Journal List > Korean J Urol > v.48(6) > 1004945

Ryu, Kim, and Jeong: A Recent Study on the Antimicrobial Sensitivity of the Organisms that Cause Urinary Tract Infection

Abstract

Purpose

The overuse and misuse of antimicrobial agents have made choosing an appropriate antibiotic more difficult. We studied changes in the antibiotic sensitivities of the causative microorganisms of urinary tract infection (UTI), in 2000 versus 2005, in order to provide useful information and to aid physicians to make better choices of adequate drugs for treating UTI.

Materials and Methods

We retrospectively analyzed 5,266 uropathogens and their antimicrobial sensitivities in 3,346 patients who were admitted to or they had visited two tertiary hospitals located in Honam province, in 2000 versus 2005. This revealed the isolated causative organisms in the urine cultures.

Results

The incidence of UTI shows bimodal peaks in the first decade (22.3%) and 7th decade (18.8%). The common pathogens were E. coli (34.4%), Enterococcus (19.0%), Staphylococcus (10.2%), Pseudomonas (9.9%) and Klebsiella (9.8%). The incidence of Gram positive organisms was increased from 35.7% in 2000 to 38.1% by 2005. For the Gram negative isolates, imipenem and amikacin showed relatively higher sensitivity, while ampicillin and ciprofloxacin showed relatively lower sensitivity. For the Gram positive isolates, vancomycin and teicoplanin showed relatively higher sensitivity, while penicillin and ciprofloxacin showed relatively lower sensitivity. Significant declines for the third-generation cephalosporins' and fluoquinolones' sensitivity to E. coli and Klebsiella isolates were found.

Conclusions

E. coli was the most common single organism causing UTI. We should be concerned about the increase of Gram positive organisms, especially Enterococcus. The use of TMP/SMX and nitrofurantoin as the first choices of treatment for UTI should be reconsidered. It is recommended that fluoroquinolone should be restricted because of the high antibiotic resistance and the economic aspects.

References

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Fig. 1.
Age and gender distribution of the urinary tract infections.
kju-48-638f1.tif
Table 1.
Species distribution of the isolates from patients with urinary tract infections for 2000 versus 2005
Organism Year Inpatient (%) Outpatient (%)
E. coli 2000 21.5 41.9
  2005 22.8 51.2
Enterobacter 2000 2.2 2.9
  2005 4.2 3.8
Klebsiella 2000 10.6 5.3
  2005 15.6 7.7
Proteus 2000 1.6 5.6
  2005 1.2 3.8
Acinetobacter 2000 5.7 0.7
  2005 4.4 0.8
Citrobacter 2000 2.4 4.8
  2005 1.6 3.1
Serratia 2000 2.7 0.7
  2005 1.9 0.9
Pseudomonas 2000 17.6 7.1
  2005 10.2 4.7
Enterococcus 2000 25.1 13.3
  2005 26.1 11.3
Staphylococcus 2000 7.9 12.7
  2005 10.9 9.4
Streptococcus 2000 2.7 4.9
  2005 1.1 3.3
Table 2.
Changes of drug sensitivities for the Gram stained pathogens for 2000 versus 2005
  Drug susceptibility (%)
Year AC CL CX CZ CT GM AK TM CF OF NF NFN TS IP
Gram (-) 2000 6.8 23.4 42.3 66.3 51.4 53.1 60.9 49.1 53.9       37.6 88.2
  2005 24 27.6 47.8 53.9 62.5 56.9 60.1 51 42.6 60.9 49.5 45.5 57.6 82.3
  Year EM GM TC PC AC CL TS TP VM CF  
Gram (+) 2000 24 22.2 32.8 28.6 31.3 48.2 81.8 96.1 95.9 37.9
  2005 34 28.1 43.2 41.6 40.3 16.5 56.1 95.4 95.2 50.9

AC: ampicillin, CL: cephalothin, CX: cefoxitin, CZ: ceftazidime, CT: cefotaxime, GM: gentamicin, AK: amikacin, TM: tobramycin, CF: ciprofloxacin, OF: ofloxacin, NF: norfloxacin, NFN: nitrofurantoin, TS: trimethoprim/sulfamethoxazole, IP: imipenem

Table 3.
Antibiotic sensitivities of the Gram-negative organisms in inpatients
Organism Year Drug susceptibility (%)
AC CL CX CZ CT GM AK TM CF OF NF NFN TS IP
E. coli 2000 21.2 41.9 81.3 88.2 87.9 68.8 86.3 59.9 57.2       43.6 100
  2005 23.4 38.2 78.4 81.9 84.4 63.3 91.3 54.6 47.5 50.2 48.9 89.1 51.4 100
Enterobacter 2000 6.1 0 7.7 60.6 54.5 66.7 81.8 66.7 93.9       77.8 96.9
  2005 13.6 23.5 12.9 65.7 79.6 84.3 94.3 84.7 94.3 91.7 94.4 16.7 81.4 98.6
Klebsiella 2000 0.6 18.3 38.9 44.2 40.4 54.5 55.1 40.5 59.4       59.8 100
  2005 0 21.5 29.7 27.1 30.3 40.3 49.4 32.8 31.2 29.1 35.4 13.3 76.4 98.9
Proteus 2000 29.2 54.5 62.5 95.8 91.7 83.3 95.8 100 83.3       45.5 100
  2005 47.1 80 90.9 85.7 82.4 80.9 85.7 73.3 80.9 80 100 0 71.4 90.5
Acinetobacter 2000 4.3     62.5 12.9 32.1 35.7 40.4 34.5 25     35.1 83.1
  2005 0 0 0 37.8 16.7 31.1 40.5 44.6 48.6 80 83.3 0 52.7 90.5
Citrobacter 2000 2.9 0 0 60 60 34.3 57.1 43.8 51.4       15.8 100
  2005 0 0 0 72 66.7 96.3 100 94.7 59.3 61.5 61.9 66.7 77.8 100
Serratia 2000 0 0 21.6 67.5 27.5 45 80 96.2 50       37.8 100
  2005 14.3 0 0 51.5 66.3 75 42.4 26.7 62.5 61.2 56.9 12.1 63.6 96.9
Pseudomonas 2000 0     70.9 8.4 20.4 22.9 21.3 27.3 22.1     7.5 60.9
  2005 0 0 0 59.6 4.9 45.3 47.9 44.4 43.9 20 25 0 34.9 51.2

AC: ampicillin, CL: cephalothin, CX: cefoxitin, CZ: ceftazidime, CT: cefotaxime, GM: gentamicin, AK: amikacin, TM: tobramycin, CF: ciprofloxacin, OF: ofloxacin, NF: norfloxacin, NFN: nitrofurantoin, TS: trimethoprim/sulfamethoxazole, IP: imipenem

Table 4.
Antibiotic sensitivities of the Gram-positive organisms in inpatients
Organism Year Drug susceptibility (%)
EM GM TC PC AC CL TS TP VM CF
Enterococcus 2000 2.1 0 61.1   27.8 1.3   86.4 84.4 7.7
  2005 2.9 14.5 67.3 19.1 24.9 0 1.1 84.3 83.1 13.6
Staphylococcus 2000 12.9 12.8 31.3 2.9 0 28.3 68.6 99.1 100 25
  2005 28.1 29.1 53 1.1 0 14.3 77.3 99.5 100 32.6
Streptococcus 2000 38.5   55.6 61.5 25 65.4   100 100 51.9
  2005 40 33.3 25 93.3 83.3 67.5 80 100 100 80

EM: erythromycin, GM: gentamicin, TC: tetracycline, PC: penicillin, AC: ampicilline, CL: cephalothin, TS: trimethoprim/sulfamethoxazole, TP: teicoplanin, VM: vancomycin, CF: ciprofloxacin

Table 5.
Antibiotic sensitivities of the Gram-negative organisms in outpatients
Organism Year Drug susceptibility (%)
AC CL CX CZ CT GM AK TM CF OF NF NFN TS IP
E. coli 2000 20.2 47.3 82.3 95.9 95.1 69.4 97.1 71.9 73.8       50 100
  2005 32.2 50.5 73.2 89.9 92.5 74.1 97.1 75.1 65.1 68.2 68.5 93.3 58.4 100
Enterobacter 2000 0 0 14.3 62.5 62.5 87.5 95.8 92.9 87.5       70 98.3
  2005 6.7 0 0 54.5 73.3 96.9 100 90 93.9 90 95.2 28.6 93.9 100
Klebsiella 2000 0 59.1 76.9 88.6 84.1 95.3 84.1 90.9 97.7       63.6 100
  2005 0 63.6 63.5 60.6 63.6 73.1 76.1 75.5 61.2 68.2 61.3 22.6 80.6 100
Proteus 2000 30.4 55.5 61.4 100 100 86.9 100 94.6 89.1       55.5 100
  2005 35 66.7 88.9 84.8 85.2 75.8 90.9 73.1 68.8 66.7 81.3 0 56.3 72.7
Acinetobacter 2000 50 0   66.7 33.3 66.7 66.7 100 66.7       50 100
  2005 0 0 50 85.7 50 71.4 71.4 71.4 71.4 85.7 83.3 0 71.4 100
Citrobacter 2000 2.5 0 23.5 62.5 55 55 82.5 72.2 72.5       36.4 100
  2005 7.7 0 0 55.6 61.5 81.5 96.3 86.4 81.5 78.6 84.2 84.2 70.4 100
Serratia 2000 0 0 66.7 100 100 100 100 100 100       100 100
  2005 0 0 33.3 100 100 100 100 83.3 100 100 100 0 100 100
Pseudomonas 2000 0     93.2 33.3 67.8 71.2 66.7 54.2 52     23.1 79.7
  2005 10 20 5 65.9 31.2 26.8 56.1 53.7 56.1 53.3     26.8 92.6

AC: ampicillin, CL: cephalothin, CX: cefoxitin, CZ: ceftazidime, CT: cefotaxime, GM: gentamicin, AK: amikacin, TM: tobramycin, CF: ciprofloxacin, OF: ofloxacin, NF: norfloxacin, NFN: nitrofurantoin, TS: trimethoprim/sulfamethoxazole, IP: imipenem

Table 6.
Antibiotic sensitivities of the Gram-positive organisms in outpatients
Organism Year Drug susceptibility (%)
EM GM TC PC AC CL TS TP VM CF
Enterococcus 2000 3.6   16.4   78.2 6.1   100 99.1 16.4
  2005 5.5 34.1 30.3 67.7 72.7 5.9 0 100 97.9 18.2
Staphylococcus 2000 28.6 28.6 41.2 0 5.9 59.5 47.6 98.1 100 64.8
  2005 52.4 54.9 62.2 4.9 0 25 85.4 99.3 100 64.6
Streptococcus 2000 51.5 0 15.2 42.9 52.5 93.9 100 100 100 61.8
  2005 70.4 42.9 7.4 93.1 89.7   96 100 100 92

EM: erythromycin, GM: gentamicin, TC: tetracycline, PC: penicillin, AC: ampicilline, CL: cephalothin, TS: trimethoprim/sulfamethoxazole, TP: teicoplanin, VM: vancomycin, CF: ciprofloxacin

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