Urinary Tract Infections in the Emergency Department: Which Antibiotics are Most Appropriate?

Abstract

Aim: Urinary tract infections (UTIs) are frequently seen and also empirically treated in the emergency department (ED). It is known that the antimicrobial resistance of uropathogens is increasing worldwide. Because geographical location plays an important role in antimicrobial resistance and can be used as a guide for treatment, regional studies are particularly important. The aim of this study is to analyze the urine cultures performed at our ED.Materials and Methods: We investigated the medical records of 4,493 patients who were requested to give urine samples for culture at the ED of the Tepecik Training and Research Hospital between 2010 and 2014.Results: In our study, 47.3% cultures were positive, and the most frequent microorganism was found to be Escherichia coli (E. coli) (66.7%). Trimethoprim/sulfamethoxazole (TMP-SMX) and ciprofloxacin resistance rates were detected as 44.8% and 36.8%, respectively; further, nitrofurantoin and fosfomycin resistance rates were detected as 13.3% and 7.6%, respectively. The relationship of nitrite positivity with the reproduction of pathogens was found to be stronger than that of leukocyte esterase (LE).Conclusion: For our region, for the empirical treatment of uncomplicated UTIs, fosfomycin and nitrofurantoin must be considered as the first-line agents. Because of the increasing ratio of antibiotic resistance, urinary culture samples must be arranged for in the ED itself where administering first-line treatment has mostly been initiated.

Keywords

• Urinary tract infection
• emergency medicine
• antibiotic resistance