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ORIGINAL ARTICLE
Year : 2017  |  Volume : 4  |  Issue : 1  |  Page : 1-5

Management of community-acquired urinary tract infection in a tertiary care setting: A prospective study


1 Department of Internal Medicine and Diabetology, Global Hospitals, Chennai, Tamil Nadu, India
2 Department of Microbiology, Global Hospitals, Chennai, Tamil Nadu, India
3 Department of Research and Academics, Global Hospitals, Chennai, Tamil Nadu, India

Correspondence Address:
M Madhu Bashini
Global Hospitals, Cheran Nagar, Perumbakkam, Chennai - 600 100, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cai.cai_22_16

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Background and Objectives: Carbapenems and beta-lactam-beta-lactamase inhibitors are empirical drugs of choice in the treatment of urinary tract infection. (UTI); however, de-escalation of therapy is necessary to ensure compliance. Objectives: The objective is to study the impact of antibiotic susceptibility report on the management of community-acquired UTI. Materials and Methods: Patients were classified prospectively as uncomplicated UTI (UC-UTI) and complicated UTI (C-UTI), and symptoms, microbiology, antibiotic susceptibility pattern, and treatment modification following culture report were analyzed. Extended spectrum beta-lactamase (ESBL) prevalence in patients was compared among naive and those who received empirical treatment before presentation. Patients with a history of recurrent UTI were given prophylaxis and all were followed up for 1 month. SPSS version 20 package was used for statistical analysis. Results: Nearly 75% of the study population had C-UTI. Around 70% of C-UTI and 50% of UC-UTI had ESBL-producing Gram-negative enterobacteriace. In UC-UTI, failed empirical treatment before presentation at our center was significantly associated with positive ESBL producer status. Sensitivity to amikacin and carbapenems was over. 90%; nitrofurantoin and piperacillin-tazobactam followed at around 70%. Following culture report, a significant number of C-UTI were de-escalated to oral regimens. Conclusions: Despite the high prevalence of ESBL-producing pathogens in community.acquired UTI, once systemic signs of sepsis are controlled, de-escalation is possible in the majority of patients.


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