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Coordinator, Infection Control Team Clinical Microbiology Sant Parmanand Hospital 18 Alipore Road New Delhi 110054, India fax 91112397406 subhashji{at}hotmail.com
Chief, Gynecology and Obstetrics Gynecology and Obstetrics Sant Paramand Hospital
Published Online, April 12, 2005. www.theannals.com, DOI 10.1345/aph.1D630a
Effective October 2004, culture-based figures for antimicrobial
susceptibility of 28 antimicrobials were analyzed to identify the most
promising antimicrobial at the Sant Parmanand Hospital, a private-sector
tertiary care 140-bed hospital in the Indian capital metropolis of New Delhi.
Isolates from urinary tract, blood, and pyogenic foci, as well as enteritis
and enteric fever, were grouped. Antimicrobials, systemic or oral, exhibiting
75% susceptibility were compartmentalized in relation to divergent
clinical disorders. For urinary tract infection caused by Escherichia
coli (103 isolates), Klebsiella (20 isolates), Proteus
(13 isolates), and Pseudomonas (11 isolates), systemic antimicrobials
chosen empirically were amikacin and ceftazidime. Similarly based on in vitro
culture/sensitivity profiles, oral agents chosen included
ampicillin/clavulanic acid, chloramphenicol, and
nitrofurantoin.2
Occasionally, cultures might not be feasible, available, or even acceptable; there also may be fiscal restraints. Undoubtedly, local retrospective figures on antimicrobial susceptibility resulting from cultures obtained from pregnant women would be a rational approach during any pilot therapy without culture. During such a scenario, a regimen including more than one antimicrobial agent would significantly reduce the probability of therapeutic failure.
While data retrieved from in vitro sensitivity profiles would not be
applicable for every episode of urinary tract infection during pregnancy,
antimicrobial treatment would often be successful based on the sensitivity
profile of the usual urinary pathogens in the area. The probability of any
patient receiving adequate therapeutic treatment would increase with
additional antimicrobials. The odds of a patient receiving ideal antimicrobial
therapy for resistant microbes would follow a binomial distribution as
follows:
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With an antimicrobial effective against 75% of urinary isolates, the probability of encountering not more than 1, 2, and 3 failures during treatment of the next 30 patients would be 0.001785, 0.008631, and 0.026853, respectively (Table 1). Identical figures for antimicrobial agents exhibiting 85% and 95% susceptibility would be 0.040398, 0.103371, and 0.170259, respectively. Treatment with 2 antimicrobials, systemic and/or oral, would significantly diminish the prospects of future therapeutic failures (Figure 1).
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To conclude, therapeutic regimens with one or more of the locally promising antimicrobials2 would be effective in episodes of urinary tract infection including any symptomatic bacteriuria during pregnancy.1
References
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