Age and gender-specific antibiotic resistance patterns among Bangladeshi patients with urinary tract infection caused by Escherichia coli.

ABSTRACT

BACKGROUND: In Bangladesh, treatment for urinary tract infection has become increasingly difficult due to antibiotic resistance. In addition, the prescription of age and gender-specific drugs is still far from being practiced in Bangladesh. We are examining trends of antibiotic resistance per age and gender in patients with urinary tract infection (UTI) caused by the most frequent agent, Escherichia coli. METHODS: We determined the resistance of 1663 E. coli isolates obtained from urine cultures. A sensitivity study using the Kirby-Bauer method was carried out to identify the antibiotic resistance trends. RESULTS: Imipenem with 1.9% resistance of all isolates found to be the lowest percentage of resistance. Meropenem (2.8%), amikacin (2.8%), colistin (2.9%), and nitrofurantoin (15.8%) showed low resistance percentages. The sensitivity analysis suggests that age and gender (area under curve = 0.67) should be taken into consideration to prescribe amikacin. The increasing odds ratios (OR) by age groups suggest that amikacin is a less effective agent for older patients with UTIs. Moreover, nitrofurantoin (OR = 1.45, 95% confidence interval (CI) = 1.07-1.95) and colistin (OR = 2.09, CI = 1.13-3.76) were less effective against isolates obtained from males compared to isolates obtained from females. Meropenem was effective against bacteria obtained from all age groups and genders. On the other hand, efficacy of imipenem was lower in isolates obtained from adults older than 40 years (OR 0.44 for < = 18 years, OR = 0.47 for 19-40 years, OR = 0.86 for 41-60 years; reference > = 61 years). CONCLUSION: In Bangladesh, meropenem, imipenem, amikacin, colistin, and nitrofurantoin are suitable therapeutic alternatives against urinary tract pathogens. Among the oral agents, amikacin, colistin, and nitrofurantoin should be prescribed, taking consideration of age and gender. These results will assist physicians in prescribing effective primary care antibiotics for UTI patients and encouraging the implementation of health policies for a safe prescription of antibiotics.