Investigation of the patterns of antibiotic use and bacterial resistance in patients with UTI in Buraidah Centre Hospital, Saudi Arabia

Abstract

Urinary tract infections (UTIs) are one of the most common bacterial infections in hospital and community settings requiring antimicrobial treatment. Antimicrobial resistance (AMR) reduces the effectiveness of antimicrobial agents, leading to difficulties in the treatment of patients with the potential of prolonging the duration of illness and increasing mortality in patients. The misuse of antibiotics could result in public health problems, including the high prevalence of antibiotic resistance. This study aims: to determine the most common antimicrobial drugs resistance in regards to bacteria in UTI patients in Buraidah Centre Hospital (BCH), Saudi Arabia; to investigate the relationship between demographic data, bacteria, and antimicrobial drugs resistance; to investigate the relationship between the empirical and final treatments with regard to bacteria, antimicrobial drugs resistance, and diseases; to explore the background knowledge of physicians regarding antimicrobial drugs resistance in UTI patients; and, to measure the attitudes of physicians towards antimicrobial drugs resistance in UTI patients. Our study is divided into two phases: 1) retrospective analysis of UTI cases at BCH from August 2016 to January 2017; 2) quantity and quality studies were conducted on the BCH’s physicians to measure their knowledge, attitude, and practice. In Phase I, 104 (14.7%) of the 709 patients who met the criteria for UTI diagnosis had a positive urine culture (55.8%, female and 44.2%, male; mean [SD] age 53.3 [21.51] years) were reviewed. Forty-one (39.4%) admitted during the winter, and 44 (42.3%) were to the Medical ward. Gram-negative bacilli (GNB) were the most frequent bacteria, followed by E-coli. Phase II has two categories—quantitative and qualitative. Of the 110 participants, 103 (93.6%) returned the questionnaires. Their attitudes did not differ across speciality or level of training. Wide-spread antibiotic use was believed by more than 85% of the participants to be a very important general cause of resistance, and inappropriate empirical choices were believed by 73.8% of the participants to be a very important general cause of resistance. About 68% of participants said that the lack of guidelines on antibiotic use is a very important general cause of resistance. A total of 16 doctors were interviewed regarding antibiotic choices in the case scenario of uncomplicated cystitis. A majority (50.2%) of participants recommended ciprofloxacin as the first-mentioned antibiotic. Fluoroquinolones were chosen as the first-line agent rather than trimethoprim-sulfamethoxazole or nitrofurantoin, for controlling UTI symptoms. It was unknown whether forfomycin is a familiar first-line treatment option for uncomplicated cystitis to the participants. Urine cultures are (20.2%) obtained from hospitalised patients, even in the absence of urinary symptoms. The appropriateness of treatment was higher in the empirical treatment compared to the final treatment. Meanwhile, the final treatment had more drug resistance than empirical treatment. The physicians acknowledged that among the most significant factors of AMR is antimicrobial misuse, either by over-prescribing or providing inappropriate drugs. By adhering to local guidelines, continuous education, and other practical interventions, the burden of resistance can be alleviated.