Urinary tract infeccions: the reality of an Internal Medicine ward

Abstract

Urinary tract Infections are highly prevalent. In Portugal, they
represent the second most frequent community acquired infectious disease and the main hospital acquired infection in
Internal Medicine wards. A great prevalence of antibiotic resistance may exist against the first line of recommended antibiotics for urinary tract infections. A retrospective analysis for
a one year period was performed aiming to characterize the
population of patients discharged from an Internal Medicine
ward diagnosed with urinary tract infections. This population
was assessed in terms of age, gender, type of urinary tract infection, etiologic agent, resistance profiles, prescribed antibiotics and associated diseases. From the results obtained, the
authors state that 91% of urinary tract infections diagnoses
corresponded to acute cystitis. The majority were community acquired (CAUTI) and 31% were hospital acquired (HAUTI). The etiologic agent was identified in 68% of performed
urine cultures. 21 different spp were identified in the following
order of frequency: Escherichia coli, Klebsiella pneumoniae,
Pseudomonas aeruginosa and Proteus mirabilis. There was
low susceptibility to quinolones (19-20%), ampicillin (12-19%)
and first generation cephalosporin (11%). The most frequently
prescribed antibiotics were amoxicillin clavulanate, ciprofloxacin and piperacillin/tazobactam. The most prevalent associated diseases were diabetes, dementia and the presence
of a chronic vesicle catheter. This work demonstrates high
resistance to quinolones, ampicillin and first generation cephalosporins for CAUTI as for HAUTI this may be caused by the
excessive use of these antibiotics in the last years. Ciprofloxacin was the second most prescribed antibiotic and the second
most resistant one what reinforces the need of knowledge of
the local microbial reality to adjust prescribing habits.