A Comparison of Antibiotic Susceptibility Patterns of Klebsiella Associated Urinary Tract Infection in Spinal Cord Injured Patients with Nosocomial Infection
,
Abstract
Just regarding different risk factors for antibiotic resistant uropathogenes, it seems justice to improve diagnostic power for drug resistant uropathogenes and well appropriate empirical therapy. 300 and 145 cases of clinicopathologically diagnosed nosocomial and spinal cord injured (SCI) associated urinary tract infection (UTI), respectively, were considered as our samples included in our 24 months study (2005 and 2006). 50 (16.6%) and 26 (17.9%) correctly diagnosed Klebsiella, respectively, were cultured from our specimens . MIC pattern of this uropathogenes for 8 antibiotics was determined by gradient concentration method. The prevalence of antibiotic resistant Klebsiella was more among nosocomial associated UTI rather than SCI UTI (P<0.05). According to susceptibility cut-off point criteria of CLSI M7-A6 (Clinical and Laboratory Standard Institute), Klebsiella resistance rate of nosocomial and SCI were 40% and 0 in amikacin (P <0.0001), 86.2% and 16.7% in ceftazidime (P<0.001), 69% and 25% in ceftriaxon (P<0.005), 5.1% and 0 in imipenem (P<0.0001), 50% and 25% in ciprofloxacin (P< 0.05), 81% and 22.2% in gentamicin 100%and 62.5% (P<0.001) in trimethoprim/sulfamethoxazole (P<0.05 ) respectively. Only resistance to nalidixic acid was mildly higher in SCI Klebsiella (68.8%, 66.7%). MIC 50 of all antibiotics except nalidixic acid and trimethoprim/sulfamethoxazole were higher in nosocomial Klebsiella (P<0.05). In conclusion although the whole risk factors for UTI in the cases of SCI associated UTI are more than for nosocomial UTI. Interestingly, the prevalence of Klebsiella resistant UTI was more in the second group.
Hooton TM. The epidemiology of urinary tract infection and the concept of significant bacteriuria. Infection 1990;18 (Suppl 2):S40-3.
Ronald A. The etiology of urinary tract infection: traditional and emerging pathogens. Dis Mon 2003;49(2): 71-82.
Leung AK, Kao CP, Robson WL. Urinary tract infection due to Salmonella stanleyville in an otherwise healthy child. J Natl Med Assoc 2005;97(2):281-3.
Milo G, Katchman EA, Paul M, Christiaens T, Baerheim A, Leibovici L. Duration of antibacterial treatment for uncomplicated urinary tract infection in women. Cochrane Database Syst Rev 2005;(2):CD004682.
Rizvi MF, Hasan Y, Memon AR, Abdullah M, Rizvi MF, Saleem S, et al. Pattern of nosocomial infection in two intensive care units of a tertiary care hospital in Karachi. J Coll Physicians Surg Pak 2007;17(3):136-9.
Alos JI. Epidemiology and etiology of urinary tract infections in the community. Antimicrobial susceptibility of the main pathogens and clinical significance of resistance] Enferm Infecc Microbiol Clin. 2005;23 (Suppl 4):3-8.
Lopardo G, Fridman D, Gonzalez Arzac M, Calmaggi A, Smayevsky J, Podesta O, Clara L. Uropathogen resistance: are laboratory-generated data reliable enough? J Chemother. 2007;19(1):33-7
Klebsiella pneumoniae infection on a rehabilitation unit: comparison of epidemiologic typing methods Infect Control Hosp Epidemiol. 1993 Apr;14(4):203-10.
Moser C, Kriegbaum NJ, Larsen SO, Hoiby N, Biering- Sorensen F. Antibodies to urinary tract pathogens in patients with spinal cord lesions Spinal Cord 1998;36(9):613-6.
Reid G, Nicolle LE. Asymptomatic bacteriuria in spinal cord patients and the elderly Urol Clin North Am. 1999;26(4):789-95.
Garcia Leoni ME, Esclarin De Ruz A. Management of urinary tract infection in patients with spinal cord injuries Clin Microbiol Infect. 2003;9(8):780-5.
Siroky MB Pathogenesis of bacteriuria and infection in the spinal cord injured patient Am J Med. 2002 Jul 8;113 Suppl 1A:67S-79S.
Jombo GT, Egah DZ, Banwat EB, Ayeni JA. Nosocomial and community acquired urinary tract infections at a teaching hospital in north central Nigeria: findings from a study of 12,458 urine samples. Niger J Med 2006;15(3):230-6.
Savas L, Guvel S, Onlen Y, Savas N, Duran N. Nosocomial urinary tract infections: micro-organisms, antibiotic sensitivities and risk factors. West Indian Med J 2006;55(3):188-93.
Cox CE. Cost-effective management of complicated urinary tract infections. Adv Ther 1995;12(4):222-35.
Chan RK, Lye WC, Lee EJ, Kumarasinghe G. Nosocomial urinary tract infection: a microbiological study. Ann Acad Med Singapore 1993;22(6):873-7.
Isaack H, Mbise RL, Hirji KF. Nosocomial bacterial infections among children with severe protein energy malnutrition. East Afr Med J 1992;69(8):433-6.
Leblebicioglu H, Esen S; Turkish Nosocomial Urinary Tract Infection Study Group. Hospital-acquired urinary tract infections in Turkey: a nationwide multicenter point prevalence study. J Hosp Infect 2003;53(3):207-10.
Biering-Sørensen F, Bagi P, Høiby N. Urinary tract infections in patients with spinal cord lesions: treatment and prevention. Drugs 2001;61(9):1275-87.
| Files | ||
| Issue | Vol 47, No 6 (2009) | |
| Section | Original Article(s) | |
| Keywords | ||
| Klebsiella urinary tract infection spinal cord injuries anti-bacterial agents | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
