Background Indiscriminate and widespread use of antibiotics has resulted in emergence of many antibiotic-resistant organisms. Antibiotic administration during pregnancy is mostly avoided, unless there is compelling medical condition. We hypothesized that the uropathogens isolated from pregnant women would be more susceptible to antibiotics compared to those isolated from nonpregnant women, thus will be helpful in formulating separate empiric guideline for pregnant women based on the resistance pattern. Methods This was a prospective cross-sectional study conducted over a period of 2 years in which females with the clinical diagnosis of either cystitis or asymptomatic bacteriuria during pregnancy were included from the community settings. Uropathogen species and their antimicrobial resistance pattern were compared between the pregnant and nonpregnant groups. After accounting for centre-to-centre variation and adjusting for age and socio-economic status, the adjusted odds ratio for antibiotic resistance was calculated and compared between pregnant and nonpregnant women using logistic regression analysis. Results A total of 1758 women (pregnant: 43.3%; nonpregnant: 56.6%) were screened in the study over a period of 2 years, out of which 9.3% (163/1758) were having significant bacteriuria. Escherichia coli and Klebsiella pneumoniae were the two commonest uropathogen in both the groups; their prevalence being 83.6% in pregnant women and 85.2% in nonpregnant women, respectively. Resistance against ampicillin, cefixime, cefoxitin, ceftazidime, ceftriaxone and amoxicillin-clavulanic acid were found significantly lower in the pregnant women compared to nonpregnant. After adjusting the age and socio-economic status accounting for centre-to-centre variation, the odds of resistance for cefixime, amoxicillin-clavulanic acid and co-trimoxazole were found lower and statistically significant among the pregnant women group. Conclusions The antimicrobial resistance was significantly higher among the community-dwelling nonpregnant women compared to pregnant women in case of few antibiotics. The study highlighted the need of building local antibiogram that could help to initiate the empirical treatment and thus prevent emergence of antimicrobial resistance.
Introduction- The increasing antibiotic resistance like advent of carbapenem resistant Enterobactarales (CRE), Carbapenem Resistant Acinetobacter baumanii (CRAB) and Carbapenem Resistant Pseudomonas aeruginosa (CRPA) has led to use of toxic and older drugs like colistin for these organisms. But worldwide there is an increase in resistance even to colistin mediated both by chromosomes and plasmids. This necessitates accurate detection of resistance. This is impeded by unavailability of a user friendly phenotypic method for use in routine clinical microbiology practice. The present study attempts to evaluate two different methods- Colistin broth disc elution and MIC detection by Vitek 2 in comparison to CLSI approved broth microdilution (BMD) for colistin for Enterobactarales, Pseudomonas aeruginosa and Acinetobacter baumanii clinical isolates. Methods- Colistin susceptibility of 6013 carbapenem resistant isolates was determined by BMD, Colistin Broth Disc Elution (CBDE) and Vitek2 methods and was interpreted as per CLSI guidelines. The MIC results of CBDE, Vitek 2 were compared with that of BMD and essential agreement (EA), categorical agreement (CA), sensitivity, specificity, very major error (VME), major error (ME) and cohen’s kappa (CK) was calculated. Presence of any plasmid-mediated colistin resistance (mcr-1, 2, 3, 4 and 5) was evaluated all colistin resistant isolates by conventional polymerase chain reaction. Results- Colistin resistance was found in 778 (12.9%) strains among the carbapenem resistant isolates. Klebsiella pneumoniae had the highest (18.9%) colistin resistance by BMD method. MIC of Vitek 2 had sensitivity ranging from 78.2% to 84.8% and specificity of > 92%. There were 171 VMEs and 323 MEs by Vitek2 method, much more than CLSI acceptable range. The highest percentage of errors was committed for Acinetobacter baumanii (27.8% of VME and 7.9% ME). On the other hand the CBDE method performed well with EA, CA, VME and ME within acceptable range for all the organisms. The sensitivity of CBDE method compared to gold standard BMD varied from 97.5%-98.8% for different strains with a specificity of more than 97.6%. None of the isolated colistin resistant organism harbored mcr plasmids. Conclusion- As BMD has many technical complexities, CBDE is the best viable alternative available for countries like India. A sensitive MIC reported by Vitek2 needs to be carefully considered due high propensity for VMEs particularly for Klebsiella spp. Data summary- Supplementary material provides data regarding the comparison of MICs of three different mmethods for all samples. Sheet 1 to Sheet 5 contains data for E.coli, K.pneumoniae, A.baumannii, P.aeruginosa, E. cloacae respectively.
Urinary tract infection (UTI) in the community is a common infection in humans. The causative microorganisms for UTIs may vary in different places and also vary in their antibiotic sensitivity and resistant patterns. This study aimed to find out the incidence of gram-negative bacteria along with their antibiotic sensitivity pattern in community-acquired UTIs and to calculate the existence of Extended-spectrum beta-lactamase (ESBL) positivity among them. A Sum of 515 urine samples was tested and the causative organisms were identified. Antibiotic susceptibility tests were executed where it had shown growth for bacteria by both manual and automated methods. ESBL tests were performed to identify ESBL-producing isolates. From a total of 515 samples, 65 (12.65%) were culture positive for UTIs. The rate of infection was higher in females than in males. The most prevailing bacteria were Escherichia coli and Klebsiella pneumoniae. Out of total culture-positive isolates, only 43.08% were ESBL positives. The study found that the organisms displayed resistance to Ciprofloxacin and Cefixime and sensitivity to Gentamicin, Ertapenem, and Nitrofurantoin. Females have a higher prevalence of UTIs than males. Mostly, females suffer from UTIs in their reproductive years whereas males suffer in their old age. The prevalence of gram-negative bacteria is higher in community-acquired UTIs. These pathogens though present in the community, becoming resistant to commonly used antibiotics like Ciprofloxacin and Cefixime because of overuse and misuse of antibiotics at the community level.
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