University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Urgent Care


Dr. Elyse Watkins



Urinary tract conditions among refugees, asylees, and recent international migrants have displayed distinct patterns of diagnostic prevalence and multi-drug resistance, as studied in Europe, which could possibly inform the approach of ambulatory care providers in their empiric management as well as assessment in the United States. Appropriate initial antibiotic therapy can reduce mortality, and hospitalizations in the immigrant population who are likely at risk for MDR UTIs.


A literature search on PubMed, MEDLINE and Cochrane Database for research done in developed nations: Europe, Australia, Canada, United States in the years of 2010-2020 was performed. Preference was given to RCTs, Meta-analyses, Epidemiologic Studies, and studies that established quantitative analysis. We identify the importance of epidemiologic studies in answering our question and evidence ratings are given as such after assessment using the Critical Skills Appraisal Took.


There is moderate to significant evidence for the presence of multi-drug resistant gram negative bacilli in immigrant communities of refugees, with specific patterns of resistance. Given America’s current migrant trends, diagnosis and treatment of multi-drug resistant (MDR) urinary tuberculosis can be missed, and should be correlated with urinanalysis, history and physical exam findings, as a matter of practice in ambulatory care settings. There is utility in ordering nucleic acid amplification tests and ultrasounds in the ambulatory care setting to assess for multi-drug resistant tuberculosis. Urinary schistosomiasis is sub-diagnosed and is more prevalent among immigrants than foreseen. Immigrants are likely to be more resistant to Trimethoprim/Sulfamethoxazole and carry Extended Spectrum Beta-lactamase E.coli, Carbapenem resistant A.bauminii. Research shows that an insightful and multi-faceted approach can be used to encourage appropriate antibiotic usage for migrants at first visit in an ambulatory care setting, as healthcare providers show appropriate cultural awareness towards the need of migrants, although the need is not met, especially in the case of MDR gram negative hospitalizations.


The problem of inappropriate antimicrobial therapy, given the current scenario of a much higher and hidden prevalence of multi-drug resistant carrier rate among migrants, including refugees, puts this population at risk for increased mortality, increased hospital stays, and reduced confidence. Meta-analyses, and epidemiologic studies indicate strong patterns that can be taken up by the medical community serving the immigrant population in the United States through diligent history taking with regards to journey, complete blood count findings, refugee status, and physical exam findings in the treatment of urinary tuberculosis, urinary schistosomiasis, and multi-drug resistant gram-negative bacteriuria. This study is unable to provide a comprehensive correlation to antibiotic resistance with increased length of stay in the developed nation.

Keywords: Immigrant, Urinary tract infection, treatment, Gram-negative bacteria.


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