Urinary tract infections at Aga Khan University hospital Nairobi - A one year experience
AbstractBackground: In developing countries, most of these patients with urinary tract infections (UTI) are normally treated empirically and urine culture is usual ordered for as a last resort in patients refractory to antibiotic treatment.
Objective: To explore the possibility of designing empiric antibiotic therapy for symptomatic UTI in patients at Aga Khan University Hospital by looking at the trends of UTI, common pathogens isolated and their antibiotic susceptibility pattern.
Design: A retrospective clinical-laboratory study.
Setting: Aga Kahn University Hospital- Nairobi.
Subjects: All positive urine cultures between January and December 2008 were included in the study.
Results: A total of 409 urine specimens were retrieved and analysed and 100 cases had negative cultures. Three hundred and nine cases had positive cultures. Sixty eight point seven percent were females while 31.3% were males with a mean age of 31 years. One hundred and thirty five out of 409 patients (33%) had classical signs and symptoms. In 143 (35%) cases E. coli was isolated. The other cultures were organisms other than E.
coli. There was a higher resistance to clotrimazole in E. coli (71%) as compared to non- E. coli organisms (23%). There was a higher resistance rate to Nalidixic acid in non-E. Coli organisms (35%) and higher resistance rate to Augmentin in E. Coli 43 versus 18% (c/f non-E.Coli). Forty patients in the study had predisposing factors for UTI.
Conclusions: It is sometimes warranted to start the patient on empiric antibiotic treatment before culture results are available. Nitrofurantoin, Cefuroxime, Ciprofloxacin have good sensitively rates and are therefore drugs of first choice for the treatment of uncomplicated urinary tract infection provided that the contraindications and specific precautions are noted.