents (2003) 10.1016/s0924-8579(02)00244-3
[9]
Colgan "Risk Factors for Trimethoprim-Sulfamethoxazole Resistance in Patients with Acute Uncomplicated Cystitis" Antimicrob. Agents Chemother. (2008) 10.1128/aac.01200-07
[10]
McGregor "A Systematic Review of the Methods Used to Assess the Association between Appropriate Antibiotic Therapy and Mortality in Bacteremic Patients" Clin. Infect. Dis. (2007) 10.1086/519283
[11]
World Health Organization (WHO) (2023, March 12). Antimicrobial Resistance. Available online: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance.
[12]
Kass "Bacteriuria and the diagnosis of infections of the urinary tract; with observations on the use of methionine as a uri-nary antiseptic" AMA Arch. Intern. Med. (1957) 10.1001/archinte.1957.00260110025004
[13]
Clinical and Laboratory Standards Institute (2014). Performance Standards for Antimicrobial Susceptibility Testing, CLSI. Twenty-Fourth Infor-mational Supplement; CLSI Document M100-S24.
[14]
Drekonja "Appropriateness of Urinary Tract Infection Diagnosis and Treatment Duration" Arch. Intern. Med. (2010) 10.1001/archinternmed.2009.543
[15]
Huang "National patterns in the treatment of urinary tract infections in women by ambulatory care physicians" Arch. Intern. Med. (2002) 10.1001/archinte.162.1.41
[16]
Warren "Guidelinesfor antimicrobial treatment of un-complicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA)" Clin. Infect. Dis. (1999) 10.1086/520427
[17]
Percival "Impact of an antimicrobial stewardship intervention on urinary tract infection treatment in the ED" Am. J. Emerg. Med. (2015) 10.1016/j.ajem.2015.04.067
[18]
Erdem "Community-acquired lower urinary tract infections: Etiology, antimicrobial resistance, and treatment results in female patients" J. Glob. Infect. Dis. (2018) 10.4103/jgid.jgid_86_17
[19]
Balkhi "Antimicrobial susceptibility of micro-organisms causing urinary tract infections in Saudi Arabia" J. Infect. Dev. Ctries. (2018) 10.3855/jidc.9517
[21]
Ahmad "Urinary tract infection at a specialist hospital in Saudi Arabia" Bangladesh Med. Res. Counc. Bull. (1995)
[22]
Alzohairy "Frequency and antibiotic susceptibility pattern of uro-pathogens isolated from community and hospital-acquired infections in Saudi Arabia—A prospective case study" Brit. J. Med. Med. Res. (2011) 10.9734/bjmmr/2011/207
[23]
Aly "The prevalence of antimicrobial resistance in clinical isolates from Gulf Corporation Council countries" Antimicrob. Resist. Infect. Control (2012) 10.1186/2047-2994-1-26
[24]
Brown "Urologic complication of diabetes" Diabetes Care (2005) 10.2337/diacare.28.1.177
[25]
Meiland "Asymptomatic bacteriuria in women with diabetes mellitus" Arch. Int. Med. (2006) 10.1001/archinte.166.20.2222
[26]
Moharram "Prevalence of urinary tract infection and risk factors among Saudi patients with diabetes" World J. Urol. (2012)
[27]
Saliba "Urinary tract infections in patients with type 2 diabetes mellitus: Review of prevalence, diagnosis, and management" Diabetes Metab. Syndr. Obes. Targets Ther. (2015) 10.2147/dmso.s51792
[28]
Patterson "Bacterial urinary tract infections in diabetes" Infect. Dis. Clin. N. Am. (1997) 10.1016/s0891-5520(05)70383-4
[29]
Delamaire "Impaired Leucocyte Functions in Diabetic Patients" Diabet. Med. (1997) 10.1002/(sici)1096-9136(199701)14:1<29::aid-dia300>3.0.co;2-v
[30]
Increasing Antimicrobial Resistance and the Management of Uncomplicated Community-Acquired Urinary Tract Infections

Kalpana Gupta, Thomas M. Hooton, Walter E. Stamm

Annals of Internal Medicine 2001 10.7326/0003-4819-135-1-200107030-00012
[31]
WHO (2011). World Health Day—7 April 2011, WHO.
[32]
Ceran "A randomized comparative study of single-dose fosfomycin and 5-day ciprofloxacin in female patients with uncomplicated lower urinary tract infections" J. Infect. Chemother. (2010) 10.1007/s10156-010-0079-z
[33]
Kader "Prevalence and antimicrobial susceptibility of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniaee in a general hospital" Ann. Saudi Med. (2005) 10.5144/0256-4947.2005.239
[34]
Anani "Antimicrobial Susceptibility Pattern of Bacterial Pathogens Causing Urinary Tract Infections in a Saudi Arabian Hospital" Chemotherapy (2009) 10.1159/000198698
[35]
Sahm "Multidrug-Resistant Urinary Tract Isolates of Escherichia coli: Prevalence and Patient Demographics in the United States in 2000" Antimicrob. Agents Chemother. (2001) 10.1128/aac.45.5.1402-1406.2001
[36]
Cormican "Extended spectrum beta-lactamase production and fluorquinolone resistance in pathogens associated with community acquired urinary tract infection" Diagn. Microbiol. Infect. Dis. (1998) 10.1016/s0732-8893(98)00113-8
[37]
Olson "Antibiotic Resistance in Urinary Isolates of Escherichia coli from College Women with Urinary Tract Infections" Antimicrob. Agents Chemother. (2009) 10.1128/aac.01188-08
[38]
Younis "Clinical and laboratory profile of urinary tract infections associated with extended spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniaee" Ann. Clin. Lab. Sci. (2016)
[39]
"Antibiotic resistance pattern and empirical therapy for urinary tract infections in children" Saudi Med. J. (2008)
[40]
Bukhari "Clinical and laboratory profiles of urinary tract infections caused by extended-spectrum be-ta-lactamase-producing Escherichia coli in a tertiary care center in central Saudi Arabia" Saudi Med. J. (2013)
[41]
Karlowsky "Trends in Antimicrobial Resistance among Urinary Tract Infection Isolates of Escherichia coli from Female Outpatients in the United States" Antimicrob. Agents Chemother. (2002) 10.1128/aac.46.8.2540-2545.2002
[42]
Shim "Antimicrobial resistance in community-acquired urinary tract infections: Results from the Korean Antimicrobial Resistance Monitoring System" J. Infect. Chemother. (2011) 10.1007/s10156-010-0178-x
[43]
Schmiemann "Resistance profiles of urinary tract infections in general practice—An observational study" BMC Urol. (2012) 10.1186/1471-2490-12-33
[44]
Grigoryan "Diagnosis and management of urinary tract infections in the outpatient setting: A review" JAMA (2014) 10.1001/jama.2014.12842
[45]
Koguchi, D., Murakami, Y., Ikeda, M., Dobashi, M., and Ishii, J. (2020). Cefaclor as a first-line treatment for acute uncomplicated cystitis: A retrospective single-center study. BMC Urol., 20. 10.1186/s12894-020-00605-6
[46]
Yamamoto "Treatment of urinary tract infections by cefaclor, with special reference to the antibody-coated bacteria (ACB) detected by the immunoenzyme technique" Hinyokika Kiyo Acta Urol. Jpn. (1983)
[47]
Korzeniowski "Comparative Pharmacology of Cefaclor and Cephalexin" Antimicrob. Agents Chemother. (1977) 10.1128/aac.12.2.157
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Published
Jul 03, 2023
Vol/Issue
13(4)
Pages
743-752
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Cite This Article
Majid A. Darraj (2023). The Appropriateness of Empirical Antimicrobial Treatment of Uncomplicated Urinary Tract Infection in Adult Female Patients in Jazan Region, Saudi Arabia. Clinics and Practice, 13(4), 743-752. https://doi.org/10.3390/clinpract13040067