Tapasyapreeti Mukhopadhyay, Vrushali Patwardhan, Sarman Singh Microbiological profile and antimicrobial susceptibility pattern of uropathogens isolated from community acquired urinary tract infection in Northern parts of India Tapasyapreeti Mukhopadhyay, Vrushali Patwardhan, Sarman Singh Division of Clinical Microbiology Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi INTRODUCTION Figure 3: Frequency of various uropathogens isolated Urinary tract infections (UTI) are one of the most frequent bacterial infections all over the world. UTI especially uncomplicated are usually treated with empiric antibiotic treatment for which local pattern of susceptibility profile is essential. This study was conducted to know the local antimicrobial susceptibility pattern in an apex tertiary care institute of North India. p value < 0.012 AIM AND OBJECTIVE To determine the incidence and microbiological profile of uropathogens in community acquired urinary tract infection and to study their antimicrobial susceptibility pattern. Figure 4: Frequency of various uropathogens isolated as per gender METHOD In this retrospective observational study conducted over a period of 3 months (August-October 2015) A total of 1535 urine non repetitive samples were received from various OPDs of our institute. Urine culture was performed using semi-quantitative technique on cysteine lactose electrolyte deficient medium (CLED agar, Hi-Media, India). Antibiotic sensitivity was put up by the Kirby Bauer disc diffusion method on Mueller Hinton agar (MHA) (Hi-Media India) adhering to the clinical laboratory standards institute (CLSI) guidelines. TABLE 1: Percentage of multi drug resistant (MDR) organism and extended spectrum beta lactamase (ESBL) producers ORGANISM ISOLATED (n=270) MDR CASES ISOLATED (n=41) ESBL CASES ISOLATED (n=83) E. coli (167) 19 (11.37%) 61 (36.52%) Klebsiella (56) 9 (29.95%) 17 (30.35%) Pseudomonas spp. (19) 8 (50.0%) 4 (21.05%) Enterobacter (10) 1 (10.0%) - Citrobacter (8) 3 (37.5%) 1 (12.5%) Proteus (5) Staphyloccocus (5) 1 (20%) RESULTS A total of 270/1535 (17.58%) urine specimens yielded significant growth mostly in males (58.51%) (Figure1). Figure -1 TABLE 2: Difference in susceptibility pattern in ESBL and MDR bacteria isolated in various age groups ANTIMICROBIAL AGENT <19 years 19-65 years >65 years p value Amikacin 5 (26.32%) 36 (43.37%) 1 (7.69%) 0.023 Ampicillin-Sulbactum 11 (57.89%) 49 (59.76%) 3 (23.08%) 0.045 Cefepime 4 (20.0%) 14 (17.5%) 2 (15.38%) 0.926 Norfloxacin 8 (42.11%) 38 (45.24%) 4 (36.36%) 0.844 Cotrimoxazole 4 (21.05%) 12 (16.0%) 0.651 Chloramphenicol 3 (60.0%) 7 (43.75%) 2 (33.33%) 0.530 Fosfomycin 6 (75.0%) 30 (83.33%) 5 (83.33%) 0.757 Piperacillin-Tazobactum 2 (50.0%) 20 (58.82%) 3 (25.0%) 0.840 Majority (72.86%) of the patients were adults (19-65 years) (Figure 2) The commonest organism isolated was Escherichia coli (61.62%), followed by Klebsiella sp. (20.67%), Pseudomonas spp. (7.01%), others being Enterobacter sp., Citrobacter sp, Proteus sp. and Staphylococcus aureus. (Figure 3) 30.74% extended spectrum beta lactamase (ESBL) producers were isolated, of which 73.49% were E. coli. (Table-1) Figure 2: Frequency of various uropathogens isolated as per age TABLE 3: Comparative analysis of susceptibility pattern of MDR and ESBL producing E. coli and Klebsiella Antimicrobial agent Susceptibility of E. coli (%) Susceptibility of Klebsiella (%) Amikacin 44.00 42.85 Ampicillin-Sulbactum 63.51 52.17 Cefepime 17.33 21.73 Ceftazidime-clavulinic acid 80.26 73.91 Norfloxacin 52.05 39.13 Cotrimoxazole 14.29 Chloramphenicol 57.14 50.0 Fosfomycin 91.43 85.71 Piperacillin-Tazobactum 56.25 CONCLUSION Over the counter use of antibiotics along with non compliance of medicines have led to wide spread antibiotic resistance. ESBL producers and multi drug resistant bacteria are emerging as pathogens even in community acquired UTI. ESBL producing uropathogens were substantially encountered in males, and similarly in pediatric and adult patients. (p value < 0.05) Pseudomonas spp. was the most common MDR organism, and among ESBL producers was E. coli. Antibiotic susceptibility testing is must, even in uncomplicated community acquired UTI.