Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and
used by patients. Providers who are top antibiotic stewards have a multi-faceted approach. They work
continuously to stay informed of the etiology of diseases and they continuously review the literature regarding
the use of antibiotics for specific pathogens. Additionally, and one of the most important in my opinion, they
educate their patients on the appropriate use of the prescribed antibiotic, and then they, or their staff, follow up
with the patient during the course of treatment and after. They also make use of the most accurate and
fastest type of diagnostic testing such as PCR testing for UTIs.
When to order a PCR test is also part of good stewardship to prevent unnecessary antibiotic use. Focusing on
urinary tract infections in this article, patients MUST have signs/symptoms of a UTI to order PCR testing.
Specifically fever, frequency of urination, urgency, dysuria, costovertebral or suprapubic pain, etc. A urinalysis
is not made to be a screen for a UTI infection alone. Everything on the urinalysis is non-specific. Okay, I
already hear the gnashing of teeth and the “Yeah, but nitrites were present on the UA”. Nitrites in the urine
do suggest the presence of bacteria that have reduced nitrates to nitrites, however urethral, rectal, and vaginal
contaminants can cause bacteria to be present and thus produce nitrites on a UA. Furthermore, hematuria,
proteinuria, and bacteriuria found on a UA without symptoms are not sensitive or specific enough to
diagnose a UTI.
E. Coli and UTIs
Recent studies show E. Coli is still responsible for the majority of UTIs, with Klebsiella pneumonia,
Pseudomonas aeruginosa and Proteus mirabilis following closely behind. Interestingly Proteus and
Providencia caused more UTIs in elderly men than E. Coli. With the discovery of a new drug-resistant gene
NDM-1 in E. Coli and Klebsiella, the practice of antibiotic stewardship becomes more critical. Irrational use of
antibiotics is still conducted in many parts of the world and perhaps in certain regions of our own country,
enabling the continued growth of more drug-resistant pathogens. In one study, E. Coli was resistant against
ampicillin (92%), cotrimoxazole (80%), ciprofloxacin (62%), nitrofurantoin (47%), and amikacin (4%). Patients
who have drug-resistant pathogens don’t require a history of overuse of antibiotics as the reason for acquiring
them. Environments such as nursing homes are known for the spread of these types of pathogens.
How We’re Helping
The cat is out of the bag so to speak in regard to rampant antibiotic usage. It is our job as a lab to assist the
provider to make the appropriate decision regarding the medications they prescribe their patients. Our
testing for drug resistance markers enables us to do this and allows us to contribute to our community
antibiotic stewardship. Please hug your elderly family members. As always we thank you for your
business and reach out to us to find out how we may be of service to you.