Original article MICROBIOLOGICAL STUDY OF URINE ISOLATES IN OUT PATIENTS AND ITS RESISTANCE PATTERN AT A TERTIARY CARE HOSPITAL IN KANPUR. R.Sujatha 1,Deepak S 2, Nidhi P 3, Vaishali S 2, Dilshad K 2 1. Professor& Head, Department of Microbiology Rama Medical College Hospital And Research Center, Mandhana Kanpur 2. PG student, Department Of Microbiology Rama Medical College Hospital And Research Center, Mandhana Kanpur.. 3. Ph.D.s Scholar, Department Of Microbiology Rama Medical College Hospital And Research Center, Mandhana Kanpur ABSTRACT Back ground: Urinary tract infections (UTIs) are one of the most common bacterial infections that encountered by medical clinicians in developing countries and lead patients to seek medical care. UTI has become difficult to treat because of appearance of pathogens with increasing resistance to antimicrobial agents. We aimed to study the antibiotic resistance pattern of the urinary pathogens isolated from patients is our tertiary care hospital. Methods: A retrospective study was done during Aug 2016 Feb2017. All positive urine culture was collected from the previous records and sensitivity report of male and females age 20-70 years a total of 174 positive urine culture reports of opd patients were included. Results :Out of 174 adults, females were more infected. E coli (50%) was the most common organism, followed by Klebsiella(14.3%), Staphylococcus (10%). 2.29% of Candida sp. were isolated. E-coli and Klebsiella was most resistant to Ampicillin, followed by Norfloxacin. It was most sensitive to Nitrofurantoin followed by Amikacin and Meropenem All GNB showed better sensitivity to Nitrofurantoin and meropenem. S.aureus showed better sensitivity for Erythromycin and Nitrofurantoin. Conclusion: In this study, female were mostly affected and the most common organism were E.coli and Klebsiella sps, these isolates are sensitive to nitrofurantoin. As drug resistance among pathogens is an evolving process, routine surveillance and monitoring studies should be conducted to help clinician to start most effective empirical treatment for the outpatients to decrease the morbidity. Key words: Urinary tract infection, Antibiotic resistance, E.coli. 14
INTRODUCTION Urinary tract infections (UTIs) are one of the most common bacterial infections that encountered by medical clinicians in developing countries and lead patients to seek medical care. Annual global incidence of UTI has been estimated at least 250 million [1, 2]. It is estimated that 20% or more of the female population suffers some form of UTI in their lifetime. Infection in the male population remains uncommon through the fifth decade of life, when enlargement of the prostate begins to interfere with emptying of the bladder.[3] The most common pathogenic organisms of UTI are Escherichia coli, Staphylococcus saprophyticus and less common organisms are Proteus sps, Klebsiella pneumonia, Pseudomonas aeruginosa, Enterococcus sps and Candida albicans. 3 Treatment of UTI cases is often started empirically and therapy is based on information determined from the antimicrobial resistance pattern of the urinary pathogens. In spite of the availability and use of the antimicrobial drugs, UTIs caused by bacteria have been showing increasing trends. In patients with suspected UTI, antibiotic treatment is usually started empirically, before urine culture results are available. To ensure appropriate treatment, knowledge of the organisms that cause UTI and their antibiotic susceptibility is mandatory 4. This study was planned to explore the common pathogens responsible for UTI and to determine the antibiotic susceptibility pattern of them. MATERIAL AND METHODS The study was done at Rama Medical College hospital and Research Center Mandhana, Kanpur UP, India from Aug 2016 to Feb 2017. The study included all the patients who were visited the outpatient department in the hospital with symptoms of UTI during the study period and had UTI confirmed by positive urine culture from previous records. Results: Total 174 culture positive urine isolates were showed females were more infected than males and in the age group of 20-40 years adults. E.coli and K.pneumonea were the common isolates. Other organisms and their antibiotic sensitivity are showed in Table 1 and 2. 15
Table 1: Distribution of microorganism from Urine Gram positive cocci 46 S.aureus 18 Enterococcus 17 CONS 11 Gram Negative bacilli 121 E.coli 87 K. pneumoneae 25 Enterobacter 5 Citrobacter 4 Proteus 3 Budding yeast cell 4 Candida albicance 3 C.krusie 1 Table 2: Antibiotic sensitivity pattern of isolates E.coli K.pneumoneae Enterobacter Citrobacter Proteus S.auerus CONS Enterococcus AMP 32.18 40 40 75 66.7 22.22 90.90 NA CTX 55.17 44 40 50 33.3 33.3 90.90 NA CX 52.873563 60 80 50 33.3 66.66 81.81 NA AK 75.86 64 80 50 66.7 61.1 100 NA NIT 70.1 76 20 25 66.7 66.66 100 94.11 NX 44.83 36 40 50 33.3 50 72.72 70.58 CIP 54.02 68 60 25 66.7 44.4 90.90 88.23 HLG NA NA NA NA NA NA NA 94.11 E NA NA NA NA NA 72.22 81.8 88.23 MRP 67.82 72 60 25 66.7 94.4 100 NA Discussion UTI causing bacteria s have been changing over the years. 5,6 Over the last decade, the treatment of choice for urinary tract infections (UTIs) has changed from cotrimoxazole to quinolone showing the rate of resistance to Co-trimoxazole and its high level of therapeutic failure.7 In our study the total 174 UTI cases were recorded. Prevalence of UTIs was more in females when compared to males. This was in agreement with other studies by Bashir MF et al. 11 Women are more prone to UTIs then men because, in females, the urethra is much shorter and closer to the anus 12. In this study, 69.5% were Gram negative bacilli, 26.4% were Gram positive cocci 16
and 2.29% were candida sp. The most commonly isolated organism in UTI outpatients in our study was E.coli(50%) followed by K.pneumoniae and S.aureus. The proportion of bacterial species isolated was similar to those described in several previous studies. 13, 14, 15,16 In our study E- coli and Klebsiella was most resistant to Ampicillin, followed by Norfloxacin. It was most sensitive to Nitrofurantoin followed by Amikacin and meropenem. The similar findings were seen in a study by Bashir MF et al who concluded that the organisms showed resistance to older urinary antimicrobial agents such as Ampicillin which indicates that increased consumption of a particular antibiotic can be a pathway to its resistance. 11 CONCLUSION In this study, the most common organism were E.coli and Klebsiella sps. As drug resistance among pathogens is an evolving process, routine surveillance and monitoring studies should be conducted to help clinician to start most effective empirical treatment for the outpatients to decrease the morbidity. REFERENCES 1. Kumazawa J, Matsumoto T. Complicated UTIs. In: Bergan T, editor. UTIs. Infectiology. Basel: Karger; 1997; 1:19-26 2. Nicolle LE. A practical guide to the management of complicated urinary tract infection. Drugs 1997; 53(4):583-92. 3. Salek, SB., 1992. Infective syndrome in medical microbiology,4 th edition,pp.740 4. Ashkenazi S, EvenTov S, Samra Z, et al. Uropathogens of various childhood populations and their antibiotic susceptibility.pediatrinfectdisj.1991;10:742 6. 5. New HC. Urinary tract infections. Am J Med. 1996; 100(Suppl.4A):S63-70. 6. Jones RN. Impact of changing pathogens and antimicrobial susceptibility pattern in treatment of serious infections in hospitalized patients. Am J Med. 1996; 100 (Suppl.6A):S3-12. 7. Yilmaz K, Nilay C, Aysegül G, et al. Co-trimoxazole and quinolone resistance in Escherichia coli isolated from urinary tract infections over the last 10 years. International J AntimicrbialAgents.2005;26(1 ):75-77. 8. Blondeau JM. Current issues in the management of urinary 17
tract infections: extendedrelease ciprofloxacin asa novel treatment option.drugs.2004;64(6):611-628 9. Das RN, Chandrashekhar TS, Joshi HS, Gurung M, Shrestha N, Shivananda PG. Frequency and susceptibility profile of pathogens causing urinary tract infections at a tertiary care hospital in western Nepal. Singapore Med J 2006;47(4) :281. 10. Razak SK, Gurushantappa V. Bacteriology of urinary tractinfectionandantibioticsusc eptibilitypatterninatertiary care hospital in South India. Int J Med Sci Public Health2012;1:109-112. 11. Bashir MF, Qazi JI, AhmadNRiaz S. Diversity of urinary tract pathogens and drug resistant isolates of Escherichiacoli in different age and gender groups of Pakistanis. Tropical Journal of Pharmaceutical Research September 2008;7(3):1025-1031. 12. Dielubanza EJ, Schaeffer AJ (2011 Jan). Urinary tract Medical clinics of North America95(1):27 41. 13. Zhanel GG etal. Antibiotic resistance in outpatient urinary isolates: final results from the North American Urinary Tract Infection Collaborative Alliance.IntJAntimicrobAgents 2005;26:380-388. 14. Andrade SS, Sader HS, Jones RN, Pereira AS, Pignatari AC, Gales AC Increased resistance to first-line agents among bacterial pathogens isolated from urinary tract infections in Latin America: time for local guidelines?meminstoswaldoc ruz. 2006;101:741-748. 15. Gupta KD, Scholes WE, Stamm. Inreasing prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in women. Journal of the AmericanMedicalAssociation1 999;281:736-738. 16. Dala P. Et al. Microbiological profile of urinary tract infection in a tertiary care hospital.jrmds.2016;4(3):204-209 infections in women. The CORRESPONDING AUTHOR: Dr. R.Sujatha 18 Professor and Head of Department of Microbiology Rama Medical College Hospital& Research Centre,Mandhana, Kanpur, U.P. EmailID: drsujatha152@gmail.com