A contemporary view of antibiotic resistance in Urology in the United Kingdom
Antibiotic resistance is a growing public health concern globally; the rise of extended spectrum beta lactamase (ESBL)-producing organisms and the emergence of carbapenem-resistance is now recognised. Antibiotic choices for urinary tract infection (UTI) treatment as well as for prophylaxis before urological procedures mean that all units should know their local resistance patterns. In our busy tertiary unit, we aimed to determine the prevalence of ESBL across all Urology patients, and to rationalise our antimicrobial regimes based on this.
We examined positive urine culture results among all Urology inpatients and outpatients, collected over an 8-month period during 2017. The prevalence of ESBL producers (defined as resistance to cephalexin, ceftazidime or cefotaxime) and carbapenem resistance were analysed, and also the resistance rates to commonly used antibiotics.
During the 8-month period, the Microbiology laboratory cultured 468 positive urine samples from the Urology department. The number of ESBL producers was 75 (16%). Of the ESBL producers, 78% were identified as multi drug resistant (defined as resistance to at least one agent in three or more antibiotic categories). The number of carbapenem resistant organisms was 4 (0.85%). Resistance rates to commonly used antibiotics in the treatment of UTIs were examined. Trimethoprim resistance was the highest at 24%, ciprofloxacin 15.6%, nitrofurantoin 11.8% and gentamicin 8.1%. Escherichia Coli was found to be the most common causative organism, representing 44.2 % of all positive urine cultures, and accounting for 50.7 % of ESBL producers.
The prevalence of ESBL remains significant, particularly the high proportion of these that have become multi drug-resistant. The choice of oral agent for UTI treatment, and use of aminoglycosides for procedure prophylaxis, requires close liaison between the laboratory and surgical staff. The high rates are in line with published data from our city a decade ago, though the development of ESBL is a newer concern, and the emergence of carbapenem resistance may continue to follow a similar trajectory in the next few years. Tighter controls of peri-operative and treatment antibiotic regimes may play a part in slowing down this inexorable rise in resistance.