Etiology and antimicrobial resistance pattern of uropathogens in a hospital from suburban mumbai

Authors:Praseeda Desai, Pawankumar M. Ukey, Alka R Chauhan , Sapna Malik, Meenakshi Mathur
Int J Biol Med Res. 2012; 3(3): 2007-2012  |  PDF File

Abstract

Abstract: Background: Urinary tract infection (UTI) remains one of the common infections in OPD as well as hospitalized patients with significant morbidity. Area specific studies are intended to acquire knowledge of pathogens and their antimicrobial susceptibility pattern which is essential for appropriate empiric therapy. Aim: To evaluate the distribution of bacterial pathogens responsible for UTI & their resistance to antimicrobials in our setting. Methods: Early morning freshly voided mid-stream urine samples from patients with suspected UTI were tested for significant bacteriuria using calibrated loop, Blood agar & MacConkey agar. Isolates were identified by ATB instrument using API identification strips and antimicrobial susceptibility test was done by ATB instrument using ATB strips according to CLSI guidelines. Results: Out of 658 urine samples tested, 155 (23.56%) yielded significant pathogens. Majority i.e. 108 (69.68%) of the isolates were from females. E. coli 67 (43.22%) was observed to be the most predominant organism followed by Klebsiella pneumoniae 25 (16.13%) and Coagulase negative Staphylococci 22 (14.19%). It was observed that Enteric gram negative bacilli (GNB) were highly resistance to commonly prescribed antimicrobials like Ampicillin 89 (90.82%), Amoxicillin - Clavulinic acid 67(68.37%), Norfloxacin 61 (62.24%) and Cotrimoxazole 54 (55.10%). Imipenem was found to be the most effective drug against Enteric GNB with zero resistance followed by Piperacillin-Tazobactam 12 (12.24% resistance) and Nitrofurantoin 41 (41.84% resistance). Gram positive cocci (GPC) were highly resistant to the routinely used drugs like Penicillin 36 (90%), Erythromycin 31(77.5%) and Amoxicillin-Clavulinic acid 26 (65%). Linezolid was found to be the most effective drug against GPC with zero resistance followed by Vancomycin 1 (2.5% resistance) and Nitrofurantoin 2 (5% resistance). Conclusion: E coli was the most common uropathogen, Multidrug resistance in uropathogens denotes the importance of judicious use of antimicrobials. Imipenem and Piperacillin-Tazobactam were the most promising drugs against Gram negative bacilli. Linezolid and Vancomycin were highly effective drugs against GPC.