Methods: A prospective observational study was performed from November-2014 to June-2015 in two primary healthcare centers of the urban area of Lima, Peru. Antimicrobial prescriptions of patients older than 14 years with diagnosis of UTI were randomly selected for analysis. In parallel, urine cultures of patients that had a suspected diagnosis of UTI were performed in order to determine the antimicrobial susceptibility pattern of uropathogens. An antimicrobial prescription was defined as appropriate if (i) had an adequate coverage for the most common microorganisms in UTIs, (ii) was a single therapy, and (iii) had less than 30% of resistance according to antimicrobial susceptibility testing of Escherichia coli isolated from urine.
Results: We evaluated 160 antimicrobial prescriptions; the frequency of antimicrobials used was as follows: ciprofloxacin (55.6%), cephalosporins (12.5%), nitrofurantoin (9.4%), and others (22.5%). The most frequent microorganism isolated from 205 positive urine cultures was E. coli (77.6%), which were resistant to cotrimoxazole (62.9%), ciprofloxacin (54.7%), cefalotin (58.2%), ceftriaxone (32.1%), amoxicillin/ clavulanic acid (22%), gentamicin (23.3%), amikacin (5%) and nitrofurantoin (3.8%). Regarding the appropriateness of prescribing habits, 148 (92.5%) had an adequate coverage for common microorganisms causing UTIs, 150 (93.7%) used a single therapy and 27 (16.9%) chosen an antimicrobial that had less than 30% of resistance according to resistance rates of E. coli. Only 26/160 cases (16.5%) were considered appropriate.
Conclusion: A high percentage of prescriptions for UTI treatment were considered inappropriate mainly because of the use of quinolones and cephalosporins. Local antimicrobial guidelines are mandatory in order to allow the prescribing physicians to choose adequate empirical treatments for common bacterial infections in the community.
L. Astocondor, None
N. Hinostroza, None
C. Banda, None
J. Jacobs, None
C. Garcia, None
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