Bacteriological Profile and Antimicrobial Drug Resistance Pattern of Urinary Tract Pathogens

(1)

International Journal of Medical Science and Current Research (IJMSCR)

Available online at: www.ijmscr.com

Volume2, Issue 3,Page No: 316-320 May-June 2019

316

Medicine ID-101739732

IJMSCR

Bacteriological Profile and Antimicrobial Drug Resistance Pattern of Urinary Tract

Pathogens

1

Arthi.K, 2GeethaBanu S* 1, 2

Assistant Professor, Department of Microbiology,

Meenakshi Ammal Dental College, Alapakkam Main Road,Maduravoyal, Chennai 600095, India

*Corresponding Author:

GeethaBanu S

Assistant Professor, Department of Microbiology

Meenakshi Ammal Dental College, Alapakkam Main Road,Maduravoyal, Chennai 600095, India

Type of Publication: Original Research Paper Conflicts of Interest: Nil

ABSTRACT

Urinary tract infections are among the most common infections worldwide for which empirical as well as over the counter medications are prescribed. Liberal use of antimicrobial agents have given rise to the emergence of multidrug resistant strains that are posing a threat to the community. This study was conducted on 135 urine samples received in the Microbiology laboratory of a General Hospital. Significant bacteriuria was observed in 19.3% of samples of which 85% were gram negative bacilli. Escherichia coli (64 %) and Klebsiella

pneumoniae (27%) were the common bacteria isolated. We also reported bacteria that were Extended spectrum

beta lactamase producing in 32% of the isolates and Amp C beta lactamase producing in 14%. All the bacteria isolated were sensitive to carbapenems. This study was conducted to emphasize the importance of culture and sensitivity testing and to curtail the use of a single antimicrobial agent for empirical use..

Keywords: antimicrobial, bacteriuria, multidrug, significant

INTRODUCTION

Urinary Tract Infections are one among the most common infections for clinic visits or inpatient admissions worldwide. They are also one among the reasons for which empirical antibiotic prescription is recommended. UTI is more common in women than men, however associated with complications in male patients. Bacteria implicated in the causation of UTI include Escherichia coli and Klebsiella, very commonly although other Gram negative bacilli, a few gram positive cocci and even fungus coud be the etiology. Common symptoms include fever, increase in frequency and burning micturition, urgency and lower abdominal pain. It has been noted that there is an increase in trend of antimicrobial resistance in urinary pathogens even in community acquired

immunocompromised individuals and hospital

acquired pathogens, multidrug resistant organisms have evolved in the general population due to reasons such as misuse of antibiotics, freely available over the counter drugs and indiscriminate use of antimicrobials in livestock. The primary mechanism of drug resistance could be attributed to random

mutations occurring spontaneously, enzymatic

degradation of antibiotics, alteration in the nature of bacterial proteins or due to changes in membrane permeability of antibiotics.[2]

This study was conducted in a General hospital for a period of 3 months with a sample size of 135 subjects .Patients were given appropriate instructions for sample collection such as clean catch early morning midstream urine in a sterile container after cleaning the genital area with soap and water. The samples were transported to the Microbiology laboratory and were processed without any further delay. Samples were diluted 1:100 (100µl of urine with 900 µl of normal saline) and streaked onto MacConkey and 5% Sheep blood agar using a 100 µl volume calibrated loop. Plates were incubated aerobically with the agar surface down at 37°C in the presence of ambient air for 18-24 hours. Plates were read the next day

visually and a Gram stain was put up. Gram positive bacteria were processed further using catalase, slide and tube coagulase whereas for Gram negative bacteria, the basic biochemical reactions were carried out as per standard laboratory protocol. Antimicrobial susceptibility was carried out by Kirby Bauer’s disc diffusion method on Mueller Hinton agar and the antibiotics were chosen accordingly as per the Clinical Laboratory Standards and Institute (CLSI) guidelines. Interpretation of zone diameters and further testing of resistance pattern was also done according to CLSI guidelines.[3]

RESULTS.

This study was carried out on 135 urine samples received in the Microbiology laboratory during a time period of 3 months. Among the samples tested, 19.3% showed significant growth of bacteria.

Table1: Distribution of Samples With Reference To Colony Count

CFU/ml No.of samples (n=135)

102 Nil (0%)

103 18 (13%)

104 10 (7.4%)

105 26 (19.3%)

Cfu/ml- colony forming units/ml

Table 2: List of Bacteria Isolated

Total number of bacteria isolated (n=26)

GRAM POSITIVE COCCI (n=4) (15%) GRAM NEGATIVE BACILLI (n=22) (85%)

Staphylococcus aureus 4 (100%) Escherichia coli 14 (64%)

Klebsiella pneumoniae 6 (27%)

Pseudomonas aeruginosa 2 (9%)

Table 3: Susceptibility Pattern of The Bacterial Isolates

Gram Positive Cocci

BACTERIA PEN AK GM TET NITRO CIP NOR COT

S.aureus

(n=4)

50% 100% 100% 100% 100% 100% 100% 75%

(n=14)

56% 44% 6% 56% 75% 81% 81% 87% 81% 44% 81% 100% 100%

K.pneumo

(n=6)

40% 60% 80% 80% 40% 80% 100% 80% 80% 60% 80% 100% 100%

P.aeruginosa

(n=2)

- - 100% 100% 100% 50% - - 50% 100% - 100% 100%

PEN- Penicillin, GM- Gentamicin,AK-Amikacin,TET-Tetracycline, NIT-Nitrofurantoin,

CIP-Ciprofloxacin, NOR-Norfloxacin, COT-Cotrimoxazole, CTX-Cefotaxime, CEC-Cefotaxime-clavulanate, CAZ-Ceftazidime, PT-Piperacillin Tazobactam,IMI- Imipenem, MER- Meropenem.

Table 4: Drug Resistance Pattern Of The Bacteria Isolated

GRAM POSITIVE COCCI

(n=4)

GRAM NEGATIVE BACILLI

(n=22)

MRSA 0 ESBL producers 7 (32%)

Carbapenemase producers 0 (0%)

Amp C producers 3(14%)

DISCUSSION

Among 135 urine samples tested 19.3% (26 samples) showed significant growth of bacteria with a colony count of 1,00,000 and above.It has been studied that urine colony counts of more than 1,00,000 cfu/ml have been associated with clinically significant illness and those less than 105 cfu/ml are infrequently associated with clinically significant disease.Over reporting of such cases may contribute to unnecessary antibiotic usage and spread of resistance. Hence colony counts of ≥ 105

cfu/ml were chosen as the cut off in our study [4] Majority of the patients in our study were females (69.6%) which could be attributed to factors such as the short urethra and its proximity to the perianal region [5].The prevalence rate of UTI in our study was similar to the one reported by Gupta et al which was 17.16%. Gram negative bacilli were isolated with a maximum of 85% and 15% of the bacteria isolated were gram positive cocci. Among the GNB isolated Escherichia coli were the majority (64%), while Klebsiella

pneumoniae and Pseudomonas aeruginosa amounted

to 27% and 9% of the gram negative isolates

respectively[6]. Escherichia coli was found to be the most common organism isolated in several other Indian studies conducted by Nivedita Thass (53.9%)

and Thattil (37.4%) followed by Klebsiella

pneumoniae[7]. Gram positive cocci caused only

15% of the UTIs in our set up, caused by

Staphlococcus aureus and were found to be

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