Antibiotic Resistance in Urinary Tract Infection in a Tertiary Care Hospital in Bangladesh-A Follow-up Study

Abstract

Introduction: Bacterial resistance to antibiotics is one of the most challenging global health threats. Urinary tract infections (UTIs) are a common infection. Regional surveillance programs are necessary to update knowledge on antimicrobial resistance pattern where empirical antibiotic treatment is the mainstay. The aim of this follow up study is to see the changing trends in bacteriology and antibiotic resistance pattern among urological pathogens in comparison to similar study 5 years back. Materials and Methods: We performed a prospective study in Comilla Medical College Hospital, Bangladesh during the period of July 2015-June 2016. Midstream clean-catch urine samples were collected from 658 suspected UTI patients with age more than 12 years and inoculated in MacConkey& Blood agar media for semi quantitative urine culture and sensitivity test. Antibiotic susceptibility pattern was done by Kirby-Bauer disc diffusion method following clinical laboratory science (CLS) program. Results: Culture positive were in 198 samples among 658 inoculated samples. E. coli was isolated from 171(86%) samples which was the most predominant bacteria followed by Klebsiella and Enterococcus. UTI with E. coli was significantly increased in the year 2016 in comparison to 2011. Meropenem, imipenem, amikacin, tazobactum, gentamycin nitrofurantoin, and mecillinum found resistance against 0% to 12% of the urological pathogens. Bacteria offered high degree of resistance against commonly used antibiotics -amoxycillin, amoxiclav, cephradine and cefixime ranging 60% to 86%. Comparative study of 2016 vs 2011 shows significant increased resistance for ceftriaxone, amoxiclav and reduced resistance for nalidexic acid, mecillinum and cefuroxime. Conclusion: E. coli infection is significantly increaseing in follow up study from 2011 to 2016 with no steady increase in resistance to all antibiotics. Imipenem, meropenem, tazobactum, amikacin and nitrofurantoin still remain more sensitive while comparative study of 2016 vs 2011 shows significant increased resistance for ceftriaxone, and amoxiclave and reduced resistance for nalidexic acid, mecillinum, cefixime and cefuroxime.

Uropathogens and Their Resistance Pattern in Urinary Tract Infection Cases of Tertiary Care Hospital, Bhopal

“…Meropenem which is at par with Deshpande et al 2011 [17]. In our study, resistance to Piperacillin Tazobactam by P. aeruginosa was found to be nearly 30% which coincides with that of Baveja et al 2014 [22].…”

“…In our study, the majority (72%) of cases were older than 46 years old, compared to young patients (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) [12].…”

Bacterial association in urinary tract infection and their drug resistance among patients in Rajshahi, Bangladesh

“…Out of suspected patients of UTI, 30% were found infected where 70% did not show any significant infection which very closely correlates with a previous study where 31% samples were found positive for UTI. 28 Nonetheless, the highest rate of infection was observed among the females (65.28%) aged 21-40. A higher incidence of UTI infection in females than males was very commonly observed in the earlier investigations and the prevalence is due to their physical structure where the anus is close to the vagina in females in association with the vaginal colonization with uropathogens, sexual activity, pregnancy and obstruction.…”

“…A higher incidence of UTI infection in females than males was very commonly observed in the earlier investigations and the prevalence is due to their physical structure where the anus is close to the vagina in females in association with the vaginal colonization with uropathogens, sexual activity, pregnancy and obstruction. 28,[29][30][31][32][33][34] Conversely, in men, the reasons behind UTI may include insertive anal intercourse or lack of circumcision or having sexual partner with vaginal colonization with uropathogenic microorganisms or lack of immunity. 35,36 In our study, we observed a wide extent of resistance of uropathogens against several antibiotics which is a matter of great concern.…”

Prevalence, etiology and antibiotic resistance patterns of community-acquired urinary tract infections in Dhaka, Bangladesh

“…However, two studies carried out with patients attending tertiary level hospitals outside of Dhaka (in Rajshahi and Mymensingh), reported that Staphylococcus saprophyticus was the second leading cause of UTI after E . coli [ 15 , 18 ] while another study (in Comilla) reported Klebsiella pneumoniae as the second leading cause [ 30 ]. There might be some geographical variations in the etiology of UTI in Bangladesh, which might also be dependent on the age, sex, sexual activity (for female), clinical features and demographic characteristics of patients.…”