Uropathogens Antimicrobial Sensitivity and Resistance Pattern From Outpatients in Balochistan, Pakistan

Objective To determine the pattern of microbes responsible for urinary tract infections and their susceptibility to different antibiotics. Method This is a cross-sectional study conducted at Quetta, Pakistan. The urine samples of 400 patients were collected and sent for culture and sensitivity analysis. The results were recorded on an excel datasheet. Descriptive statistics were used to describe the data. Results Out of 400 urine samples, 266 samples were culture positive for microorganisms. The most common organism on analysis was Escherichia coli 123/266 (46.24%) followed by Staphylococcus saprophyticus 59/266 (22.18%) and Klebsiella pneumonia 49/266 (18.42%). Gram-negative microorganisms were most susceptible to fosfomycin, cefoperazone/sulbactam, and meropenem. Gram-positive microorganisms were most susceptible to fosfomycin, cefoperazone/sulbactam, meropenem, and amoxicillin/clavulanate. High rates of resistance in E. coli were observed to most commonly prescribed broad-spectrum antibiotics; ceftriaxone (64.35%), cefotaxime (76.54%), ceftazidime (49.43%), cefepime (53.44%), levofloxacin (71.26%), and amoxicillin/clavulanate (70.31%). E. coli was the major multidrug-resistant organism. Conclusion High rates of antibiotic resistance and multi-drug resistance were revealed in this study due to the widespread and injudicious use of broad-spectrum antibiotics. Thus, it is highly recommended to regulate the pharmacies. Physicians should judiciously prescribe antibiotics and practice the culture and sensitivity of urine samples rather than blind prescription. Continued surveillance on uropathogens prevalence and resistance, new and next-generation antibiotics, and rapid diagnostic tests to differentiate viral from bacterial infections is the need of time.

[1]  R. Zachoval,et al.  Current Antibiotic Resistance Trends of Uropathogens in Central Europe: Survey from a Tertiary Hospital Urology Department 2011–2019 , 2020, Antibiotics.

[2]  Daneyal Arshad,et al.  Exploring Antimicrobial Resistance in Agents Causing Urinary Tract Infections at a Tertiary Care Hospital in a Developing Country , 2020, Cureus.

[3]  N. Javed,et al.  Microbial Resistance in Urinary Tract Infections , 2020, Cureus.

[4]  M. Muzammil,et al.  Study of Culture and Sensitivity Patterns of Urinary Tract Infections in Patients Presenting with Urinary Symptoms in a Tertiary Care Hospital , 2020, Cureus.

[5]  A. Pantosti,et al.  Bloodstream infections due to carbapenemase-producing Enterobacteriaceae in Italy: results from nationwide surveillance, 2014 to 2017 , 2019, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[6]  S. Ryu,et al.  Changing trends in clinical characteristics and antibiotic susceptibility of Klebsiella pneumoniae bacteremia , 2017, The Korean journal of internal medicine.

[7]  L. Richardson Understanding and overcoming antibiotic resistance , 2017, PLoS biology.

[8]  Byung-Chun Kim,et al.  Self-medication and antibiotic resistance: Crisis, current challenges, and prevention , 2017, Saudi journal of biological sciences.

[9]  A. Gardner,et al.  Five-Year Antimicrobial Resistance Patterns of Urinary Escherichia coli at an Australian Tertiary Hospital: Time Series Analyses of Prevalence Data , 2016, PloS one.

[10]  K. Kazmierczak,et al.  Susceptibility patterns and ESBL rates of Escherichia coli from urinary tract infections in Canada and the United States, SMART 2010-2014. , 2016, Diagnostic microbiology and infectious disease.

[11]  F. Leroy,et al.  Temporal trends and risks factors for antimicrobial resistant Enterobacteriaceae urinary isolates from outpatients in Guadeloupe , 2016, BMC Microbiology.

[12]  D. Paterson,et al.  The emerging threat of multidrug-resistant Gram-negative bacteria in urology , 2015, Nature Reviews Urology.

[13]  D. Akena,et al.  Household antimicrobial self-medication: a systematic review and meta-analysis of the burden, risk factors and outcomes in developing countries , 2015, BMC Public Health.

[14]  Shamshad Ali,et al.  Antimicrobial susceptibility pattern of bacteria isolated from patients with urinary tract infection. , 2014, Journal of the College of Physicians and Surgeons--Pakistan : JCPSP.

[15]  C. Alberti,et al.  Impact of 2011 French guidelines on antibiotic prescription for acute otitis media in infants. , 2014, Medecine et maladies infectieuses.

[16]  I. Morrissey,et al.  A Review of Ten Years of the Study for Monitoring Antimicrobial Resistance Trends (SMART) from 2002 to 2011 , 2013, Pharmaceuticals.

[17]  R. Islam,et al.  Urinary Tract Infection in Children: A Review , 2013 .

[18]  S. Kelekçi,et al.  Community-acquired urinary tract infections in children: pathogens, antibiotic susceptibility and seasonal changes. , 2013, European review for medical and pharmacological sciences.

[19]  T. Gasser,et al.  Increasing prevalence of ciprofloxacin resistance in extended-spectrum-β-lactamase-producing Escherichia coli urinary isolates , 2013, World Journal of Urology.

[20]  I. Cullen,et al.  The changing pattern of antimicrobial resistance within 42 033 Escherichia coli isolates from nosocomial, community and urology patient‐specific urinary tract infections, Dublin, 1999–2009 , 2012, BJU international.

[21]  M. Pennesi,et al.  Managing children under 36 months of age with febrile urinary tract infection: a new approach , 2012, Pediatric Nephrology.

[22]  E. Sanders,et al.  Otitis media and its consequences: beyond the earache. , 2010, The Lancet. Infectious diseases.

[23]  Adeel Akram,et al.  Nosocomial uropathogens and their antibiotic sensitivity patterns in a tertiary referral teaching hospital in Rawalpindi, Pakistan. , 2010, Journal of Ayub Medical College, Abbottabad : JAMC.

[24]  J. Alós Epidemiología y etiología de la infección urinaria comunitaria. Sensibilidad antimicrobiana de los principales patógenos y significado clínico de la resistencia , 2005 .

[25]  Ramanan Laxminarayan,et al.  Antimicrobial resistance in developing countries. Part I: recent trends and current status. , 2005, The Lancet. Infectious diseases.

[26]  H. Qureshi,et al.  Changing pattern of antimicrobial susceptibility of organisms causing community acquired urinary tract infections. , 2000, JPMA. The Journal of the Pakistan Medical Association.

[27]  W. J. Martin Infections of the Urinary Tract , 1937, Clinical obstetrics and gynecology.

[28]  E. Sierra-Diaz,et al.  Antibiotic resistance: Microbiological profile of urinary tract infections in Mexico. , 2019, Cirugia y cirujanos.

[29]  M. Hackel,et al.  Antimicrobial susceptibility of Gram‐negative ESKAPE pathogens isolated from hospitalized patients with intra‐abdominal and urinary tract infections in Asia‐Pacific countries: SMART 2013‐2015 , 2017, Journal of medical microbiology.