Anti-Microbial Resistance Stratified by Risk Factor Among Escherichia Coli Strains Isolated From the Urinary Tract at a Rural Clinic in Central India

Abstract

under intense selection pressure in the hospital environment.In the course of our work in central India, with a predominantly rural population that has poor access to healthcare, we have seen failure of empirical treatment of community-acquired UTIs with commonly-used, orallyadministered drugs in more than a third of cases. This happens regardless of the presence of complicating factors. Failure of empirical treatment of nosocomial UTI occurs even more frequently.The aim of the present study was to document resistance patterns of E. coli responsible for urinary tract infections in our area. We compared resistance rates between communityacquired isolates from patients with or without complicating factors and between community-acquired and hospitalacquired isolates to look for possible differences that could aid clinical decision-making while awaiting laboratory test results. In particular, we looked at community-acquired UTI in reproductive age-group women without apparent complicating factors, since they comprise the commonest subset of UTI patients in an outpatient setting. Materials and Methods SubjectsThe subjects of the study were 356 consecutive outpatients and inpatients with symptoms suggestive of IntroductionUrinary tract infections (UTIs) are one of the commonest bacterial infections and a single species, Escherichia coli, accounts for majority of these.[1,2] Community-acquired strains of E. coli causing UTI in the absence of complicating factors such as obstruction, calculi, anatomic anomalies, reß ux etc. often belong to successful uropathogenic clones that possess adhesins, siderophores, haemolysins and other virulence factors that facilitate colonisation and infection.[3] Some of these strains have also been found to carry integrons with genes that mediate multiple antimicrobial resistance. [4] Strains of E. coli that infect patients with complicating factors or a history of invasive procedures on the urinary tract, may lack specialized virulence factors. Anti-microbial resistance rates of these latter strains vary and are highest among nosocomial strains The failure of empirical therapy is frequently observed, even in community-acquired urinary tract infections. We, therefore, conducted a prospective, clinic-based study in 2004-2005 to document anti-microbial resistance rates and correlate them with possible risk factors to assist empirical decision-making. Materials and Methods: Symptomatic patients with pyuria underwent urine culture. Isolates were identiÞ ed using standard methods and anti-microbial resistance was determined by disk-diffusion. Ultrasonography was used to detect complicating factors. Patients were stratiÞ ed by the presence of complicating factors and history of invasive procedures for comparison of resistance rates. Statistical Method Used: Chi-square or Fisher exact tests, as appropriate. Results: There were 156 E. coli isolates, of which 105 were community-acquired. Twenty-three community-acquired isolates were from patients with complicating factors while 82 were from patient...

Hospital and community isolates of uropathogens and their antibiotic sensitivity pattern from a tertiary care hospital in North West India

“…[41517] Similarly, all uropathogens in the present study showed a high resistance to 1 st , 2 nd and 3 rd generation cephalosporins (44-100%), while other studies have reported a comparatively lower resistance. [11524] The high resistance to fluroquinolones and cephalosporins in the present study can be attributed to the easy access and indiscriminate use of these drugs for all types of infections, and emphasizes the role of selective drug pressure in emergence of drug-resistant mutants. It is recommended that these drugs should not be considered as first-line therapy for the empiric treatment of UTIs in this part of the country, as opposed to that recommended by other studies both from India and from abroad.…”

“…[91013] However, studies from some other parts of the country have shown higher isolation rates (65% to more than 90%). [151617] This difference probably occurred because ours is a tertiary care center as compared with the primary and secondary care levels of these centers.…”

Multi-drug Resistance and Extended-Spectrum β-Lactamase Production in Uropathogens from Hospitalized Patients in Gurugram, India

“…This was similar to the studies conducted by other researchers 16,21,22 . However, studies from some other parts of the country had shown higher frequency rates (65-90%) [23][24][25] . This variation might be due to the different environmental conditions in different areas.…”

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“…Microorganisms were initially identified using the colony characters on the above medias and Gram staining, Stock cultures were maintained at 4 o C on nutrient agar. The bacterial strains were identified by performing IMViC tests 8 , and extended biochemical reactions like catalase, oxidase, H 2 S production, urease test 9 .…”

“…Gelatinase production was tested using gelatin agar 9 . Production of beta lactamases was determined by iodometric method by Sng et al, 1980 13 .…”