Hospital and Community Isolates of Uropathogens and their Antibiotic Sensitivity Pattern from a Tertiary Care Hospital in North West India

Abstract

Background: Urinary tract infection remains one of the most common infections, both in the community and in the hospital. The causative pathogen profile varies from region to region, but Escherichia coli (E. coli) remains the most common causative pathogen. The sensitivity of uropathogens to different drugs varies in different areas, and changes with time. This necessitates periodic studies of the causative uropathogens and their antibiotic sensitivity pattern. Aim: To investigate the profile of common uropathogens and assess their antibiotic sensitivity patterns to commonly used antimicrobial agents. Materials and Methods: Analysis of all urine specimens submitted for culture and sensitivity was carried out over a 1‑year period in a tertiary care hospital in North West India. Urine culture was done by a semi‑quantitative method. Antibiotic sensitivity was done on bacterial isolates according to the Clinical and Laboratory Standards Institute CLSI guidelines for disc diffusion susceptibility test. Data was analysed for significance using Chi square test. Results: Of a total of 6348 urine specimens received over the 1‑year study period, 41.8% (2653) of the urine samples were culture positive. The most common bacterial isolate was E. coli (45.7%, 1103/2412), followed by Coagulase-negative Staphylococci (18.6%, 449/2412) and Klebsiella species (8.3%, 199/2412). The Candida species’ isolation rate was 10.3% (277/2689). The uropathogens displayed a very high level of resistance to fluroquinolones 70.3% (1084/1542)[Inpatient Department (IPD) – 70.5%(572/812), Outpatient Department (OPD) – 70.2%(512/730)] and cephalosporins 75.1%(1158/1542)[IPD – 73.8%(599/812), OPD – 76.6%(559/730)], whereas resistance to nitrofurantoin 19.8%(305/1542) [ IPD – 23.9%, OPD – 15.2%(111/730)], amikacin 32.4%(573/1769) [IPD – 36.1%(235/934), OPD – 28.1%(235/835)] and ephoperazone + sulbactam combination 22%(349/1583) [IPD – 26.2%(244/914), OPD – 15.8%(105/669)] was low. Conclusion: Empiric selection of antimicrobial agents should be based on the antibiotic sensitivity pattern of the uropathogens prevalent in that area, which is derived from epidemiological studies carried out in that environment.

Keywords: Antibiotic resistance, Urinary tract infections, Uropathogens