Urinary tract infections – Etiology, antibiotic susceptibility, and treatment in surgical patients in Nepal

Abstract

Degree Project Thesis, Programme in Medicine. TITLE: Urinary tract infections – Etiology, antibiotic susceptibility, and treatment in surgical patients in Nepal. Background: Urinary tract infections (UTI) are among the most common postoperative nosocomial infections and the second most common reason for empirical antibiotic treatment. Optimal treatment could decrease mortality and morbidity in surgical patients and play a vital role in combating the ongoing crises of increasing antibiotic resistance. Aims: To study the pathogens and their antibiotic susceptibility in urinary cultures from a surgical clinic in a tertiary care hospital in Nepal; and to study the use of antibiotics, rationality of antibiotic treatment and surgical risk factors for urinary tract infection. Methods: All urinary cultures from the surgical clinic during 18 month were reviewed. In addition, 50 patients had their medical chart reviewed for treatment and risk factors. Result: E. coli was the most common bacteria (74 %). The overall level of resistance to commonly used antibiotics were high in all pathogens. Amikacin and nitrofurantoin were generally the antibiotics with lowest rates of resistance. Aminoglycosides and fluoroquinolones were the most often used antibiotics. In first-line treatment, only 55 % of cases were given at least one antibiotic to which the bacteria was sensitive. A statistical significant higher resistant to both ciprofloxacin and cefotaxime were found in cultures from the surgical ward compared to the surgical reference clinic (P = 0.02 and P = 0.002), and to ciprofloxacin in cases with indwelling urinary catheter compared to cases without indwelling urinary catheter (P = 0.005) and in cases with previous admittance to hospital compared to cases without previous admittance to hospital (P = 0.008). Conclusions: This study found an exceptional high rate of antibiotic resistance, and a low rate of effective empirical antibiotic treatment. Guidelines on antibiotic treatment are needed, and for empirical treatment of nosocomial UTI an increased use of nitrofurantoin and amikacin is recommended, rather than cephalosporins and fluoroquinolones.