1. 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.