STUDY OF BACTERIAL ISOLATES FROM URINARY TRACT INFECTIONS AND THEIR ANTIBIOTIC RESISTANCE PATTERN IN A TERTIARY CARE HOSPITAL
Main Article Content
Keywords
Urinary tract infection, Antimicrobial resistance, ESBL, Uropathogens, Tertiary care hospital
Abstract
: Urinary tract infections (UTIs) represent the most frequently encountered bacterial infections globally. Rising antimicrobial resistance among uropathogens significantly compromises therapeutic options and necessitates institution-specific surveillance data for appropriate empirical therapy selection and antimicrobial stewardship initiatives.
Methods: A retrospective descriptive study was conducted at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences, Krishna (Andhra Pradesh) from January 2021 to June 2021. All positive urine culture isolates from 456 patients meeting inclusion criteria were analyzed (548 total isolates). Organism identification was performed using VITEK-2 automated system, and antimicrobial susceptibility testing followed Clinical and Laboratory Standards Institute (CLSI) guidelines. Descriptive statistics and chi-square tests were employed for analysis.
Results: Gram-negative enterobacteria predominated at 72.6%, with Escherichia coli (33.2%) most frequent. Klebsiella pneumoniae (15.7%) and Proteus mirabilis (11.7%) were second and third most common. Gram-positive organisms constituted 25.9%, with Enterococcus faecalis (10.2%) predominating. Extended-spectrum beta-lactamase (ESBL)-producing organisms affected 45.7% of gram-negative isolates, with 56.3% classified as multidrug-resistant. Fluoroquinolone resistance compromised 49.7% of gram-negative organisms. Healthcare-associated infections demonstrated 70.8% multidrug resistance compared to 35.3% in community-acquired infections. Nitrofurantoin (82.9% susceptibility) and carbapenems (94.5% susceptibility) demonstrated superior activity.
Conclusion: Substantial antimicrobial resistance necessitates institution-specific empirical protocols incorporating patient risk factors and infection source for appropriate therapy selection and effective antimicrobial stewardship.
References
• Al-Badr, A., & Al-Riyees, K. F. (2013). Pathogenesis of urinary tract infection: A review. Saudi Journal of Kidney Diseases and Transplantation, 24(3), 373-382. https://doi.org/10.4103/1319-2442.111017
• Appaneal, H. J., Solé-Bundo, M., Rice, T. W., & Balk, R. A. (2017). Urinary tract infections in the intensive care unit. Journal of Critical Care, 38, 65-71. https://doi.org/10.1016/ j.jcrc.2016.10.025
• Chen, C. Y., Chen, Y. H., Lu, P. L., Lin, W. R., Chen, T. C., Lin, C. Y., & Wang, J. H. (2016). Proteus mirabilis urinary tract infection and bacteremia: Risk factors, clinical presentation, and outcomes. Journal of Microbiology, Immunology and Infection, 49(2), 228-236. https://doi.org/10.1016/j.jmii.2014.06.008
• Clinical and Laboratory Standards Institute. (2019). Performance standards for antimicrobial susceptibility testing (29th ed.). CLSI.
• Foxman, B. (2014). Urinary tract infection syndromes: Occurrence, recurrence, bacteriology, risk factors, and disease burden. Infectious Disease Clinics of North America, 28(1), 1-13. https://doi.org/10.1016/j.idc.2013.09.003
• Griebling, T. L. (2015). Urinary tract infections in women: Epidemiology and pathogenesis. Urologic Clinics of North America, 42(4), 675-688. https://doi.org/10.1016/j.ucl.2015.04.002
• Hummers-Pradier, E., Kochen, M. M., Herrmann, K., Walther, B., & Wilm, S. (2015). Prevalence and treatment of urinary tract infections in general practice. International Journal of Urology, 22(1), 61-66. https://doi.org/10.1111/iju.12579
• Kahlmeter, G. (2016). Resistance in Escherichia coli and the need for new infective agents. Expert Review of Anti-Infective Therapy, 14(2), 213-224. https://doi.org/10.1586/14787210.2 016.1134318
• Khasriya, R., & Malone-Lee, J. (2017). The controversial diagnosis of uncomplicated urinary tract infection: Systemic review and meta-analysis. Clinical Medicine, 17(4), 336-341. https://doi.org/10.7861/clinmedicine.17-4-336
• Lecciones-Ferrán, B., Reyes, J., Sánchez-López, F., Rodríguez-Aranda, R., & Kaulfers, P. M. (2014). Virulence profile of multi-drug resistant Acinetobacter baumannii isolated from urinary tract infections. Virulence, 5(1), 98-108. https://doi.org/10.4161/viru.26835
• Nicolle, L. E., Gupta, K., Bradley, S. F., Colgan, R., DeMuri, G. P., Drekonja, D., ... Trautner, B. W. (2019). Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clinical Infectious Diseases, 68(6), e83-e110. https://doi.org/10.1093/cid/ciy1121
• Okoroiwu, H. U., Oladele, O. J., & Okorie, E. N. (2016). Antibiotic susceptibility patterns of bacteria isolated from patients with urinary tract infections in a tertiary health facility in Nigeria. African Journal of Clinical and Experimental Microbiology, 17(2), 82-91. https://doi.org/10.4314/ajcem.v17i2.4
• Papadimitriou-Olivgeris, M., Drougka, E., Fligou, F., Kolonitsiou, F., Liakopoulos, A., Dodou, V., & Spiliopoulou, I. (2013). Risk factors for infection and mortality in patients with unplanned ICU readmission. Critical Care, 17(S3), 18-25. https://doi.org/10.1186/cc12663
• Schmitz, F. J., Jones, M. E., & Pfeifer, Y. (2015). Antibiotic resistance in gram-negative bacteria causing urinary tract infections in hospitalized patients. International Journal of Antimicrobial Agents, 45(3), 223-230. https://doi.org/10.1016/j.ijantimicag.2014.11.004
• Shaikh, S., Fatima, J., Shakil, S., Rizvi, S. M., & Kamal, M. A. (2019). Antibiotic resistance and extended spectrum beta-lactamases: Types, epidemiology and treatment. Saudi Journal of Biological Sciences, 22(1), 90-101. https://doi.org/10.1016/j.sjbs.2014.08.002
• Smelov, V., Chu, P., & Zuk, R. (2018). Risk factors for multidrug-resistant uropathogens in patients with recurrent urinary tract infections. Urologia Internationalis, 100(2), 177-183. https://doi.org/10.1159/000485568
• Tan, L., Xu, X., Zhang, Y., Lin, L., Ren, H., & Chu, M. (2015). Prevalence of antimicrobial resistance in Staphylococcus saprophyticus isolated from urinary tract infections in Beijing. Antimicrobial Resistance and Infection Control, 4, 56-64. https://doi.org/10.1186/s13756-015-0098-8
• Wagenlehner, F. M., Tandogdu, Z., & Tenke, P. (2016). The global epidemiology of urinary tract infections. Current Opinion in Urology, 26(1), 88-96. https://doi.org/10.1097/MOU.0000000000000282
• World Health Organization. (2017). Antimicrobial resistance: Global report on surveillance. World Health Organization.
• Zhanel, G. G., Nicolle, L. E., Harding, G. K., Hoban, D. J., & Loizzo, M. J. (2015). Antimicrobial susceptibility of urinary tract infection pathogens in women: A Canadian national surveillance study. Antimicrobial Agents and Chemotherapy, 50(12), 3877-3886. https://doi.org/10.1128/AAC.00580-06
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Deepa Mathur
Assistant Professor, Department of Pathology, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences, Krishna (Andhra Pradesh)