Antibiotic usage and susceptibility patterns in Uncomplicated UTI in a Tertiary Hospital in South India

Abstract

Purpose Urinary tract infections (UTI) are common infections in otherwise healthy young women and there is considerable heterogeneity in antibiotic prescribing practices contributing to increased health expenditure, hospitalization, and collateral damage with the unprecedented use of fluoroquinolones and beta-lactams leading to the increase in MRSA strains and gram-negative bacilli. This study was designed to study the appropriateness of empirical antimicrobial therapy with clinical outcomes among outpatients and analyze antibiotic susceptibility patterns. Methods A longitudinal study involving women clinically diagnosed with uncomplicated UTI as per IDSA guidelines across a study period of 18 months was conducted from 2008-2020. Antibiotic appropriateness was analyzed with respect to IDSA guidelines with subgroup analysis of culture- proven UTI. Results Among 105 cases of uncomplicated UTI, fluoroquinolones were prescribed the most (41%) followed by Beta-Lactams (30.5%). Choice of antimicrobial agent was appropriate in 60 (57%) cases and duration in 30 (28.5%) cases. Subgroup Analysis of 25 culture-proven cases revealed most common organism isolated was E. coli (60%) with prevalence of MDR organisms being 36%. The susceptibility pattern revealed similar levels of resistance between fluoroquinolones (38%), beta- lactams (36%), Nitrofurantoin(32%), Trimethoprim-sulfamethoxazole (32%), and Fosfomycin (20%) with clinical cure rates non-inferior among those prescribed the latter group of antibiotics (84.2% vs 96.6%) Conclusion The spectrum of uropathogens in our clinical setting is evolving with a substantial rise in MDR pathogens due to inappropriate antibiotic prescribing practices. The use of antibiotics such as Nitrofurantoin, Trimethoprim-sulfamethoxazole, and Fosfomycin in accordance with local antibiograms must be encouraged as empirical therapy for uncomplicated UTI. Keywords Urinary tract infection, antibiotic stewardship, Nitrofurantoin, Cotrimoxazole, Fosfomycin