PRESENTED BY RAJANI D. P

MICROCARE LABORATORY, SURAT.

GUIDED BY: DESAI P. BDIRECTOR & HEAD

DEPARTMENT OF MICROBIOLOGY,SHREE RAMKRISHNA INSTI. OF COMP. EDU. & APPL. SCIENCES, SURAT.

“ANTIMICROBIAL RESISTANCE PATTERNS OF THE ORGANISMS ISOLATED FROM URINE CULTURE IN

SURAT REGION”

INTRODUCTION

Urinary tract infection (UTI) is common both in the community and hospitalized patients.

The widespread use of antimicrobial agents often leads to the emergence of resistant microorganisms to one or several of them. [1]

Urinary tract infection (UTI) is a broad term that encompasses both asymptomatic microbial colonization of the urine and symptomatic infection with microbial invasion and inflammation of urinary tract structures .

ETIOLOGY

Majority of UTI are due to a single pathogen.

The Enterobacteriaceae responsible for 90% of all UTI- gram negative bacilli- facultative anaerobic- common intestinal flora

Escherichia coli most commonly isolated pathogen 80% of all UTI (1)

Apart from the outer one-third of the female urethra, the urinary tract is normally sterile (2).

From a microbiologic perspective, urinary tract infection exists when pathogenic microorganisms are detected in the urine, urethra, bladder, kidney, or prostate.

In most instances, growth of more than 105 organisms per milliliter from a properly collected midstream "clean-catch" urine sample indicates infection.

However, significant bacteriuria is lacking in some cases of true UTI

Especially in symptomatic patients, a smaller number of bacteria (102 to 104/ml) may signify infection.

colony counts of >105/ml of midstream urine are occasionally due to specimen contamination, which is especially likely when multiple species are found (3).

Every female has a 20% life time risk of coming down with a UTI (5)

In children approximately 5% of girls and 1% of boys have a UTI by 11 years of age (6).

Antibiotics which have been recommended to treat UTIs include Ampicillin, Trimethoprim-Sulfamethoxazole, Flouroquinolones and Nitrofurantoin (7)

However due to incessant abuse and misuse of these antibiotics, extensive resistance of micro-organisms to these antibiotics has developed.

AIM OF STUDY

Identification and characterization of pathogen from UTI cases.

To find out Resistant Pattern from isolated pathogen.

Find out prevalence of UTI in South Gujarat region.

MATERIALS AND METHOD

The present study was conducted during June., 2009 to Nov., 2009.

Only patients who have clinical symptoms of UTI were studied

Total 538 mid-stream urine specimens were obtained by clean – catch method (Kunin, 1987).

The samples were collected in sterile universal containers and cultured within 30 minutes of collection by standard method.

Samples that showed pure growth of isolate in a count of ≥105 colony-forming units (CFU) per ml of urine after overnight incubation were considered to indicate significant bacteriuria (Sleigh and Timbury, 1986; Gerald et al, 1990).

Identification of organism was done by standard methods and further tested for drug susceptibility testing by disc diffusion method as per CLSI guideline.(Clinical and Laboratory Standards Institute ). (8)

RESULT

Table-1: SEX WISE DISTRIBUTION :

SEX NO.OF PATIENTS

MALE 235

FEMALE 303TOTAL 538

Table 1 shows that among 538 patients, majority were female patients.

CHART-1

Table-2: SEX AND CULTURE POSITIVE:

SEX NO .OF POSITIVE CULTURE

TOTAL NO. PATIENTS

MALE 121 235

FEMALE 181 303TOTAL 302 538

Table 2 shows that total 302 positive culture, significantly high in female patients.

CHART-2

TABLE-3: ISOLATED SPECIES WISE DISTRIBUTION:

Isolated pathogen No. of strain

E.coli 213

Klebsiella spp 42

Pseudomonas aeruginosa 15

Group D Enterococci 9

coagulase negative Staphylococci 8

Proteus spp 2

Candida albicans 16

Table 3 shows that predominant organism was E.coli which was responsible for 70.52% of the infection.

CHART-3

TABLE-4 PERCENT RESISTANCE AGAINST EACH ANTIBIOTICIsolated pathogen E.coli Klebsiella

sppPseudomonas aeruginosa

Group D Enterococci

coagulase negative Staphylococci

Proteus spp

No of Antibiotics @

Ampicillin10 95 97 99 10 6 92Amikacin 30 1 0 2 3 2 0Netromycin30 1 0 1 4 3 0Nitrofuradantine 300 43 53 78 82 28 78Cephaparazonesulbactum 105

0 0 1 4 1 0

Piperacilin tazobactum 110

0 0 0 3 1 0

Table 4 shows that cephaparazone-sulbactum, piperacillin-tazobactum, amikacin and netromycin were highly sensitive to gram negative pathogen.

CHART-4

DISCUSION

Our results demonstrate that drug resistance of Gram negative pathogen to many antibiotics was high with the maximum prevalence of resistance being to drugs that have been used for a long time, such as ampicillin.

Our results are similar to one other study that has been conducted in Iran.

They have reported Gram negative pathogen resistance to ampicillin of 96.8%. (11)

In this research, combination of two drug ccephaparazone-sulbactum, and piperacillin-tazobactum were lowest resistant to all isolated pathogen compare to other antibiotics.Our result are similar to other study that has been conducted in Turkey. (12)

In present study also highly sensitive to amikacin and netromycin that is app. (98-99%). Our result is some higher to other study that has been conducted in Iran (13

CONCLUSION

The prevalence of UTI was significantly higher in women (56.32%) than man (43.68%) with E.coli (70.52%) being the major isolated pathogen.

Gram negative pathogens were highly sensitive to amikacin, netromycin, piperacillin/tazobactum and cefoperazone /sulbactum.

1. Calvin M. Cunin. Urinary Tract Infections and Pyelonephritis. In: Goldman E. editor. Cecil Textbook of Medicine 21st edition. W. B. Saunders Company; 2000. p. 138

REFERENCES

2. Bailey RR. Urinary Tract Infection. In: Oxford Textbook of Medicine on CD-ROM. Oxford University Press and Electronic Publishing B. V; 1996 Section 20.8.1

3. Stamm EW. Urinary Tract Infections and Pyelonephritis. In: Harrison's Principles of Internal Medicine 15th Edition on CD-ROM. McGraw and Hill Companies Inc; 2001

4. Levi ME, Redington J Barth L. The Patient With Urinary Tract Infection. In: Schrier RW editor. Manual of Nephrology, 6th Edition. Lippincott Williams & Wilkins, 2005

8. Muller HJ, Hinton J : Proc Soc Expt Biol Med, 48:330-333,

9. Association of Clinical Pathologists Broadsheet. Antibiotic Sensitivity Tests by Diffusion Methods. 1999; 55

10. Cowan S. T., Steel K. J. Manual for the Identification of Medical Bacteria. Cambridge University Press. 2001

6. Jenson BH, Baltimore RS. Infectious Diseases.In: Kleigman RM, Marcdante KJ, Jenson BH, Berhman RE editors. Nelson Essentials of Paediatrics 5th edition. Philadelphia: Elsevier Inc; 2006. p. 522.

7. Peter I. A. Hendry‌1, Brian S. Gibson‌1 and Sandra Nicholson‌ Antibiotic Sensitivity of Bacteria from Urine Pathology 1975, Vol. 7, No. 4, Pages 293-297

5. David Howes. Urinary Tract Infection, Male. eMedicine April 25 2005

11. Falahatkar S Sobhani M, Ghilpour H. Urinary tract infection in spinal cord transected war. Arch Iran Med 2000; 13(3):133-5.

12. Ferhat Catal1, Nuket Bavbek2, 3 , Omer Bayrak4, Musemma Karabel1 Antimicrobial resistance patterns of urinary tract pathogens and rationale for empirical therapy in Turkish children for the years 2000–2006 .