Empirical treatment of community acquired urinary tract infections: is there a need to update the current policies?

Introduction: The empirical use and abuse of antibiotics is quite common in community acquired urinary tract infection, leading to increase in antimicrobial resistance. Patients presenting to the outpatient department of a hospital are a heterogenous set of population, including all age groups and socioeconomic strata. Monthly and annual review of the antibiotic prescribing pattern and the trends in antimicrobial resistance is needed to curb the menace of antimicrobial resistance. Objectives: To study the etiology and trends in antimicrobial resistance of community acquired urinary tract infections and to update the antibiotic policy for the treatment of community acquired urinary tract infections at our institution. Methods: The study was performed at a tertiary care super speciality hospital in North India. This was an observational study including urine samples from patients presenting to the outpatient department of the hospital, with symptoms suggestive of urinary tract infection. The samples were cultured on routine culture media and identified according to standard guidelines. Antimicrobial susceptibility testing was done on Mueller Hinton agar plates by Kirby Bauer disc diffusion method as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Extended spectrum beta lactamase (ESBL) testing was also performed as per CLSI guidelines. Results: A total of 3758 urine specimens from outpatient department were received, out of which 452 samples were culture positive, of which 414 (91.6%) were Gram negative and 38 (8.4%) were Gram positive. Escherichia coli(67.0%),Klebsiella pneumonia (12.4%) and Pseudomonas aeruginosa (3.0%) were the predominant Gram negative isolates. Of the 414 Gram negative isolates, 271 (65.5%) were found to be multidrug resistant (MDR) strains. By combined disc test, 182 (44.0%) Gram negative isolates were found to be ESBL producers. Conclusion: The present study emphasizes on the need to develop and regularly update the antibiotic policy in each hospital, as the antimicrobial resistance trends are changing rapidly and the trends vary in each region.