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首页> 外文期刊>The Internet Journal of Orthopedic Surgery >Evaluation of Empirical Antibiotic Prescription and Urinalysis in Patients with Symptoms Suggestive of Uncomplicated Urinary Tract Infection in Abakaliki, Nigeria
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Evaluation of Empirical Antibiotic Prescription and Urinalysis in Patients with Symptoms Suggestive of Uncomplicated Urinary Tract Infection in Abakaliki, Nigeria

机译：尼日利亚阿巴卡利基有简单尿路感染症状的经验性抗生素处方和尿液分析的评估

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Objective: To investigate the pattern of antibiotic prescriptions to patients with symptoms suggestive of uncomplicated urinary tract infection (UTI), the appropriateness of such prescriptions based on outcomes of subsequent urine culture and susceptibility test and the role of routine urinalysis in the diagnosis of UTI.Methods: Urine samples from 500 patients provisionally diagnosed of UTI and given empirical antibiotic prescription were subjected to dipstick analysis, microscopy and quantitative culture using standard methods. Antimicrobial susceptibility of isolates from cultures that yielded significant bacteriuria (≥ 105 cfu/ml) was carried out using the Kirby-Bauer disc diffusion technique.Results: Significant bacteriuria was recorded in 213 (42.6 %) of the urine specimens while 182 (36.4 %) showed insignificant bacteriuria and 105 (21.0 %) were sterile. Amoxycillin plus clavulanic acid was the most frequently prescribed antibiotic (23.6 %) and Clarithromycin was the least (1.4 %). Only 99 (46.5 %) of the isolates from the 213 positive cultures were found to be sensitive to the antibiotics empirically prescribed, with ciprofloxacin exhibiting the broadest spectrum of in vitro activity against the isolates. Urinalysis results for nitrite, protein and pyuria were comparable to that of culture. Conclusion: UTI is likely over-diagnosed in the study area and urinalysis result if well interpreted could be a guide to empirical prescriptions prior to results of culture and sensitivity tests. However, ciprofloxacin should be considered as the choice antibiotic when empirical prescriptions are inevitable. Introduction Antibiotic prescriptions without proper indication has been noted as a major contributory factor to the growing rate of bacteria resistance to antimicrobial agents.[1-3] Urinary tract infection (UTI) is one of the most common causes of morbidity in the general population, accounting for the majority of hospital visits.[4] However, majority of patients do not eventually demonstrate significant bacteriuria.[2] Urinalysis has been argued as cost effective adjunct to culture in the diagnosis and management of UTI[5]. The aims of this study therefore were to evaluate pattern of antibiotic prescriptions, the appropriateness of such prescriptions and the role of routine urinalysis in the diagnosis of UTI. Materials and methods Study siteThis study was conducted at Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki. The hospital is a state owned tertiary health facility serving a population of about 255,000 within Abakaliki, the state capital. It also serves as a referral centre to other hospitals in the state and its environs. The study spanned from November 2008 to October 2009.Study populationThese comprised individuals who were attending the Out Patient Clinic of the hospital with symptoms suggestive of urinary tract infection and were provisionally diagnosed as such and were prescribed antibiotics prior to urine culture and sensitivity test. Patients with symptoms but did not receive empirical antibiotic prescription were excluded from the study. The protocol for this study was approved by the Ethics and Research Committee of Ebonyi State University Teaching Hospital, Abakaliki. The approval was on the agreement that patient anonymity must be maintained, good laboratory practice/quality control ensured, and that every finding would be treated with utmost confidentiality and for the purpose of this research only. All work was performed according to the international guidelines for human experimentation in clinical research. [6] Sample collectionMidstream “clean catch” urine samples were collected from 500 adult patients who gave their consent to participate in the study, into sterile plastic universal containers. Information on prescribed antibiotics was retrieved from Out-patient drug sales register at the Pharmacy Department as most out-patients of the hospital procure their drugs at the hospital Pharmacy. S
机译：目的：探讨症状提示无并发症尿路感染（UTI）的患者的抗生素处方的模式，基于随后尿培养和药敏试验结果的处方的适当性以及常规尿液分析在UTI诊断中的作用。方法：对500名临时诊断为UTI并给予经验性抗生素处方的患者的尿液样本进行试纸分析，显微镜检查和定量培养。使用Kirby-Bauer圆盘扩散技术对产生显着菌尿（≥105 cfu / ml）的培养物分离物进行抗菌敏感性分析。结果：尿标本中有213（42.6％）记录到显着菌尿，而182（36.4％） ）显示微不足道的细菌尿，并且105个（21.0％）是无菌的。阿莫西林加克拉维酸是最常用的抗生素（23.6％），克拉霉素最小（1.4％）。发现从213种阳性培养物中分离出的分离株中只有99个（46.5％）对根据经验开具的抗生素敏感，环丙沙星对分离株的体外活性范围最广。亚硝酸盐，蛋白质和脓尿的尿液分析结果与培养物相当。结论：如果正确解释尿路感染，可能会在研究区域过度诊断尿液分析结果，这可以指导培养和敏感性试验之前的经验性处方。但是，当不可避免地需要经验处方时，应考虑使用环丙沙星作为抗生素的选择。简介没有适当适应症的抗生素处方被认为是细菌对抗菌剂耐药性增长的主要原因。[1-3]尿路感染（UTI）是普通人群中最常见的发病原因之一，占医院就诊的大部分。[4]但是，大多数患者最终并未显示出明显的细菌尿。[2]在尿路感染的诊断和管理中，尿液分析被认为是成本有效的辅助手段[5]。因此，本研究的目的是评估抗生素处方的模式，此类处方的适用性以及常规尿液分析在尿路感染诊断中的作用。材料和方法研究地点本研究在阿巴卡利基的埃邦依州立大学教学医院（EBSUTH）进行。该医院是国有的三级医疗机构，为州首府Abakaliki的约255,000人口提供服务。它也可以作为该州及其周边地区其他医院的转诊中心。研究范围为2008年11月至2009年10月。研究人群包括正在医院门诊就诊的患者，这些患者的症状提示尿路感染，并已被初步诊断，并在进行尿培养和敏感性试验之前开了抗生素。有症状但未接受经验性抗生素处方的患者被排除在研究之外。这项研究的方案已由阿巴卡里奇（Ebabayi）的埃邦伊州立大学教学医院伦理与研究委员会批准。批准的依据是必须保持患者的匿名性，确保良好的实验室操作/质量控制，并且将对每个发现进行最大程度的保密，并且仅出于本研究目的。所有工作均根据临床研究中人体实验的国际准则进行。 [6]样品收集从500位同意参加研究的成年患者中采集“中间捕获”尿液样品到通用塑料无菌容器中。有关处方抗生素的信息可从药房的门诊药品销售登记处获取，因为医院的大多数门诊病人都在药房购买药物。小号

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