Conference Papers

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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine

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Subject: search.filters.subject.urinary tract infections

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    Recurrent urinary tract infections in females - a prospective analysis
    (Sri Lanka Medical Association, 2012) Mettananda, K.C.D.; Ranaweera, A.; Mettananda, D.S.G.
    INTRODUCTION: Urinary tract infection (UTI) is the commonest infection in women worldwide. Patients with co-morbidities or predisposing factors are at risk of developing recurrent UTI. They require hospitalisation, since causative organisms acquire resistance to first-line antibiotics and intravenous second-line antibiotics are indicated for complete eradication. Consequently, there is disturbance to lifestyle and loss of productivity for the patient. AIMS: To describe clinical profile and risk factors of female patients with recurrent UTI. Methods: All females admitted to the University Medical Unit at Teaching Hospital, Ragama from April 2011- March 2012, with >2 UTI occurring within the previous 12-months, were recruited. Data was collected using an interviewer-administered questionnaire. Results: 22 patients [mean age 48.8 years (SD+16.8, range 14-73]] fulfilled inclusion criteria. 16 (73%) were post-menopausal.13(59%) had diabetes, with poor control in 12. Other risk factors were constipation (27%), cystocele (14%), urinary calculi (9%) and hydronephrosis (9%). Urine culture was performed before antibiotics in 17(77%). 88% pre-treatment cultures were positive. 11(50%) had pyelonephritis during the current admission. 85% of diabetics had positive cultures compared to non-diabetics (77%) (p=0.55). Escherichia coll was the commonest pathogen (in 67.5%). Pyelonephritis was commoner among diabetics (61%) than non-diabetics (33%) 0=0.193). CONCLUSIONS: Post-menopausal women with poorly controlled diabetes are likely to have pyelonephritis when they develop recurrent UTI. Better glycaemic control, avoiding constipation and early treatment of structural abnormalities will reduce recurrent UTI in the at-risk population.
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    Antimicrobial susceptibility and empirical prescribing practices in treating urinary tract infections
    (Sri Lanka Medical Association, 2012) Wijekoon, C.N.; Dassanayake, K.M.M.P.; Pathmeswaran, A.
    INTRODUCTION: Empiric antimicrobials are recommended for urinary tract infection (UTI). Knowledge of local antimicrobial susceptibility is essential for prudent empiric therapy. Aims: To describe antimicrobial susceptibility patterns and empirical prescribing practices in adult in¬ward patients with UTI. METHODS: Data for this descriptive study was collected prospectively from consecutive adult patients with positive urine culture admitted to Colombo North Teaching Hospital. Sensitivity testing was done using Joan Stokes method. RESULTS: Among 745 patients, 441 (59.2%] were females. Mean (SD) age of the study population was 48.2 (19) years. Coliforms were the commonest (85.6%) isolates followed by Streptococcus spp., Candida spp., Staphylococcus spp., and Pseudomonas spp.. Susceptibility of bacteria to antimicrobials was as follows; nitrofurantoin- 76.8%, gentamicin- 62.7%, cefuroxime- 46.3%, co-trimoxazole- 44.1%, norfloxacin-43.6%, cefalexin- 37.6%, ciprofloxacin- 37.3%, co-amoxiclav- 20.7%, ampiciUin- 17.6%. 381(51.1%) received empirical antimicrobial therapy. 75 received more than one antimicrobial. Ciprofloxacin was the most frequently prescribed empirical antimicrobial (208/381; 54.6%). Nitrofurantoin was prescribed in only 9.2%. Concordance between the empirical antimicrobial prescribed and the sensitivity of the isolated organism was seen only in 25.7%. In 29.6%, urinary isolate was resistant to the empirical antimicrobial and in 44.7% the prescribed empirical antimicrobial was not included in sensitivity testing. CONCLUSIONS: Susceptibility was low (<50%) to the first line antimicrobials other than nitrofurantoin and gentamicin. Ciprofloxacin was the most frequently prescribed empiric therapy even though susceptibility to it was low. Despite high susceptibility nitrofurantoin was underutilized. There was obvious discrepancy between empirical prescribing practices and susceptibility pattern of isolates.