Escherichia coli and Klebsiella pneumoniae Sensitivity/Resistance Pattern Towards Antimicrobial Agents in Primary and Simple Urinary Tract Infection Patients Visiting University Hospital of Jamia Hamdard New Delhi

 

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Abstract

Aim This study was carried out to record the sensitivity/resistance pattern of Escherichia coli and Klebsiella pneumoniae towards antimicrobial drugs prescribed to urinary tract infection (UTI) patients.

Materials and Methods A total of 68 bacteriologically proven simple UTI patients were included in the study, based on inclusion and exclusion criteria. Subjects demographics, antibiotics prescribed, sensitivity pattern of antibiotics towards the urinary pathogens were recorded in drug utilization and documentation form.

Results The mean age of the patients was 29.32 years. The maximum number of patients fell under the age group 21–30 years. The maximum no of male and female patients belonged to the age group 21–30 years, 82.35% were females and 17.64% were males. E. coli found to be the most common uropathogens followed by Klebsiella pneumoniae. Nitrofurantoin was the most commonly prescribed drug followed by ciprofloxacin, levofloxacin and amoxicillin + clavulanic acid and amikacin. E. coli isolates showed high resistance for ampicillin followed by cotrimoxazole, norfloxacin, ciprofloxacin, gentamicin, tetracycline and ceftazidime and least resistance to amikacin, nitrofurantoin. Klebsiella pneumoniae isolates were highly resistant against ceftazidime, ampicilline, cotrimoxazole, nitrofurantoin, gentamicin, amoxicillin + sulbactam. Overall, the antibiotic against with high resistance found was ampicillin followed by cotrimoxazole, gentamicin, ceftazidime, norfloxacin, ciprofloxacin, tetracycline, levofloxacin, cefepime and least resistance to amikacin, netilmicin and nitrofurantoin.

Conclusion Majority of UTIs in this study were caused by E. coli followed by Klebsiella pneumoniae. The high resistance was found with ampicillin (75%). Nitrofurantoin was the most commonly prescribed drug followed by other flouroquinolones.

• References

• 1 Davidson AM, Cumming AD, Swainson CP. Disease of kidney and genitourinary system. In: Edward CRW, Brucheier IAD, Hustel C, Ahifrus ER. , eds. Davidson’s principle and practice of Medicine. 17^th ed. New York: Churchill Livingstone; 1995: 611-668
  Google Scholar
• 2 Astal ZE. Increasing ciprofloxacin, resistance among prevalent urinary tract bacterial isolates in the Gaza Strip. Singapore Med J. 2005; 46: 457-460
  PubMedGoogle Scholar
• 3 Gonzalez CM, Schaeffer AJ. Treatment of urinary tract infection: What’s old, what’s new and what’ works. World J Urol. 1999; 17: 372-382
  CrossrefPubMedGoogle Scholar
• 4 Souhami RL, Moxham J. , eds. Renal and urinary disease. Text book of medicine. 1^st ed. Hong Kong: ESBS with Churchill Livingstone; 1990: 785-839
  Google Scholar
• 5 Hooton TM, Besser R, Foxman B. et al. Acute uncomplicated cystitis in an Era of increasing antibiotic resistance: A proposed approach to empirical therapy. Clinical Infectious Diseases 2004; 39: 75-80
  CrossrefPubMedGoogle Scholar
• 6 Kunin CM. Urinary tract infections in females. Clin Infect Dis. 1994; 18: 1-12
  CrossrefPubMedGoogle Scholar
• 7 Gupta K, Hooton TM, Naber KG. et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the infectious diseases society of america and the european society for microbiology and infectious diseases. Clin Infect Dis 2011; 52: e103-e120
  CrossrefPubMedGoogle Scholar
• 8 Grabe M, Chairman BM, Bjerklund-Johansen TE. et al. Guidelines on urological infections. In: EAU, ed. European Association of Urology Guidelines. Arnhem, The Netherlands: European Association of Urology; 2010: 1-110
  Google Scholar
• 9 Wagenlehner FME, Schmiemann G, Hoyme U et al. Epidemiologie, Diagnostik, Therapie and Management unkomplizierter bakterieller ambulant erworbener Harnwegsinfektionen bei erwachsenen Patienten. S-3 Leitlinie der Arbeitsgemeinschaft Wissenschaftlicher Medizinischer Fachgesellschaften (AWMF) AWMF-Register-Nr 043/044 2010 [cited 2010 October]; Available from: www.uniduesseldorf. de/AWMF
  PubMed
• 10 Ananthanarayan R, Paniker CKJ. , eds. Laboratory control of antimicrobial therapy Textbook of Microbiology. 6^th Hyderabad (India). Orient Longman private Limited. 2000: 581-583
  Google Scholar
• 11 Magalit SL, Gler MTS, Tupasi TE. Increasing antimicrobial resistance patterns of community and nosocomial uropathogens in Makati Medical Center. Phil J Microbiol Infect Dis 2004; 33: 143-148
  PubMedGoogle Scholar
• 12 Ejrnaes K, Sandvang D, Lundergren B. et al. Pulsed-field gel electrophoresis typing of escherichia coli strains from samples collected before and after pivmecillinam or placebo treatment of uncomplicated community-acquired urinary tract infection in women. J Clin Microbiol 2006; 44: 1776-1781
  CrossrefPubMedGoogle Scholar
• 13 Gebre-Selassie S. Asymptomatic bacteriuria in pregnancy: epidemiological, clinical and microbiological approach. Ethiop Med J 1998; 36: 185-192
  PubMedGoogle Scholar
• 14 Lipsky BA. Urinary tract infections in men. Epidemiology, pathophysiology, diagnosis, and treatment. Ann Intern Med 1989; 110: 138-150
  CrossrefPubMedGoogle Scholar
• 15 Akram M, Shahid M, Khan AU. Etiology and antibiotic resistance patterns of community-acquired urinary tract infections in JNMC Hospital Aligarh, India. Annals Clinical Microbiol and Antimicrob 2007; 6: 1-7
  PubMedGoogle Scholar
• 16 Das RN, Chandershekhar TS, Joshi HS. et al. Frequency and susceptibility profile of pathogens causing urinary tract infection at a tertiary care hospital in western Nepal. Singapore Med J 2006; 47: 281-285
  PubMedGoogle Scholar
• 17 Mohanthy S, Kapil A, Das BK. et al. Antimicrobial resistance profile of nosocomial uropathogens in tertiary care hospital. Ind J Med Sci 2003; 57: 148-153
  PubMedGoogle Scholar
• 18 Mathai E, Thomas RJ, Chandy S. et al. Antimicrobials for the treatment of urinary tract infection in pregnancy: practices in southern India. Pharmacoepidemiol Drug Safety 2004; 13: 645-652
  CrossrefPubMedGoogle Scholar
• 19 Goswami R, Bal CS, Tejaswi S. et al. Prevalence of urinary tract infection and renal scars in patients with diabetes mellitus. Diabetes Res Clin Pract 2001; 53: 181-186
  CrossrefPubMedGoogle Scholar
• 20 Sood S, Gupta R. Antibiotic resistance pattern of community acquired uropathogens at a tertiary care hospital in Jaipur, Rajasthan. Ind J Community Med 2012; 37: 39-44
  PubMedGoogle Scholar
• 21 Biswas D, Gupta P, Prasad R. et al. Choice of antibiotic for empirical therapy of acute cystitis in setting of high antimicrobial resistance. Ind J Med Sci 2006; 60: 53-58
  PubMedGoogle Scholar
• 22 Kothari A, Sagar V. Antibiotic resistances in pathogens causing community- acquired urinary tract infection in India: A multi center study. J Infect Developing Countries 2008; 2: 354-358
  PubMedGoogle Scholar
• 23 Bhargavi PS, Gopala Rao TV, Mukkanti K. et al. Increasing emergence of antibacterial resistance mainly in uropathogens: southeast part of India. Int J Microbiol Res ISSN: 0975-5276 2010; 2: 1-06
  PubMedGoogle Scholar
• 24 Pais P, Khurana R, George J. Urinary tract infections: A retrospective survey of causative organisms and antibiotics prescribed in a tertiary care setting. Ind J Pharma 2002; 34: 278-280
  PubMedGoogle Scholar
• 25 Tankhiwale SS, Jalgaonkar SV, Ahamad S. et al. Evaluation of extended spectrum beta lactamase in urinary isolates. Ind J Med Res 2004; 120: 553-556
  PubMedGoogle Scholar
• 26 Kamberi M, Tsutsumi K, Kotegawa T. et al. Influences of urinary pH on ciprofloxacin pharmacokinetics in humans and antimicrobial activity in vitro versus those of sparfloxacin. Antimicrob Agents Chemother. 1999; 43: 525-529
  CrossrefPubMedGoogle Scholar
• 27 King DE, Malone R, Lilley SH. New classification and update on the quinolone antibiotics. Am Fam Physician 2000; 61: 2741-2748
  PubMedGoogle Scholar
• 28 Naber KG. Experience with the new guidelines on evaluation of new anti-infective drugs for the treatment of urinary tract infections. Int J Antimicrob Agents 1999; 11: 189-196 discussion 213–216
  CrossrefPubMedGoogle Scholar