Objectives: to evaluate the antibiotic susceptibility of uropathogens circulating in the Hyderabad region.
Methodology: A single midstream urine sample was collected by clean catch method from 119 outdoor and indoor patients attending various diagnostic centers across Hyderabad, during July 2012 to December 2012. Duplicate samples from the same patient were excluded. In vitro antimicrobial sensitivity tests were carried out using Kirby-Bauer disc diffusion technique.
Results: Predominant isolate found in the present study was E. coli (57.14%), followed by Pseudomonas aureginosa (6.12%), Klebsiella pneumonia (4.08%), and Proteus mirabilis (4.08%). Antibiotic susceptibility testing demonstrated varying patterns of susceptibilities against tested antibiotics. All E. coli isolates showed highest sensitivity against Amikacin (100%) followed by Fosfomycin (96.4%), Nitrofurantion (89.2%), and Amoxacillin plus Clavulanate, (82.1%). Amikacin showed 100% sensitivity against E. coli, P. aureginosa, K. pneumonia & P. mirabilis. Importantly, Amoxicillin plus Clavulanate showed comparable sensitivity patterns against E. coli, K. pneumoniae, P. mirabilis, and Enterococcus species, the most common uropathogens in the region. Furthermore, it was observed that 64.29% of the E. coli isolates were resistant to Co‑trimaxazole, which has previously been used as an antibiotic of choice for treatment of uropathogens.
Conclusion: The commonest uropathogens in Hyderabad was E. coli and Pseudomonas aureginosa. Amikacin with highest sensitivity against multiple uropathogens, can be prescribed as the drug of choice in empirical treatment of UTIs. Furthermore, proper knowledge of susceptibility pattern of uropathogens is crucial in order to discourage the indiscriminate use of antibiotics as well as in formulating effective empiric therapy.
Gupta K, Sahm DF, Mayfield D, Stamm WE. Antimicrobial resistance among uropathogens that cause community-acquired urinary tract infections in women: A nationwide analysis. Clin Infect Dis 2001;33:89-94.
Ronald AR, Nicolle LE, Stamm E, Krieger J, Warren J, Schaeffer A, et al. Urinary tract infection in adults: research priorities and strategies. Int J Antimicrob Agents. 2001;17: 343-8.
Gupta V, Yadav A, Joshi RM. Antibiotic resistance pattern in uropathogens. Indian J Med Microbiol 2002; 20: 96-8.
Tankhiwale SS, Jalgaonkar SV, Ahamad S, Hassani U. Evaluation of extended spectrum beta lactamase in urinary isolates. Indian J Med Res 2004; 120: 553-6.
Kumar MS, Lakshmi V, Rajagopalan R. Occurrence of extended spectrum beta-lactamases among Enterobacteriaceae spp. isolated at a tertiary care institute. Indian J Med Microbiol. 2006; 24: 208-11.
Kabins SA, Cohen S. Resistance-transfer factor in Enterobacteriaceae. N Engl J Med 1966; 275: 248-52.
Lambert HP. Clinical impact of drug resistance. J Hosp Infect 1988; 11 Suppl A: 135-41.
McGowan JE, Jr. Antimicrobial resistance in hospital organisms and its relation to antibiotic use. Rev Infect Dis 1983; 5: 1033-48.
Watanabe T. Infectious drug resistance in enteric bacteria. N Engl J Med. 1966; 275: 888-94.
Bano K, Khan J, Rifat, Begum H, Munir S, Akbar N, et al. Pattern of antibiotic sensitivity of bacterial pathogens among urinary tract infections (UTI) patients in Pakistan population. Afr J Microbiol Res 2012; 6: 414-20.
Tanvir R, Hafeez R, Hasnain S. Prevalence of multiple drug resistance Esherichia coli in patients of urinary tract infections registering at a diagnostic laboratory in Lahore, Pakistan. Pakistan J Zool 2012; 44: 6.
Khan BA, Saeed S, Akram A, Khan FB, Nasim A. Nosocomial uropathogens and their antibiotic sensitivity patterns in a tertiary referral teaching hospital in Rawalpindi, Pakistan. J Ayub Med Coll Abbottabad 2010; 22: 2.
Zareef S, Zafar H, Izhar* K, Dodhy ME, Hayat A. The Culture and Sensitivity Pattern of Uropathogens Detected at Benazir Bhutto Hospital. Ann Pak Inst Med Sc. 2009; 5: 5.
Kass EH. Asymptomatic infections of the urinary tract. Trans Assoc Am Physicians. 1956; 69: 56-64.
Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol. 1966 Apr; 45: 493-6.
Nazir H, Cao S, Hasan F, Hughes D. Can phylogenetic type predict resistance development? J Antimicrob Chemother. 2011; 66: 778-87.
Renuart AJ, Goldfarb DM, Mokomane M, Tawanana EO, Narasimhamurthy M, Steenhoff AP, et al. Microbiology of urinary tract infections in Gaborone, Botswana. PLoS One 2013; 8: e57776.
Ronald A. The etiology of urinary tract infection: traditional and emerging pathogens. Am J Med 2002; 113 Suppl 1A: 14S-9S.
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. Infectious Diseases Society of America (IDSA). Clin Infect Dis 1999; 29: 745-58.
Talan DA, Krishnadasan A, Abrahamian FM, Stamm WE, Moran GJ. Prevalence and risk factor analysis of trimethoprim-sulfamethoxazole- and fluoroquinolone-resistant Escherichia coli infection among emergency department patients with pyelonephritis. Clin Infect Dis 2008; 47: 1150-8.
Cuevas O, Cercenado E, Gimeno M, Marin M, Coronel P, Bouza E. Comparative in vitro activity of cefditoren and other antimicrobials against Enterobacteriaceae causing community-acquired uncomplicated urinary tract infections in women: A Spanish nationwide multicenter study. Diagn Microbiol Infect Dis 2010;67:251-60.
Naber KG, Schito G, Botto H, Palou J, Mazzei T. Surveillance study in Europe and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): implications for empiric therapy. Eur Urol 2008 Nov; 54: 1164-75.
Shigemura K, Tanaka K, Okada H, Nakano Y, Kinoshita S, Gotoh A, et al. Pathogen occurrence and antimicrobial susceptibility of urinary tract infection cases during a 20-year period (1983-2002) at a single institution in Japan. Jpn J Infect Dis 2005; 58: 303-8.
Sabharwal ER. Antibiotic susceptibility patterns of uropathogens in obstetric patients. N Am J Med Sci. 2012; 4: 316-9.
Sreeja S, Babu PRS, Prathab AG. The prevalence and the characterization of the enterococcus species from various clinical samples in a tertiary care hospital. J Clin Diagn Res 2012; 6: 1486-8.
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