Urinary tract infection in the community of Ribeirão Preto, SP, brazil

etiology, bacterial susceptibility to antimicrobials, and therapeutic implications

Abstract

This study intended to evaluate the etiology of urinary tract infection and the antimicrobial susceptibility of the bacteria more frequently isolated of the urine of patients assisted in Primary Health Care Units of Ribeirão Preto, SP, Brazil. The urine was collected between October 1996 and May 2000. The identification and antimicrobial susceptibility of the isolated bacteria were made in the automated system Microscan ( Dade — Behring ), except in the first six months of the study, when conventional bacteriological identification and disk diffusion methods were used causative agents were distributed in Enterobacteriaceae (87,6%), nonfermentative Gram —negative bacilli (1,5%), and Gram — positive cocci (11,9%). Most prevalent species in a total of 1638 bacteria were Escherichia coli (1108 — 67,6%), Klebsiella pneumoniae (107 — 6,5%), Proteus mirabilis ( 67 — 4,1% ), Staphylococcus saprophyticus ( 63 — 3,8% ), Citrobacter koseri (26 — 1,6%), and Enterococcus faecalis (25 — 1,5%). The susceptibility of E. coli was low for ampicillin (45% ) and cephalothin ( 54% ), median for trimethoprim — sulphamethoxazole ( 63%), and high for amoxicillin — clavulanate, cefuroxime, ceftazidime, gentamicin, amikacin, nitrofurantoin, norfloxacin, pipemidic acid, nalidixic acid and ciprofloxacin (92% - 100% ). The overall sensitivities of uropathogens suggest that norfloxacin and other quinolones, nitrofurantoin, cefuroxime, and gentamicin are adequate therapeutic options for community urinary tract infections.