Prevalence of uropathogens in reproductive age group females and their antibiotic resistance pattern

Introduction: Urinary Tract Infection (UTI) remains the most common bacterial infection in human population. The prevalence of UTI is much higher in females as compared to males. The present study was planned with the aim to find out prevalence of uropathogens and their antibiotic resistance pattern in reproductive age group females. Materials and Methods: The present study was carried out in department of microbiology, Santosh Medical College and Hospital, Ghaziabad from Jan. 2018 to May 2018. Total 100 urine sample were processed for culture and sensitivity testing. Isolation of organism were done by inoculation of samples on Mac-Conkey Agar and Blood Agra media. After 24 hour of incubation at 37 C, each isolates were identified on the basis of morphology of colony in culture media, Gram stain, motility and biochemical reactions. Antibiotic sensitivity testing were carried out on Mueller Hinton Agar by Kirby Bauer method. Results: The prevalence of uropathogen was found 36%. The Gram-negative bacteria were most common isolates in comparison to Grampositive bacteria. E. coli was the most common isolates followed by S. saprophyticus. Gram-negative organism were found more sensitive to Amikacin, Piperacillin Tazobactum, Ampicillin sulbactum, Cefoperazone sulbactum and Nitrofurantoin. Gram-positive bacteria were found more sensitive to Piperacillin Tazobactum, Tetracycline, Ampicillin sulbactum and Linezolid. E. coli were found more sensitive to Amikacin, Ampicillin sulbactum, Piperacillin Tazobactum and Cefoperazone sulbactum. Conclusion: Changing antimicrobial resistance pose challenge in treating urinary tract infections. Appropriate and judicious selection of antibiotic would limit the emerging drug resistant isolate in the future to treat this clinical condition successfully.


Introduction
Urinary Tract Infections (UTI) frequently occur in both community and hospital environment are of the most common bacterial infections in humans. The outcomes of urinary tract infections are increase hospitalization, increase patient treatment cost and mortality. 1 Bacteria can invade and cause UTI via two major routes ascending and heamatogenous pathway. Ascending route is most common route of infection in females. Urinary tract infections are characterized as either upper or lower UTI primarily on the basis of anatomical location of infection. The lower UTI affecting the bladder and urethra and the upper UTI affecting the ureter and kidneys mainly.
Women are at three times greater risk for UTI then man because of short, straight anatomy of the urethra, and termination of female urethra beneath the labia resulting in colonization by colonic gram negative bacilli. 2 Most of the UTI are caused by gram-negative bacteria like E. coli, Proteus species, Klebsiella species, Pseudomonas aeruginosa, Acinetobacter, Serratia and Morganella morganii. UTI also caused by gram positive bacteria like Enterococcus, Staphylococcus specially coagulase negative Staphylococci and Streptococcus agalactiae. 3 E. coli are one of the most prevalent pathogens among gram-negative bacteria capable of causing complicated and uncomplicated UTI. 4 UTI during pregnancy leads to low birth weight babies, increase perinatal mortality and premature births along with acute and chronic sequelae in mothers. 5 Diagnosis and definitive treatment of UTI mainly based on bacteriological culture and antibiotic sensitivity. In past decade, indiscriminate use of antibiotics resulted in word wide rise of multidrug resistance cases. 6 Hence, present study planned to find out the prevalence of urinary pathogens and their antibiotic resistance pattern in reproductive age group females to provide better cost effective treatment to female patients.

Materials and Methods
A cross sectional study was carried out in the department of microbiology, Santosh Medical College and Hospital, Ghaziabad from January 2018 to May 2018. A total of 100 urine samples were collected from female patients clinically suspected of urinary tract infection. The women in reproductive age group 18 to 45 years with history of urinary tract infection were included in the study and only one sample was collected from each patient. The exclusion criteria were leaky or dirty container, delay in transportation of sample more than 2 hours, previous history of antibiotics, surgery or operative procedure. Midstream clean catch urine samples were collected and transported to microbiology laboratory for processing. Urine culture and antibiotic susceptibility testing was performed in laboratory. The urine culture was done using a sterile calibrated loop of 4 mm diameter delivering 10 microliter volume of urine. A loopful of well mixed uncentrifuged urine was inoculated on the Mac-Conkey Agar and Blood Agar media plates. All plates were incubated at 37 0 C aerobically for 24 hours. 7 The bacterial growth was identify by Gram stain, motility and a set of biochemical test including catalase, coagulase, oxidase, indole, methyl red, Voges Proskauer, citrate, urease and triple sugar iron media.

Results and Discussions
In present study, the prevalence of uropathogens in reproductive age group female was found to be 36% (Table  1). B. Shanthi et al. (2018) 9 found the higher prevalence rate due to their large sample size. The maximum number of cases were found in the age group 18 -30 years and minimum number of cases were found in the age group 31 -45 years ( Table 2). The reason being women in this age group are more sexually active and more prone to develop UTI probably due to characteristic anatomy of the urethra and the effect of normal physiological changes that affects the urinary tractshort urethra, its close proximity to the anus, urethral trauma during intercourse, dilatation of urethra and stasis of urine during pregnancy. 10,11 Out of 100 cases, 11 females were found pregnant and 89 were found non-pregnant. All 11 pregnant women were found culture positive due to a number of factors including urethral dilation, increase bladder volume and decrease bladder tone, along with decrease urethral tone, which contributes to increase urinary stasis and vesicoureteral reflex and up to 70% of pregnant women develop glycosuria, which favors bacterial growth in the urine. 12 Gram-negative bacteria dominated over gram-positive bacteria as the etiological agent for UTI as shown in Table 3 15 The gram-negative bacteria were found more sensitive to antibiotics Amikacin, Piperacillin Tazobactum, Ampicillin sulbactum, Cefoperazone sulbactum and Nitrofurantoin (Table 4) 16 The gram-positive bacteria were found more sensitive to antibiotics Piperacillin Tazobactum, Tetracycline, Ampicillin sulbactum and Linezolid ( Table 5). The most effective antibiotic for the E. coli was found to be Amikacin and Ampicillin sulbactum, Iram Shaifali et al. (2012) 17 observe Nitrofurantoin followed by Amoxicillin, Nalidixic Acid and Co-Trimoxazole were sensitive. The most effective antibiotic for the S. saprophyticus was Tetracycline and Levofloxacin. Adedeji BA et al. (2009) 18 found Gentamycin and Ofloxacin were the most active antibiotics and isolates showed high resistance to Co-Trimoxazole and Amoxicillin, The reason behind different antibiotic susceptibility pattern of isolates from other studies because sensitivity varies widely by region, OPD and IPD patients included in the study.     Levofloxacin 9 (69.23) 0 (0) 0 (0) 9 Piperacillin Tazobactum 1 (7.69) 0 (0) 0 (0) 10 Ciprofloxacin 9 (69.23) 1 (7.69) 1 (7.69)

Conclusion
The present study raised awareness regarding high vulnerability of women in reproductive age group for urinary tract infections. The pregnant women were found more prone to develop UTI in comparison to the non-pregnant women.
The study provide information regarding uropathogens and their antibiotic susceptibility pattern. Gram-negative bacteria were found more common isolates in comparison to gram positive bacteria causing UTI. Analyzing antibiotic susceptibility pattern of uropathogens will help to overcome the therapeutic dilemmas and to guide in selection of appropriate antibiotics for empirical treatment to the patients Funding: Nil.
Conflict of Interest: None declared.