Main Article Content

Abstract

Background


The distribution of uropathogen and their susceptibility pattern to antibiotics vary regionally and even in same geographical region, and they change over time and during various season. Antimicrobial resistance pattern of locally occurring uropathogen is essential to serve as a basis for empirical treatment of urinary tract infection.


AIM: To study the most common uropathogen isolated, antimicrobial resistance pattern, and its seasonal trend if any from urine samples of patients suspected to be suffering from UTI.


Study design


Retrospective study of one-year period from 1st Jan 2017 to 30 Dec 2017.


Materials and methods


The culture and sensitivity data of the uropathogens from suspected cases of UTI were collected from the records of Microbiology Department, and the organisms were identified by standard methods. Antibiotic susceptibility was carried out. Percentage analysis was done.


Results


A total of 5629 urine samples were analyzed, of which 1829 (32%) samples showed significant growth of uropathogens. Gram-negative rods accounted for more than 85% of the infections. Uropathogenic E.coli was the most predominant uropathogen (36%), followed by Enterococcus faecalis (27%) and Klebsiella (10.5%).  We observed that resistance to Ampicillin is high ranging from 73.8%-95.2%, followed by amoxicillin–clavulanic acid 68.5%-90.4%, Cotrimoxazole 40.2%-83.3%, whereas nitrofurantoin 3.95%-9.50%, and carbapenem group


(imipenam, meropenam) 0.1%-4.45% showed least resistance   over one year period. We also observed that the incidence of UTI due to E.coli rises in summer months but no seasonal variation to resistance could be inferred, rather there was a progressive increase in resistance to all antimicrobial over one year period.


Conclusion


Uropathogenic E Coli are most sensitive to nitrofurantoin and carbapenem group, so we recommend them for empirical treatment in UTI. Public health guidelines must stress on measures to prevent UTI in summers.

Keywords

Urinary tract infection Antimicrobials Resistance Seasonal trends

Article Details

How to Cite
M. Agrawal, M Ramteke, R. Hishikar, & N Sherwani. (2021). Changing trend of antimicrobial resistance pattern in UTI: one year retrospective study. International Journal of Research in Pharmacology & Pharmacotherapeutics, 7(3), 271-279. https://doi.org/10.61096/ijrpp.v7.iss3.2018.271-279

References

  1. [1]. Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature reviews microbiology. 13(5), 269.
  2. [2]. Kostakioti M, Hultgren SJ, Hadjifrangiskou M. Molecular blueprint of uropathogenic Escherichia coli virulence provides clues toward the development of anti-virulence therapeutics. Virulence. 3(7), 592-3.
  3. [3]. Chakupurakal R, Ahmed M, Sobithadevi DN, Chinnappan S, Reynolds T. Urinary tract pathogens and resistance pattern. Journal of clinical pathology.jcp. 2009.074617.
  4. [4]. Sumit Gupta et al. Changing trends in resistance pattern as an alarm by bacteria before it’s too late to treat’, IOSR Journal of Dental and Medical Sciences, 12(6), 2013, 55-60
  5. [5]. Manikandan S, Ganesapandian S, Singh M, Kumaraguru AK. Emerging of multidrug resistance human pathogens from urinary tract infections. Curr Res Bacteriol. 4(1), 9-15.
  6. [6]. Fasugba O, Mitchell BG, Mnatzaganian G, Das A, Collignon P, Gardner A. Five-year antimicrobial resistance Patterns of urinary Escherichia coli at an Australian Tertiary hospital: time series analyses of prevalence data. PloS one. 11(10), e0164306.
  7. [7]. Hombach M, Bloemberg GV, Bttger EC. Effects of clinical breakpoint changes in CLSI guidelines 2010/2011 and EUCAST guidelines on antibiotic susceptibility test reporting of Gram-negative bacilli. Journal of antimicrobial Chemotherapy. 67(3), 2011, 622-32.
  8. [8]. Sonavane A, Mathur M, Turbadkar D, Baradkar V. Antimicrobial susceptibility pattern in urinary bacterial isolates. Bombay Hospital J. 50(2), 2008, 240-44.
  9. [9]. Chatterjee B, Kulathinal S, Bhargava A, Jain Y, Kataria R. Anti-microbial resistance stratified by risk factor among Escherichia coli strains isolated from the urinary tract at a rural clinic in Central India. Indian journal of medical microbiology. 27(4), 2009, 329.
  10. [10]. Saha S, Rahman MS, Hassan FMN, Sarkar S, Islam MK, Saha P, et al. Antimicrobial resistance in uropathogen isolates from patients with urinary tract infections. Biomedical Research and Therapy. 2(5), 1-7.
  11. [11]. Vasudevan R. Urinary tract infection: an overview of the infection and the associated risk factors. J Microbiol Exp. 1(2), 00008.
  12. [12]. Somashekara SC, Deepalaxmi S, Jagannath N, Ramesh B, Laveesh MR, Govindadas D. Retrospective analysis of antibiotic resistance pattern to urinary pathogens in a Tertiary Care Hospital in South India. Journal of basic and clinical pharmacy. 5(4), 105.
  13. [13]. Angami S, Jamir N, Sarma PC, Deka AC. Urinary tract infection, its causative microorganism and antibiotic susceptibility in Nagaland. Archives of Medicine and Health Sciences. 3(1), 40.
  14. [14]. Manjunath GN, Prakash R, Vamseedhar Annam KS. Changing trends in the spectrum of antimicrobial drug resistance pattern of uropathogens isolated from hospitals and community patients with urinary tract infections in tumkur and bangalore. Int J Biol Med Res. 2(2), 504-7.
  15. [15]. Tiruneh M, Yifru S, Gizachew M, Molla K, Belyhun Y, Moges F, et al. Changing trends in prevalence and antibiotics resistance of uropathogens in patients attending the Gondar University Hospital, Northwest Ethiopia. International journal of bacteriology. 2014.
  16. [16]. Kahlmeter G. An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO· SENS Project. Journal of antimicrobial Chemotherapy. 51(1), 2003, 69-76.
  17. [17]. Magyar As, Kves Bl, Nagy Kr, Dobk As, Arthanareeswaran VKA, Bálint Pt, et al. Spectrum and antibiotic resistance of uropathogens between 2004 and 2015 in a tertiary care hospital in Hungary. Journal of medical microbiology. 66(6), 788-97.
  18. [18]. Kothari A, Sagar V. Antibiotic resistance in pathogens causing community-acquired urinary tract infections in India: a multicenter study. The Journal of Infection in Developing Countries. 2(05), 2008, 354-8.
  19. [19]. Mandal J, Acharya NS, Buddhapriya D, Parija SC. Antibiotic resistance pattern among common bacterial uropathogens with a special reference to ciprofloxacin resistant Escherichia coli. The Indian journal of medical research. 136(5), 842.
  20. [20]. Karlowsky JA, Kelly LJ, Thornsberry C, Jones ME, Sahm DF. Trends in antimicrobial resistance among urinary tract infection isolates of Escherichia coli from female outpatients in the United States. Antimicrobial agents and chemotherapy. 46(8), 2002, 2540-5.
  21. [21]. Warren JW, Abrutyn E, Hebel JR, Johnson JR, Schaeffer AJ, Stamm WE. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Clinical Infectious Diseases. 29(4), 1999, 745-59.
  22. [22]. S. Venkatesh et al. National Treatment Guidelines for Antimicrobial Use in Infectious Diseases. National centre for disease control, Directorate general of health services, New Delhi, Gov of India, version 1.0 last accessed on 5, 2016, 2018.
  23. [23]. Al-Hasan MN, Lahr BD, Eckel-Passow JE, Baddour LM. Seasonal variation in Escherichia coli bloodstream infection: a population-based study. Clinical Microbiology and Infection. 15(10), 2009, 947-50.
  24. [24]. Rossignol L, Pelat C, Lambert B, Flahault A, Chartier-Kastler E, Hanslik T. A method to assess seasonality of urinary tract infections based on medication sales and google trends. PloS one. 8(10), e76020.
  25. [25]. Schwab F, Gastmeier P, Meyer E. The warmer the weather, the more gram-negative bacteria-impact of temperature on clinical isolates in intensive care units. PloS one. 9(3), e91105.
  26. [26]. Freeman JT, Anderson DJ, Sexton DJ. Seasonal peaks in Escherichia coli infections: possible explanations and implications. Clinical Microbiology and Infection. 15(10), 2009, 951-3.