Authors (including presenting author) :
Chan KF, Wong SN, Lai KPL, Luk MHM, Chan PF
Affiliation :
Department of Family Medicine and Primary Health Care, Kowloon East Cluster (KEC)
Introduction :
In clinical practice, simple UTI in female patients was treated empirically with antibiotics without saving MSU for bacterial culture. In view of the increasing prevalence of antimicrobial resistance among uropathogens, there was a clinical need to re-evaluate the assessment of patients presented with simple UTI and the choice of empirical antibiotic.
Objectives :
To describe the prevalence of different pathogens causing uncomplicated UTI and their antibiotics susceptibility in female patients in GOPC and to provide evidence-based recommendation whether MSU for bacterial culture and antibiotic sensitivity tests should be saved before empirical antibiotic in this group of patients.
Methodology :
This was a cross sectional study involving 2 KEC GOPCs. All adult female patients attending the clinics presented with acute classical UTI symptoms and fulfilled the clinical criteria of uncomplicated UTI between 1st December 2022 and 31st July 2023 would be recruited. Their MSU would be sent to the hospital laboratory for further analysis. Empirical antibiotic i.e. co-amoxiclav or nitrofurantoin was prescribed as in usual clinical practice. Types and prevalence of organisms isolated from MSU, and their susceptibility to antibiotics were studied.
Result & Outcome :
222 eligible patients were recruited. Escherichia Coli was the most common pathogen found in our samples (79.3%,), followed by Klebsiella (9.4%) and Proteus (6.3%). 11% of the identified uropathogens were Extended Spectrum Beta Lactamase (ESBL) producer.
The overall susceptibility rate of co-amoxiclav and nitrofurantoin were 87.3% and 86.5% respectively, regardless of the causative organisms. The susceptibility rate of co-amoxiclav to E Coli, Proteus and Klebsiella were 86.4%, 92.9% and 42.9% respectively. Nitrofurantoin had an impressive susceptibility rate of 98.9% to E Coli and was also effective against Klebsiella, with a susceptible rate of 95.2%. However, nitrofurantoin was naturally resistant to Proteus and therefore had a 100% resistant rate to Proteus in our study.
Conclusions:
The two current first line empirical antibiotics were effective against uncomplicated UTI in most female patients in GOPC. Saving MSU prior to empirical antibiotics treatment for these patients might not be necessary, giving the predictable organisms and high antibiotics sensitive rate.
