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 ~  Abstract
 ~  Materials and Me...
 ~  Results
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Year : 2002  |  Volume : 20  |  Issue : 2  |  Page : 96-98
 

Antibiotic resistance pattern in uropathogens


Dept. of Microbiology, Govt. Medical College Hospital, Sector 32, Chandigarh - 160 047, India

Correspondence Address:
Dept. of Microbiology, Govt. Medical College Hospital, Sector 32, Chandigarh - 160 047, India

 ~ Abstract 

Uropathogenic strains from inpatient and outpatient departments were studied from April 1997 to March 1999 for their susceptibility profiles. The various isolates were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis, Acinetobacter baumanii and Enterococcus faecalis. Antibiotic susceptibility pattern of these isolates revealed that for outpatients, first generation cephalosporins, nitrofurantoin, norfloxacin/ciprofloxacin were effective for treatment of urinary tract infection but for inpatients, parenteral therapy with newer aminoglycosides and third generation cephalosporins need to be advocated as the organisms for nosocomial UTI exhibit a high degree of drug resistance. Trimethoprim and sulphamethoxazole combination was not found to be effective for the treatment of urinary tract infections as all the uropathogens from inpatients and outpatients showed high degree of resistance to co-trimoxazole. Culture and sensitivity of the isolates from urine samples should be done as a routine before advocating the therapy.

How to cite this article:
Gupta V, Yadav A, Joshi R M. Antibiotic resistance pattern in uropathogens. Indian J Med Microbiol 2002;20:96-8


How to cite this URL:
Gupta V, Yadav A, Joshi R M. Antibiotic resistance pattern in uropathogens. Indian J Med Microbiol [serial online] 2002 [cited 2014 Apr 24];20:96-8. Available from: http://www.ijmm.org/text.asp?2002/20/2/96/8358


Despite the widespread availability of antibiotics, UTI remains the most common bacterial infection in the human population.[1] Antibiotics are usually given empirically before the laboratory results of urine culture are available. To ensure appropriate therapy, current knowledge of the organisms that cause UTI and their antibiotic susceptibility is mandatory.[2] Much of the data is available for community acquired infections. This may be different from that of hospital acquired infections. Since patterns of antibiotic resistance in a wide variety of pathogenic organisms may vary even over short periods and depend on site of isolation and on different environments, periodic evaluation of antibacterial activity is needed to update this information.[3],[4],[5] In this context, the present study, was carried out for hospitalised patients with UTI and those attending the outpatient department with UTI. Clinical laboratory records of cases of urinary tract infection were studied for the spectrum of bacterial isolates and their antibiotic susceptibility results were analysed for recommending suitable therapy.

 ~ Materials and Methods Top

One thousand four hundred and ten culture proven urine isolates were retrospectively studied. The samples were collected between April 1997 to March 1999 from both the inpatient as well as the outpatient department of the Government Medical College and Hospital, Chandigarh. Majority of the samples were midstream urine specimens, and others included catheterized urine samples and supra pubic aspirates.
Culture was done by the calibrated loop technique delivering 0.001 mL of urine and plated on Cystine-Lactose-Electrolyte Deficient (CLED) agar plates. For gram-negative bacilli more than 105 colonies per mL of urine, whereas for gram positive cocci 103-105 colonies per mL were considered significant.[6],[7] The colonies were identified by standard biochemical tests and sensitivity of the organisms was performed by modified Stoke's disk diffusion method on Mueller Hinton agar plates.[8] In the modified Stoke's disk diffusion method the control strains used were E.coli NCTC 10418, Pseudomonas aeruginosa NCTC 10662 and S.aureus NCTC 6571. The antibiotic discs and their concentrations per disc (mg) included: Trimethoprim-sulfamethoxazole (25), nitrofurantoin (300); representative antibiotics of aminoglycosides such as gentamicin (10), amikacin (10), netilmicin (10); quinolones such as nalidixic acid (30), norfloxacin (10), ciprofloxacin (5); various cephalosporins such as cephalexin (30), cefuroxime (30), cefotaxime (30), ceftazidime (30), aminopenicillin and piperacillin (100). The source of Mueller Hinton Agar (MHA) and antibiotic discs was Hi Media, India.

 ~ Results Top

Out of the 1410 patients of UTI, 808 were indoor patients (414 females and 394 males) and 602 (498 females and 114 males) were from outpatient department. Uropathogens isolated are shown in [Table - 1].
Among indoor patients, high percentage of strains showed resistance to cotrimoxazole. First generation cephalosporins were effective for E.coli, while newer aminoglycosides like amikacin and third generation cephalosporins were found to be effective against K. pneumoniae and  P.aeruginosa  , and ineffective against Acinetobacter species.
Amongst the outdoor patients, more than 50% patients showed E.coli as the commonest isolate which was 70%-80% resistant to cotrimoxazole and aminopencillin, however, first generation cephalosporins, nitrofurantoin and norfloxacin were effective but in cases where UTI was associated with agents other than E.coli, amikacin and third generation cephalosporins were found to be effective [Table - 2].

 ~ Discussion Top

This study shows that the pathogens causing UTI in community and hospital set up show different percentages of prevalence [Table - 1]. In the present study, E.coli predominated amongst the indoor as well as outdoor patients, K. pneumoniae being the second commonest in the indoor patient group followed by P.aeruginosa, Acinetobacter and Enterococcus faecalis. In a study of urinary isolates from Delhi, E.coli was found to be the commonest isolated organism followed by Klebsiella, S. aureus, Proteus species and Pseudomonas aeruginosa.[9] In another study from Aurangabad, in a combined population group of indoor as well as outdoor patients, Klebsiella was found to be the commonest followed by E.coli, P.aeruginosa and S.aureus.[10] A study done in children showed that nosocomial UTI is more due to organisms like Pseudomonas, Acinetobacter and Enterococcus while E.coli infection shows a decrease in incidence.[11]
While in outpatients, oral first generation cephalosporins, nitrofurantoin and fluoroquinolones may be effective, in indoor patients newer aminoglycosides and third generation cephalosporins are the only effective drugs. For Pseudomonas aeruginosa, amikacin, ceftazidime and piperacillin are the recommended antibiotics. Enterococcus faecalis was found to be susceptible to netilmicin and ciprofloxacin. However, no vancomycin resistant enterococci was found in our study. Acinetobacter infection in hospitalised patients showed high degree of resistance to almost all the antibiotics used routinely necessitating its susceptibility testing for newer drugs. Cotrimoxazole in the present study was no longer found to be effective for UTI as all the uropathogens showed high degree of resistance to it.
In view of the emerging drug resistance amongst bacteria, therapy should only be advocated, as far as possible, after culture and sensitivity has been performed. This would not only help in the proper treatment of the patients but would also discourage the indiscriminate use of the antibiotics and prevent further development of bacterial drug resistance. 

 ~ References Top

1.Sharma S. Current understanding of Pathogenic mechanisms in UTIs. Ann Natl Acad Med Sci 1997; 33(1):31-8.  Back to cited text no. 1    
2.Gruneberg GN. Antibiotic sensitivities of urinary pathogens: 1971-1982. J Antimicrob Chemother 1984; 14:17-23.  Back to cited text no. 2    
3.Jones RN, Thornsberry C. Cefotaxime: a review of in vitro antimicrobial properties and spectrum of activity. Rev Inf Dis 1982; 4:5300-15.  Back to cited text no. 3    
4.Fu KP, Neu HC. Betalactamase stability of HR 756 a novel cephalosporin, compared to that of cefuroxime and cefotaxime. Antimicrob Agents chemother 1978; 14:322-326.   Back to cited text no. 4    
5.Nokashino SS, Nakamuro M. In vitro activity of cefotaxime against clinically significant pathogens. Drugs 1988; 35(2):14-21.  Back to cited text no. 5    
6.Collee JG, Duguid JP, Fraser AG, Marmion BP, Simmons A. Laboratory strategy in diagnosis of infective syndromes. In Mackie and McCartney Practical Medical Microbiology 14th edition (Churchill Livingstone produced by Longman Singapore Publisher Ltd.) 1996: 88.  Back to cited text no. 6    
7.Microorganisms encountered in the urinary tract. In Bailey & Scott's diagnostic microbiology (9th edition). Baron EJ, Finegold SM, Eds (Mosby publishers, St. Louis, Missouri) 1994:256.  Back to cited text no. 7    
8.Agarwal KC. Antibiotic sensitivity test by disc diffusion method: Standardization and interpretation. Indian J Pathol Bacteriol 1974; 17:149-59.  Back to cited text no. 8  [PUBMED]  
9.Varma NC, Taneja OP, Saxena SN. Recurrent urinary tract infections in females. J Ind Med Ass 1972;58:155-58.  Back to cited text no. 9    
10.Bajaj JK, Karyokarte RP, Kulkarni JD, Deshmukh AB. Changing aetiology of urinary tract infections and emergence of drugs resistance as a major problem. J Commun Dis 1999; 31(3):181-84.  Back to cited text no. 10    
11.Ashkenazi S, Even TS, Samra Z, Dinari G. Uropathogens of various populations and their antibiotic susceptibility. Paediatr Infect Dis J 1991; 10:742-46.  Back to cited text no. 11    
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