| Abstract | OBJECTIVES: confirm the predisposing conditions, the most common causative pathogen and their sensitivity to different antibiotics in patients with urinary tract infections (UTIs).
MATERIAL AND METHODS: the study included 175 patients with the diagnosis cystitis, pyelonephritis and prostatitis, with no proven bacteremia, which were treated at the Clinic of Infectology at the University Hospital of Split, in the period of years 2016-2017. All patients were diagnosed on the basis of clinical evaluation and laboratory diagnostics. Study was conducted as an observational retrospective study. Medical data were collected by reviewing the history of medical files from the archive of at the Clinic of Infectology.
RESULTS: the largest number of patients (27.4%) were in the age group from 80 years and on. Most of the patients in the study were women (61.1%). Almost half of the patients (48.9%) had one or more predisposing conditions for UTIs. The most frequent predispositions were diabetes mellitus (14.9%), variety of neurological conditions that are associated with urin incontinence or retention (13.7%), and long term urinary catheters (7.4%). E.coli (62.8%) was by far the most common cause of urinary tract infections, in second place was P.aureginosa (10.2%) followed by P.mirabilis (8.2%), Klebsiella (5.6%). Almost half (48.0%) of the E.coli isolates where resistant to ampicillin, and only 7.3% were resistant to amoxicillin-clavulanate, while resistence to trimetoprim-sulphametoxazole and fluroquinolones was 29.3% and 22.8%, respectively. Almost all bacteria, with exception of A.baumanii, causing UTIs in our patients were sensitive do carbapenems.
CONCLUSIONS: Diabetes mellitus was the most common predisposing factor in our patients. With a number over 60% the most common pathogen was E.coli, far behind it in second place was P.aureginosa with only 10.2%. Over 90% of E.coli isolates were sensitive to amoxicillin-clavulanic acid which makes this antibiotic a reliable first choice as an empirical treatment for community acquired UTIs.Trimethoprim-sulfamethoxazole, fluoroquinolone and to a certain degree cephalosporins should not be used before the antibiotic susceptibility of the pathogen is known. Carbapenems are a reliable first choice of antibiotics. |
| Abstract (croatian) | Ciljevi: utvrditi predispozicijske čimbenike, najčešće uzročnike i njihovu osjetljivost na antibiotike u bolesnika s infekcijama mokraćnog sustava (IMS).
Materijali i metode: Studija je obuhvatila 175 bolesnika s dijagnozom cistitisa, pijelonefitisa i prostatitisa bez dokazane bakterijemije koji su liječeni na Klinici za infektologiju kliničkog bolničkog centra Split u razdoblju od 2016.-2017.godine. Svim bolesnicima je dijagnoza postavljena temeljem kliničke procjene i laboratorijske dijagnostike. Medicinski podaci su prikupljeni pregledom povijesti bolesti iz arhive Klinike za infektologiju.
Rezultati: Najviše bolesnika (27,4%) bio je u dobnoj skupni od 80 i više godina. Većina bolesnika bile su žene (61,1%). Gotovo polovica naših bolesnika (48,9%) imala je jedan ili više predispozicijskih čimbenika za infekciju mokraćnog sustava. Najzastupljenije predispozicije su bile diabetes mellitus (14,9%), različita neurološka stanja koja su povezana s inkontinencijom ili retencijom urina (13,7%) i trajni urinski kateter (7,4%). E.coli bila je daleko najčešći uzročnik IMS (62,8%), na drugom mjestu P.aureginosa (10,2%), a potom slijede P.mirabilis (8,2%) i Klebsiella (5,6%). Gotovo polovica izoliranih E.coli (48,0%) bilo je rezistentno na ampicilin, a samo 7,3% ih je bilo rezistentno na amoksicilin-klavulanat, dok ih je na trimetoprim-sulfametoksazol i flurokinolone bilo rezistetno 29,3% , odnosno 22,8%. Gotovo sve bakterije, s izuzetkom A. bauumanii, koje su uzrokovale IMS u naših bolesnka bile su osjetljive na karbapeneme.
Zaključci: Dijabetes melitus je najčešći predispozcijski faktor IMSa u naših bolesnika. S udjelom od preko 60% najčešći uzročnik bio je E.coli , a daleko iza nje na drugom mjestu je P.aeruginosa s tek 10,2% . Preko 90% izolata E.coli bilo je osjetljivo na amksicilin-klavulanat što čini ovaj antibiotik pouzdanih prvim izborom za empirijsko liječenje vanbolnički stečenih IMSa. Trimetoprim-sulfametoxazol, fluorokionolone, pa u određenom opsegu i cefalosporine ne bi trebalo primjenjivati prije nego je poznata antibiotska osjetljivost uzročnika. Karbapenemi su pouzdani antibiotici prvog izbora. |
