URINARY TRACT INFECTIONS–BACTERIOLOGICAL PROFILE AND ANTIBIOTIC SENSITIVITY PATTERN IN A TERTIARY CARE HOSPITAL

Dr. REENA JOHN; Dr. Dagny Hari; Dr. Prithi Nair K.

Volume : VIII, Issue : I, January - 2018

URINARY TRACT INFECTIONS–BACTERIOLOGICAL PROFILE AND ANTIBIOTIC SENSITIVITY PATTERN IN A TERTIARY CARE HOSPITAL

Dr. Reena John, Dr. Dagny Hari, Dr. Prithi Nair K.

Abstract :

Introduction: Bacterial urinary tract infections (UTIs) can involve the urethra, prostate, bladder, or kidneys. Diagnosis is based on analysis and culture of urine. Treatment is with antibiotics and removal of urinary tract catheters and obstructions. E. coli account for 75 to 95% of cases followed by Klebsiella species. Susceptibility patterns for the bacteria causing acute uncomplicated UTIs have generally been predictable until recently, with most susceptible to Trimethoprim–Sulfamethoxazole (TMP–SMX). Consequently, the traditional approach to therapy has been empirical short–course regimens with TMP–SMX. However, increasing antimicrobial resistance among uropathogens causing acute uncomplicated cystitis has had important ramifications for traditional empirical approaches.

Materials and methods: A retrospective study of urinary isolates was done for a period of one year from November 2016 to October 2017. The study was conducted in a tertiary care hospital in Central Kerala. The organisms isolated from urine samples of patients received in the microbiology laboratory with features of urinary tract infection were analysed. The samples included midstream urine sample (MSU), Suprapubic aspirates (SPA), Cathterised urine sample.

Results: A total of 8473 samples were processed during the one year period. Out of which 832 significant isolates obtained (9.8%). Isolates were maximum from patients above 45 years. E.coli and Klebsiella (560 &198) together accounted 91.1% of the total isolates. Among the orally acting drugs Nitrofurantin showed maximum sensitivity, followed by TMP–SMX. A total of 503 isolates (both E.coli, and Klebsiella together) were Extended Spectrum Betalactamase (ESBL) producing.

Discussion: The microbial etiology of urinary infections has been regarded as well established and reasonably consistent. Escherichia coli remains the predominant uropathogen. In our study, E. coli has a high percentage of resistance to Ampicillin, Cephalosporins and to TMP–SMX, so these antibiotics are not suitable as empirical agents. The emergence of these resistance patterns is concerning, because they are mostly resistant to oral antibiotics. Around 60% of urinary isolates showed ESBL production

Conclusion: Although the etiology of UTI remains constant, knowledge of local resistance trends is now an integral component in the successful empiric treatment of uncomplicated UTI. Selection of a therapeutic agent must now take in to account the in vitro susceptibility, in addition to potential adverse effects and cost effectiveness.