Abstract

A STUDY OF ANTIBIOTICS REDUCING THE RELAPSE OF URINARY TRACT INFECTION CAUSED BY EXTENDED –SPECTRUM –? -LACTAMASE IN POSITIVE AND NEGATIVE CASES IN A TERTIARY CARE HOSPITAL, BANGALORE

Dr. Samira Bigdelitabar*, Navid Reza Shahtaghi, and Dr. Peter Kandel

ABSTRACT

Objective: ״ A Study of Antibiotics Reducing The Relapse Of Urinary Tract Infection Caused By Extended –Spectrum –β -Lactamase In Positive And Negative Cases In A Tertiary Care Hospital, Bangalore Materials and Methods: A prospective and observational study was carried out in 155 patients for a period of 6 months in a tertiary care hospital. All data were collected form patients case sheet, prescriptions and laboratory data. Patients treated by the most affective antibiotic used for UTIs ESBL + and ESBL – on this period of time in tertiary care hospital. Patients demographic data, causative microorganism for UTI, risk factors, drugs used for the treatment, co-morbidities were analysed. Results: During the study period, we screened 155 Indian patients of whom which males constituted 81 (52%) and females 74 (48%) of study population. 41% of patients in age group of 1month – 18 years are pediatrics, 36% of patients in age group of 19 – 64 years are adults followed by 23% of patients in age group of 65 years above are geriatrics (mean 1.85 years, standard deviation 0.81 years). So the major age group was pediatrics 41% which have the 31% urinary tract infection caused by ESBL positive. During this study, out of 155 subjects were suspected to have UTI and further screened 63(41%) subjects had culture proven UTI which were colonized by an ESBL- producing organism. Specifically, 113 (73%) patients were colonized by ESBL- producing Escherichia Coli and 29 (19%) patients were colonized by ESBL producing Klebsiella pneumonia. The mean age of Escherichia coli UTI patients was 1.73 ± 2.036 years and 1.404 ± 2.044 years for Klebsiella Pneumonia UTI. Amikacin 15(9.7%) was the most affective antibiotic used for UTIs ESBL + and ESBL –. Diabetic mellitus with 21% and Catheter 14% were found the most commonly co-morbid condition for producing the ESBL positive UTI. The number of prescribed of Amikacin for E.coli which was the most pathogen isolated from the urine culture of patients was 15(9.7%) and ceftriaxone 13(8.4%) followed by Nitrofurantoin by 11(7.1%). Many combination therapies were also given to patients including Piperacillin/Tazobactam + Amikacin, (Amoxicillin/Clavulanate) +Amikacin etc. The relapse rate of UTI was reduced in cases treated with Meropenam and the above said combination therapies. Conclusion: From our study we found out that the main antibiotics prescribed in the hospital for ESBL positive UTI caused by E. coli are Amikacin, Piperacillin Tazobactam, Nitrofurantoin, Ceftriaxone. The mostly prescribed combination drugs are piperacillin tazobactam + Ceftriaxon, Amikacin + Amoxicillin and Clavulanate. The combinations were prescribed to patients with UTI whose symptoms and laboratory values do not resolve with antibiotic monotherapy. E. coli relapse rate was found less when prescribed colistin.

Keywords: Antibiotics, Extended-Spectrum ?-lactamase(ESBL), Urinary tract infection, Demographic data, Antibiotic resistance, Escherichia Coli(E.Coli), Amikacin.