Antimicrobial Resistance of Uropathogens and Rationale for Empirical Therapy in Jordan
Mansour Haddad

Department of Clinical Sciences, Faculty of Pharmacy, Philadelphia University, Jordan. P.O box 3341, Irbid, Jordan P.C 211-10.

Abstract: Urinary tract infection (UTI) is one of the most common infections in both outpatients and hospital patients. In the majority of the cases, antimicrobial treatment is usually started empirically before the laboratory results of the urine culture are available. Thus, antimicrobial resistance may increase in uropathogens due to frequent and improper use of antimicrobial agents. This study was conducted to identify the urinary pathogens of UTI, to determine the antimicrobial resistance pattern in UTI and to assess the choices available for empirical antimicrobial therapy in patients with UTI over a three-year period. This study was conducted at King Abdulla University Hospital, Irbid in the north of Jordan from 2003 to 2005. A retrospective analysis of data taken from all midstream urine samples (8,800 patients suspected of UTI) was analyzed and an antimicrobial susceptibility test for commonly usable antimicrobial agents was performed for the isolates using the standard disc diffusion method. Data was analyzed using SPSS software window version 12. The most frequent causative organisms isolated were Escherichia coli (48.2%), Klebsiella pneumoniae (14.5%), Pseudomonas aeruginosa (9.7%), Enterococcus faecalis (5.8%), and Proteus mirabilis (3.2%). Nitrofurantoin was found to be the most effective antimicrobial agent against E. coli, Klebsiella pneumonia and Enterococcus faecalis isolates. Gentamycin and ciproflaxcin were found to be the most effective antimicrobial agents against Pseudomonas aeruginosa. The progressive increase in antimicrobial resistance among patients with UTI is of great concern. Empirical antimicrobial selection should be based on knowledge of the local prevalence of bacterial organisms and antimicrobial sensitivities, because antimicrobial resistance patterns may vary in different regions. The findings of this study indicate that E. coli is the predominant pathogen of UTI. Moreover, nitrofurantoin should be considered for empirical therapy of lower tract UTI.

Keywords: Antimicrobial agents; Urinary tract infection; Susceptibility; Uropathogens; Escherichia coli

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