Characteristics and empiric antimicrobial therapy of urinary tract infections in patients treated at the Departement of Infectious Diseases, General Hospital »Dr. Josip Benčević« in Slavonski Brod

Abstract

Infekcije mokraćnog sustava (IMS) jedan su od najčešćih razloga traženja liječničke pomoći, pa stoga i među najčešćim razlozima propisivanja antibiotika. Istaknuta je analiza najčešćih uzročnika IMS u našoj sredini, uočavanje stupnja rezistencije na pojedine antibiotike, te ocjena uspješnosti ordinirane empirijske antimikrobne terapije. Retrospektivno su obrađeni podaci o bolesnicima liječenim na Odjelu za zarazne bolesti Opće bolnice »Dr. Josip Benčević« u Slavonskom Brodu, zbog akutnih infekcija mokraćnog sustava, tijekom 2004. godine. Najčešći je uzročnik IMS bila Escherichia coli, premda je u muškaraca s kompliciranim IMS bio najčešći uzročnik Pseudomonas aeruginosa. Obzirom da je 45 % izoliranih bakterija Escherichia coli bilo rezistentno na amoksicilin, a 35 % na kotrimoksazol, ovi antibiotici se u našoj sredini ne mogu upotrebljavati u empirijskoj antimikrobnoj terapiji IMS. Čak 65 % izoliranih bakterija Pseudomonas aeruginosa nije bilo osjetljivo na gentamicin, a 45 % na ciprofloksacin. Najčešći neuspjeh empirijske antimikrobne terapije zabilježen je u muškaraca s kompliciranim IMS, pa bi nam bio najbolji izbor empirijskog antimikrobnog liječenja ovih bolesnika kombinacija piperacilina s tazobaktamom, karbapenemi ili cefepim.Urinarv tract infections (UTI) are one of the most common reasons for seeking medical consultation and therefore are among the most frequent reasons for antibiotic prescription. The purpose of this paper is the analvsis of the most common etiologic agents of UTI in our environment, registration of the degree of bacterial resistance, and evaluation of empiric antibiotic therapv success. Retrospectively data of patients, hospitalized during year 2004, at the Departement of Infectious Diseases, General Hospital »Dr. Josip Benčević« in Slavonski Brod, due to acute urinarv tract infections, were analysed. The most common cause of UTI was Escherichia coli, although in male patients with complicated UTI, the most common cause was Pseudomonas aeruginosa. Since 45% of Escherichia coli were amoxicillin resistant, and 35% trimethoprim-sulfamethoxazole resistant, these antimicrobials can\u27t be used as empiric therapy drugs in our environment. As much as 65% of Pseudomonas aeruginosa were gentamicin and 45% ciprofloxacin resistant. The most frequent empiric antibiotic therapy failure was observed in male patients with complicated UTI, so the best empiric drug choice for these patients, in our situation, would be piperacillin/tazobactam, carbapenems or cefepime