Bacteriological profile and antibiotic sensitivity pattern in patients with urinary tract infection

Correspondence: Dr. Neeraj Subedi, MBBS, MS Assistant Professor, Department of Urology (Surgery), Nepal Medical College Teaching Hospital, Jorpati, Kathmandu, Nepal E-mail: nsubedi76@gmail.com Background: Urinary tract infection is one of the common bacterial infections seeking treatment in clinical practice. A variety of organisms are associated with UTI and the most common organisms are Escherichia coli and other coliforms. Bacteriological investigations of UTI are not complete without antibiotic sensitivity test of the isolate. The aim of this study is to determine the bacteriological profile and antibiotic sensitivity patterns and their disease association.


INTRODUCTION
2][3] It is more common in females as compared to males, especially females of reproductive age group. 4It can be either community acquired or hospital acquired.The common aetiological agents are Escherichia coli (E.Coli), Pseudomonas, Proteus and Klebsiella. 2,4,5bedi N 1 , Pudasaini S 2 Bacteriological investigations of UTI are not complete without an antibiotic sensitivity test of the isolate.Micro organism causing UTI vary in their susceptibility to antimicrobials from place to place and time to time. 6I can involve infection from urethra to the kidneys.Symptoms in case of cystitis include painful and frequent urination where as condition like high fever and flank pain are seen in pyelonephritis. 7Due to the empirical use of antibiotics in infectious diseases and the lack of standardisation in antimicrobial susceptibility test, resistance of the world irrespective of the age and sex.We discuss the relationship between age, sex, pathogens isolated, antibiotic sensitivity pattern and associated diseases in UTI.The culture positive cases were 165 (17.4%) out of 947 cases which were enrolled in our study.Edirisinghe et al 2 and Banerjee et al6 in their studies showed culture positive in 31% and 24.5% cases respectively.In another study, culture positive as low as 8.7% has been reported by Mansour et al. 9 Out of the culture positive samples, female patients were more (84.8%)than male patients (15.2%).Several other studies show similar findings. 6,9,10The high incidence in female is due to colonization with enteric bacteria due to short urethra. 10Most number of positive urine cultures (33.3%) was seen in age group 21-30 years and most of the to commonly used antimicrobial agent is increasing year by year.Knowing the common isolated uropathogens and their antimicrobial susceptibility is beneficial in planning treatment protocols. 8is study was conducted to determine the bacteriological profile and antibiotic sensitivity patterns in UTI and the disease associated with it.

MATERIALS AND METHODS
This was a cross-sectional observational study conducted in Shankarapur Hospital over a period of one year (January 2015 to December 2015).Prior to the study, permission was obtained from the hospital board.Patients presenting with symptoms of UTI such as fever, dysuria, increased frequency of urination, loin pain were subjected to urine culture.Parameters like age, sex and associated disease of the patients were taken into account.Pathogens isolated and the antibiotic sensitivity was also taken into account.Required clinical history and examination findings were noted.Patients were asked to follow up with urine culture sensitivity report.Antibiotics were started according to the sensitivity report and asked to follow up after one week.All the data were manually collected and analyzed using Excel wherever necessary.

RESULTS
A total of 947 patients clinically suspected of having UTI were included in this study and sent for culture sensitivity test.Out of the total samples sent for culture sensitivity test, the culture positive cases were 165 (17.4%).Out of the positive samples, female patients were 140 (84.8%) and male patents were 25 (15.2%)Age wise distribution for urine culture is shown in table 1.Most common age group was 21-30 years (37.2%)followed by age group 31-40 years (23.7%).
Table 2 shows age wise distribution for culture positive cases.Most number of positive urine cultures was seen in age group 21-30 years (33.3%) and most of the patients were female.
The most common organism isolated was E Coli and second most common was K Pneumoniae.(Table 3) Piperacillintazobactum and Ceftriaxone showed the highest number of sensitivity for the isolated organism.(Table 4) Maximum number of patients came with symptoms of simple uncomplicated UTI.Other common causes were pregnancy, PID and BPH which is shown in Table 5.The most common organism isolated in our study was E coli (86.1%) followed by K Pneumoniae (6.7%) which is in accordance to a study done by Humayun et al 4 and Mansour et al 9 where E coli (70% and 59% ) followed by K Pneumoniae (14% and 11.6%) was isolated.6][7][8][9] Pathogens like E coli are associated with population acquired acute uncomplicated infection where as Klebsiella and Enterococcus are known to confer uncomplicated cystitis and pyelonephritis. 7ong the antibiotics, Piperacilin-tazobactum (73.3%) and Ceftriaxone (73.3%) showed the highest number of sensitivity.Study done by Niranjan et al 12 also showed that Piperalcillin -tazobactum (78.2%) formed the major antibiotic sensitive to organism isolated.Contrast to our study, Ceftriaxone was resistant (71.4%) in a study done in India. 12In another study done by Nalini et al Ceftriaxone sensitivity was as low as 17.5 % as compared to our study (73.3%) 13 Amoxycillin sensitivity was 60.6 % in our study where as other studies showed resistance to amoxycillin as high as 77.4% and 84%. 5,14Sensitivity to Amikacin was 56.4% in our study which is low compared to study done by Niranjan et al where sensitivity was as high as 82.6%. 12tients with clinical diagnosis of cystitis, pyelonephritis (uncomplicated UTI) formed the major bulk in our study.Similar finding was observed in studies done by Bates et al 15 .

UTI is a common problem faced by clinicians in every part
Female with PID and pregnancy formed the second cause of UTI as seen in one study done in Nigeria. 10 Association of UTI and nephrolithiasis is not very common as seen in our study (6.9%) and in study done by Holmgrem et al (7%). 16

CONCLUSION
Though UTI is a common problem in our part of the world, its recognition, proper diagnosis with urine culture and starting appropriate antibiotics according to the culture report plays a major role in preventing an uncomplicated UTI going into a complicated one.E coli is the most common organism isolated in urine culture in most of the hospitals.However the antibiotic sensitivity pattern differs depending on the choice of antibiotic disc.Antibiotic sensitivity pattern in a particular area will give an idea to clinicians regarding empirical treatment of UTI before the availability of laboratory reports.

Table 3 : Pathogenic microorganisms isolated in culture Organism Number of cases Percentage (%)
11I : 10.3126/jpn.v7i1.16910patientswerefemales.This showed that UTI is common in reproductive age group which is comparable to studies done by Banerjee et al6, Obiogbolu et al 10 , Shahina et al11.