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Antibiotic resistance in community-acquired urinary tract infections
1Department of Medicine, Groote Schuur Hospital.
Abstract:
We studied the antibiotic susceptibility of midstream urine isolates from patients with community-acquired urinary tract infections at Groote Schuur Hospital from 1986 to 1991. The majority of the isolates was resistant to amoxycillin and co-trimoxazole, and the proportion of resistant Escherichia coli isolates increased during the study period. In a prospective 4-month study in 1991 we found that the vast majority of isolates was susceptible to aminoglycosides, amoxycillin/clavulanate, second-generation cephalosporins and the new fluoroquinolones. Based on these findings amoxycillin and co-trimoxazole should no longer be prescribed for urinary tract infections unless a susceptible isolate has been cultured. Appropriate empirical oral agents are expensive and not generally available in the public sector. There is an urgent need to make these agents available in the public sector, but their use should be restricted as widespread use for the treatment of other infections would inevitably lead to the development of resistance.
Insights
Antibiotic resistance in urinary tract infections (UTIs) is increasing. Amoxycillin and co-trimoxazole are no longer effective empirical treatments for UTIs.
Area of Science:
- Clinical microbiology
- Infectious diseases
- Pharmacology
Background:
- Antibiotic resistance is a growing concern for community-acquired urinary tract infections (UTIs).
- Historical data from 1986-1991 indicated rising resistance to common UTI antibiotics.
Purpose of the Study:
- To assess current antibiotic susceptibility patterns in UTI pathogens.
- To inform empirical treatment guidelines for community-acquired UTIs.
Main Methods:
- Analysis of midstream urine isolates from UTI patients (1986-1991).
- Prospective susceptibility testing over a 4-month period in 1991.
Main Results:
- High resistance rates to amoxycillin and co-trimoxazole observed.
- Increasing proportion of resistant Escherichia coli strains over time.
- High susceptibility to aminoglycosides, amoxycillin/clavulanate, cephalosporins, and fluoroquinolones in 1991.
Conclusions:
- Amoxycillin and co-trimoxazole should be avoided for empirical UTI treatment.
- Newer agents like fluoroquinolones are effective but require restricted use.
- Improved access to newer antibiotics in the public sector is needed, alongside stewardship.