SPECTRUM OF BACTERIAL CULTURE AND DRUG SENSITIVITY VS RESISTANCE IN UNCOMPLICATED URINARY TRACT INFECTION
AbstractBackground: The growing antibiotic resistance against uropathogens has made its treatment a challenge for the physicians. This study was conducted to know the spectrum of bacteria responsible for urinary tract infection and their susceptibility and resistance to available antibiotics. Methods: This hospital based cross-sectional study was carried out from May to October 2017. All patients presenting with urinary tract infection signs and symptoms and were included in the study. A sample of 168 patients of both gender and age were recruited for the study using convenient sampling technique. Antimicrobial isolation and differentiation was determined by using Cystine-lactose Electrolyte Deficient (CLED) Agar. Susceptibility and resistance to 30 available antibiotics were determined. Data was collected on the pre-designed proforma. SPSS version 16 was used for data entry and analysis. Results: There were 62 (36.9%) males and 106 (63.1%) females. Mean age of the male patients was 55.34±21.33 years whereas the mean age of the female patients was 45.8±22.07 years and the difference was statistically significant (p=0.007). Gram negative bacteria were isolated from 141 (83.9%) of the cases. Gender wise distribution of Gram negative and positive strains was found statistically significant (p=0.032). E. coli was the commonest bacterium found in 70.8% of cases. It was sensitive to only seven (23%) antibiotics in over 80% of the cases. E. faecalis, K. pneumoniae, P. aeruginosa and S. faecalis were susceptible to 13%, 26.7%, 40% and 23% of antibiotics respectively in over 60% of the cases. 90% of the cultured pathogens were susceptible to Nitrofurantoin in over 80% of the cases. Among cultured pathogens, 70% showed susceptibility to Imipenem, Meropenem, Amikacin, Doxycycline, Fosfomycin and Cefoperazone/Sulbactam in over 60% of the cases. Conclusion: UTI is more common in women as compared men. E. coli, E. faecalis, K. pneumoniae and P. aeruginosa are the major pathogens responsible for UTI in this part of the country and in over 80% of the cases are still sensitive to Nitrofurantoin.Keywords: Urinary tract infection; Gram positive and negative uropathogens; antibiotic susceptibility
Sarwar MI, Sarwar I, Hussain MS, Sherwani SK, Hakeem A, Kazmi SU. Frequency of urinary tract infection causing agents in pregnant women and their antimicrobial susceptibility profile. Pak J Biochem Mol Biol 2013;46(3-4):107–10.
Foxman B. The epidemiology of urinary tract infection. Nat Rev Urol 2010;7(12):653–60.
Sharef SW, El-Naggari M, Al-Nabhani D, Al Sawai A, Al Muharrmi Z, Elnour I. Incidence of antibiotics resistance among uropathogens in Omani children presenting with a single episode of urinary tract infection. J Infect Public Health 2015;8(5):458–65.
Yasir S. Uncomplicated urinary tract infection: isolated bacteria, outcome and their susceptibility to antibiotics. Pak J Med Dent 2014;3(4):43–7.
Adeghate J, Juhász E, Pongrácz J, Rimanóczy É, Kristóf K. Does Staphylococcus Saprophyticus Cause Acute Cystitis only in Young Females, or is there more to the Story? A One-Year Comprehensive Study Done in Budapest, Hungary. Acta Microbiol Immunol Hung 2016;63(1):57–67.
Kanj SS, Kanafani ZA. Current concepts in antimicrobial therapy against resistant gram-negative organisms: extended-spectrum beta-lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, and multidrug-resistant Pseudomonas aeruginosa. Mayo Clin Proc 2011;86(3):250–9.
Majeed A, Alarfaj S, Darouiche R, Mohajer M. An update on emerging therapies for urinary tract infections. Expert Opin Emerg Drugs 2017;22(1):53–62.
Ekwealor PA, Ugwu MC, Ezeobi I, Amalukwe G, Ugwu BC, Okezie U, et al. Antimicrobial evaluation of bacterial isolates from urine specimen of patients with complaints of urinary tract infections in Awka, Nigeria. Int J Microbiol 2016;2016:9740273.
Wagenlehner F, Wullt B, Ballarini S, Zingg D, Naber KG. Social and economic burden of recurrent urinary tract infections and quality of life: a patient web-based study (GESPRIT). Expert Rev Pharmacoecon Outcomes Res 2018;18(1):107–17.
Beyene G, Tsegaye W. Bacterial uropathogens in urinary tract infection and antibiotic susceptibility pattern in Jimma University Specialized hospital, Southwest Ethiopia. Ethiop J Health Sci 2011;21(2):141–6.
Almushait MA, Mohammed HA, Al-Harthy DA, Abdullah AM. Prevalence and predisposing factors of urinary tract infection among pregnant women in Abha General Hospital. Int J Sci Basic Appl Res 2013;11(1):18–29.
Vasudevan R. Urinary tract infection: an overview on the infection and associated risk factors. J Microbiol Exp 2014;1(2):00008.
Al-Badr A, Al-Shaikh G. Recurrent urinary tract infections management in women: a review. Sultan Qaboos Univ Med J 2013;13(3):359–67.
Sabir S, Anjum AA, Ijaz T, Ali MA, Khan MR, Nawaz M. Isolation and antibiotic susceptibility of E. coli from urinary tract infections in a tertiary care hospital. Pak J Med Sci 2014;30(2):389–92.
Richa C, Bhushan CS, Kumar SP, Dev PN, Nabaraj P. Bacteriology of urinary tract infection of chronic renal failure patients undergoing for hemodialysis. J Microbiol Exp 2016;3(3):00089.
Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infection: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol 2015;13(5):269–84.
Lagunas-Rangel FA. Susceptibility profile of bacteria causing urinary tract infection in Mexico-single centre experience with 10 years results. J Glob Antimicrobe Resist 2018;pii:S2213-7165(18)30056.
Sohail M, Khurshid M, Saleem HGM, Javed H, Khan AA. Characteristics and antibiotic resistance of urinary tract pathogens isolated from Punjab, Pakistan. Jundishapur Microbiol 2015;8(7):e19272.
Baral R, Timilsina S, Jha P, Bhattarai NR, Poudyal N, Gurung R, et al. Study of antimicrobial susceptibility pattern of Gram positive organisms causing UTI in a tertiary care hospital in eastern re¬gion of Nepal. Health Renaiss 2013;11(2):119–24.
Poulsen LL, Bisgaard M, Son NT, Trung NV, An HM, Dalsgaard A. Enterococcus and Steptococcus spp. Associated with chronic and self-medicated urinary tract infections in Vietnam. BMC Infect Dis 2012;23:230.
Al-Abbas MJA. Antimicrobial susceptibility of Enterococcus faecalis and a novel Planomicrobium isolate of bacterimia. Int J Med Med Sci 2012;4(2):19–27.
Kidwai SS, Nageen A, Ghaznavi S, Bashir F, Ara J. Antibiotic susceptibility in commonly isolated pathogens from urinary tract infection in a cohort of subjects from low socioeconomic strata. Pak J Med Sci 2017;33(2):254–9.
Ferdosi-Shahandashti E, Javanian M, Moradian-Kouchaksaraei M, Yeganeh B, Bijani A, Motevaseli E, et al. Resistance patterns of Escherichia coli causing urinary tract infection. Caspian J Intern Med 2015;6(3):148–51.
Sader HS, Huband MD, Castanheira M, Flamm RK. Pseudomonas aeruginosa Antimicrobial Susceptibility Results from Four Years (2012 to 2015) of the International Network for Optimal Resistance Monitoring Program in the United States. Antimicrob Agents Chemother 2017;61(3):e02252–16.