ANTIMICROBIAL SUSCEPTIBILITY OF COMMUNITY-ACQUIRED UROPATHOGENS IN GENERAL PRACTICE
SH Keah,1 EC Wee,2 KS Chng,3 KC Keah4
1Keah Say Hien FRACGP, AM, Family Physician, Elizabeth Medical Centre Sdn Bhd, 1-14, Jalan Arab, 84000 Muar, Johor, Malaysia Tel: 06-9535335, Fax: 06-9543100. Email: email@example.com (corresponding author)
2Wee Eng Chye FRACGP, Family Physician, Woo Dispensary, 4, Jalan Gambir 1, Bandar Baru Bukit Gambir, 84800 Muar, Johor. Tel: 06-9761041. Email: firstname.lastname@example.org
3Chng Kooi Seng FRACGP, AM, Family physician, Klinik Chng, 11, Jalan Bayu 2, Taman Perindustrian Tampoi Jaya, 81200 Johor Bahru, Johor, Malaysia. Tel: 07-2364600. Email: email@example.com
4Keah Kwee Chu MSc, Dip.Med.Microbiology, BSc(Hons)(Microbiology), Ministry of Health, Level 4, Block E6, Parcel E, Precinct 1, Federal Government Administrative Centre, 62590 Putrajaya, Malaysia. Email: firstname.lastname@example.org
Conflict of Interest: none
Antibiotic resistance of urinary tract pathogens has increased worldwide. The purpose of this study is to provide information regarding local resistance pattern of urinary pathogens to the commonly used antibiotics. One hundred and seventeen cases of community-acquired urinary tract infections were studied. The most common group of patients was the uncomplicated acute cystitis in women. E. coli was the most common isolate. Overall, antimicrobial susceptibility test on the organisms isolated showed a resistance of 63.0% to ampicillin, 40.1% to sulfamethoxazole-trimethoprim (S-T), 14.3% to pipemidic acid, 8.6% to norfloxacin, 3.8% to cephalexin, 3.7% to amoxicillin-clavulanate, 1.0% to cefuroxime, and 1.0% to fosfomycin. Three out of five patients on ampicillin as well as two out of five patients on S-T were likely to be inadequately treated.
Keywords: Urinary tract infection, antibiotic therapy, family practice
Broadly speaking, urinary tract infections (UTI) refer to infections occurring anywhere along the urinary tract from the perinephric fascia to the urethral meatus. Urinary tract infections are common in general practice1, 2 and have important economic consequences.2The disorders are generally treated empirically with antibiotics. It is useful for GPs to be aware of the locally prevalent strains of uropathogens and their sensitivity pattern in order to decide on their choice of antibiotics. This knowledge might help primary care physicians who were often guilty of excessive and inappropriate use of antibiotics.3The judicious use of antibiotics requires accurate data on antimicrobial susceptibility which may vary in time and place. Regular surveillance is therefore necessary.
This study investigates the prevalence of uropathogens and their antimicrobial sensitivities in community-acquired UTI. The knowledge of the organisms involved, the epidemiologic characteristics and the antibacterial susceptibility will assist in the formulation of appropriate antibiotic policy for UTI.
Patients and settings
The study was conducted in two general practice clinics in Muar, Johor. The study was a cross-sectional survey of all patients 12 years and above presenting with symptomatic UTI from February 2006 to February 2007. Patients with one or more of the symptoms were evaluated for possible UTI: frequency, dysuria, urgency, haematuria, fever, suprapubic pain and flank pain. The exclusion criteria were patients who were hospitalised or received antibiotics during the previous 2 weeks or patients on indwelling catheters. The clinical diagnosis of UTI was confirmed by urine cultures.
Collection of urine specimen and urine culturesOnce a clinical diagnosis of UTI was established, the patient was informed about the study and after consent was taken, a urine sample was obtained. Each patient was carefully instructed regarding the collection of a mid-stream urine sample. The urine specimen collected was inoculated immediately onto a culture plate by the attending doctors (who had received instruction on the correct method of inoculating urine to the culture plate). Inoculation was made on blood agar plate (with 5% defibrinated sheep blood) and MacConkey agar plate using a 0.001ml commercial inoculation loop. This bedside inoculation method was adopted to avoid sample deterioration (contamination of samples as a result of bacterial overgrowth) due to uncertain laboratory collection times and temperature effects during transport. The inoculated plates were sent to the laboratory on the same day for incubation. Urinalysis (full examination including microscopy) was also requested on each sample. Isolation and identification of the urinary pathogens was done by a private sector accredited laboratory, according to standard bacteriological techniques. Antimicrobial susceptibility testing of the isolates was done using the disc diffusion method according to the Clinical Laboratory Standards Institute guidelines.4