Is trimethoprim adequate as first-line empirical treatment for urinary tract infection?

Abstract number: P2053

Gallos I., Yee L., Diakos E.

Objectives: To establish whether bacterial urine culture isolates at Mid Staffordshire General Hospital are susceptible to our 1st {Trimethoprim(TMP) or Nitrofurantoin(NIT)} and 2nd {Ciprofloxacin(CIP), Cephalexin(CEP), Augmentin(AGM)} line empirical antibiotic policy.

Methods: During a 5-year period, all uropathogens and the antibiotic sensitivities, causing UTI were identified through our electronic database and analysed, retrospectively. Patients demographics, age, sex, date of urine culture isolate and antibiotic sensitivities were recorded. Data were analysed using SPSS® version 13 for Windows® (SPSS, Chicago, Illinois, USA).

For tables in which both rows and columns contain ordered values, Spearman's rank correlation coefficient, rho, was used. Only Mid Stream Urine cultures with single uropathogen growth of >103 CFU/ml and leucocytes of >30cu/ml were included.

Results: The mean age of the population considered was 59 years and the standard deviation was 24 years. UTI was diagnosed more frequently in women (80%). E. Coli was the most common uropathogen isolated and considered responsible for 59.4% of the UTIs. There were 40.770 uropathogens isolated, of which 72.5% were susceptible to TMP, 90% to NIT, 94% to AGM and CIP and 86% to CEP.. A general trend of increasing resistance to elder patients (63% sensitivity for patients >85 years old, rho spearman = 0.00) and in the more recent years, (70% sensitivity for 2007, rho spearman = 0.00) for TMP, was noted. NIT had a resistance rate of 10% for 2007. The 2nd line antibiotics have reduced their susceptibility over the years, but still maintain a susceptibility of about 90% for AGM and CIP and 85% for CEP. Specifically, CEP and NIT still uphold their efficacy, with a sensitivity of 90% for NIT and 85% for CEP, which remained stable over the 5-year period, with statistically insignificant change of susceptibility over the five years (rho spearman = 0.97 for NIT and rho = 0.065 for CEP).

Conclusion: Resistance to TMP is becoming problematic to several geographic areas of UK. In view of increasing resistance pattern to TMP a re-modelling of the local antibiotic policies was considered to be appropriate. Staffordshire hospitals looked into changing the local guidelines to meet new resistance antibiotic patterns, with the use as 1st line antibiotic for empirical treatment of UTI of NIT or CEP and for 2nd line the use of CIP or AGM, excluding TMP from empirical treatment of UTI.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Location: Barcelona, Spain
Presentation type:
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