Department of Pharmacology & Therapeutics, Faculty of Medicine, Gulu University, PO box 166, Gulu, Uganda.
BMC Infect Dis. 2013 Apr 29;13:193. doi: 10.1186/1471-2334-13-193.
Urinary tract infections (UTI) are common in clinical practice and empirical treatment is largely employed due to predictability of pathogens. However, variations in antibiotic sensitivity patterns do occur, and documentation is needed to inform local empirical therapy. The current edition of the Uganda Clinical Guidelines recommends amoxicillin or cotrimoxazole as choice drugs for empirical treatment of community-acquired UTI. From our clinical observations, we suspected that this recommendation was not effective in our setting. In order to examine validity, we sought to identify bacteria from community-acquired infections and determine their susceptibility against these antibiotics plus a range of potentially useful alternatives for treatment of UTI.
A cross-sectional study of mid-stream urine collected from 339 symptomatic patients over a three-month period at Gulu regional referral hospital. Qualitative culture and identification of bacteria and antibiotic sensitivity testing using the modified Kirby-Bauer disk diffusion method was done. Participants' demographic and clinical characteristics were collected using a standard form. Results were analyzed by simple proportions among related variables and confidence intervals computed using binomial exact distribution.
Eighty two cultures were positive for UTI. Staphylococcus spp (46.3%) and Escherichia coli (39%) were the most common pathogens. There was high resistance to cotrimoxazole (73.2%), nalidixic acid (52.4%) and amoxicillin (51.2%). The most favorable antibiograms were obtained with gentamicin, amoxicillin-clavulanate and levofloxacin where 85.4%, 72.0%, 67.1% of isolates respectively, were either sensitive or intermediate. Only 51% of isolates were sensitive to ciprofloxacin.
There was high resistance to most antibiotics tested in this study. The recommendations contained in the current edition of the Uganda Clinical Guidelines are not in tandem with antibiotic sensitivity pattern of uropathogens seen in our setting. Amoxicillin-clavulanate or gentamicin should be considered for replacement of amoxicillin and cotrimoxazole for empirical treatment of UTI in our setting.
尿路感染（UTI）在临床实践中很常见，由于病原体的可预测性，大量采用经验性治疗。然而，抗生素敏感性模式确实存在差异，需要记录这些信息以告知当地的经验性治疗。乌干达临床指南的当前版本建议阿莫西林或复方磺胺甲噁唑作为治疗社区获得性 UTI 的首选药物。根据我们的临床观察，我们怀疑该建议在我们的环境中并不有效。为了检验其有效性，我们试图从社区获得性感染中鉴定细菌，并确定它们对这些抗生素以及一系列潜在有用的 UTI 治疗替代品的敏感性。
对在 Gulu 地区转诊医院就诊的 339 例有症状患者在三个月期间采集的中段尿进行横断面研究。采用改良 Kirby-Bauer 纸片扩散法进行定性培养和细菌鉴定以及抗生素敏感性试验。使用标准表格收集参与者的人口统计学和临床特征。使用相关变量之间的简单比例和二项精确分布计算置信区间进行结果分析。
82 例培养物呈 UTI 阳性。葡萄球菌属（46.3%）和大肠埃希菌（39%）是最常见的病原体。对复方磺胺甲噁唑（73.2%）、萘啶酸（52.4%）和阿莫西林（51.2%）的耐药率较高。对庆大霉素、阿莫西林-克拉维酸和左氧氟沙星的药敏谱最好，分别有 85.4%、72.0%、67.1%的分离菌为敏感或中介。只有 51%的分离菌对环丙沙星敏感。
本研究中测试的大多数抗生素都存在高度耐药。当前版乌干达临床指南中的建议与我们环境中看到的尿路病原体的抗生素敏感性模式不一致。在我们的环境中，阿莫西林-克拉维酸或庆大霉素应考虑替代阿莫西林和复方磺胺甲噁唑用于经验性治疗 UTI。
