Urinary tract infections in general practice in a rural community in South Trinidad

OBJECTIVE: A prospective study was carried out at a General Practice in South Trinidad, to assess the sensitivity profiles of urinary isolates in this remote rural community.

METHODS: Quantitative bacteriologic cultures were performed according to standard procedures. Identification of isolates was based on gram reaction, morphology and biochemical reactions. Susceptibility testing was carried out using commonly prescribed antimicrobials for the treatment of urinary tract infections.

RESULTS: From 779 urine specimens, 49% were culture positive for counts >105 organisms per ml. Three hundred and eighteen were aged 21 years and above and 85.5% of these were females. The lowest incidence of urinary tract infections, 8%, was seen among the 13-20 year old age group. Most males above 50 years had indwelling urethral catheters due to prostatic disease. Escherichia coli was the predominant isolate, 71%, followed by Proteus mirabilis, 9%, and Klebsiella pneumoniae, 7%. All urinary tract infections isolates were fully sensitive to ofloxacin and >96% (except for Citrobacter species, 63%) were sensitive to cefuroxime. Apart from Enterococcus faecalis and Staphylococcus saprophyticus, the overall sensitivity to ampicillin by all isolates was <33%. The prevalence of multi-resistant Pseudomonas aeruginosa in community-acquired urinary tract infections is increasing. All Pseudomonas aeruginosa were fully sensitive to gentamicin and ofloxacin.

CONCLUSION: The high frequency of single and multiple antibiotic resistances in this rural community should cause alarm. The ease of procuring antibiotics in these areas without a prescription can result in uncontrolled self-medication. Also, the absence of antibiotic prescribing policies and inadequate information on patterns of bacterial resistance, may all contribute to the emergence of resistant strains.