Empiric Guideline Therapy for Simple Urinary Tract Infection at Outpatient Clinics: A Prospective Observational Study

Abstract

Background: Community-acquired urinary tract infection is a widespread problem encountered in the outpatient clinics of most hospitals. UTI has various clinical presentations; some are simple UTIs that can be managed with outpatient antibiotics. The current treatment of UTI is empirical, based on the limited and predictable spectrum of etiological microorganisms. Objectives: To collect information on the susceptibility tests of microorganisms in simple urinary tract infections (UTIs) and outline the best empiric antimicrobial prescribed for them. Methods: A total of 117 patients from 14 to 70 years of age (mean age = 43.61years, standard deviation = + 24.5) received the care of our surgical and urological outpatient clinics in Alnuman Teaching Hospital, Baghdad, Iraq, between March 1, 2019, and September 1, 2020. The patients who were showing symptoms of simple uncomplicated UTI and were prescribed empiric antibacterial treatment and requested for a sample of midstream urine for culture and sensitivity tests were enrolled in this prospective study. The susceptibility test for (ciprofloxacin, trimethoprim, gentamycin, and ceftriaxone) was performed using the Kirby–Bauer disc diffusion method. The data were input into SPSS 22.0 for statistical analysis. Pearson’s chi-squared test was used to compare parameters. The data have been presented as the number of variables (n) and percentages (%). Statistical significance was set at P < 0.05. Results: The frequencies of isolated uropathogens were as follows: E. coli, n = 65 (77.4%); Klebsiella spp., n = 9 (10.7%), Proteus spp., n = 3 (3.57%), Enterobacter spp., n = 3 (3.57%)., Staphylococcus spp., n = 2 (2.38%)., Pseudomonas spp., n = 1 (1.19%), and Candida spp., n = 1 (1.19%). The resistance rates of the most prevalent microorganisms were E. coli isolates to trimethoprim, ciprofloxacin, gentamycin, and ceftriaxone. The lower resistance rates to ceftriaxone in E. coli isolates (29.7%) was not clinically significant, with p < 0.05. Gentamycin showed significant sensitivity and resistance rates of 58.3% and 33.3% respectively, among the antimicrobials used (p < 0.05). The clinical effectiveness of empirical antimicrobial use in the treatment of simple UTIs showed no statistically significant correlation with P < 0.05. Conclusions: Trimethoprim and ciprofloxacin should not be used in empirical therapy for UTIs because of their increased resistance rates. A review of the local guidelines should be considered.