Prevalence of Urinary Tract Infection and Antibiotic Susceptibility Pattern to Urinary Pathogens in Kathmandu Medical College and Teaching Hospital , Duwakot

A total number of 1735 clinically suspected as UTI cases were sent for urine culture sensi vity. Total culture posi ve were 239 (13.8%). The majority of isolates were from female pa ents comprising 180 (75%). The most common pathogenic microorganism isolated was E.coli (79.1%). Second most common organism was Klebsiella (11.7%) followed by Citrobacter (3.34%) and Proteus (2.92%). The isolated microorganism showed maximum number of sensi vity with the an bio cs Ofloxacin and Ciprofloxacin. The isolated microorganism demonstrated resistance with Nalidixic Acid and Co-Trimoxazole.


Objec ve
To find out the prevalence of urinary tract infec on and sensi vity pa ern of an bio cs among bacterial pathogens isolated in pa ents a ending Kathmandu Medical College Teaching Hospital, Duwakot.

Methodology
All the pa ents with the clinical suspicion of UTI were sent for urine culture.Prevalence of UTI and urinary pathogens isolated with an microbial profile was correlated.

Result
A total number of 1735 clinically suspected as UTI cases were sent for urine culture sensi vity.Total culture posi ve were 239 (13.8%).The majority of isolates were from female pa ents comprising 180 (75%).The most common pathogenic microorganism isolated was E.coli (79.1%).Second most common organism was Klebsiella (11.7%) followed by Citrobacter (3.34%) and Proteus (2.92%).The isolated microorganism showed maximum number of sensi vity with the an bio cs Ofloxacin and Ciprofloxacin.The isolated microorganism demonstrated resistance with Nalidixic Acid and Co-Trimoxazole.

Conclusion
Urinary tract infec on is a commonly encountered case in general prac ce.Females are commonly affected than men.The microbiological profile and the an bio c sensi vity pa ern while ini a ng empirical treatment must be taken into account while planning for the management.Regular supervision of the sensi vity pa ern of pathogenic microorganism is mandatory for effec ve treatment.

INTRODUCTION
In developing countries urinary tract infec ons (UTIs) are one of the most commonly diagnosed disease among the pa ent seeking medical service with frequency of 180 per    In this study total number of 1735 pa ents clinically suspected to have UTI were included and sent for urine culture sensi vity test.Among which total of 1315 were female pa ents and 420 were male pa ents as shown in table 1.

Table 1: Prevalence of uropathogen growth in urine culture
Out of the total 1735 sample sent for culture sensi vity test, the culture posi ve were detected in 239 samples (13.8%).
Out of the culture posi ve samples, female pa ents comprise 180 (75.0 %) isolates where as male pa ents comprise 59 (25.0 %) isolates as shown in figure 1.
The most common pathogenic microorganism found in the culture was E. coli.Second most common organism was Klebsiella followed by Citobacter and Proteus.(Table 2) In figure 2 the isolated microorganism showed maximum number of sensi vity with the an bio cs Ofloxacin and Ciprofloxacin.
The most common pathogenic microorganism isolated in our study demonstrated resistance with Nalidixic Acid and Co-Trimoxazole.(Figure 3)

DISCUSSION
Urinary tract infec ons (UTIs) are one of the most commonly diagnosed disease among the pa ent seeking medical service in a developing country like Nepal.Females are more affected compared to men.
In our study the prevalence rate of isola on of urinary pathogen were 239 (13.8%) out of 1735 pa ents which were 6 5 enrolled in our study.Subedi N et al and Raza S et al studies showed culture posi ve in17.4% and 19.7% cases respec vely.
Prevalence rate in female pa ents were seen to be high in comparison to male pa ents.Female pa ents comprise 75.0 % of posi ve culture isolates in our study.Similar result were 7 found in studies done by Khan G et al showed 77.0 % females compared to 22.8% male pa ents with urine culture 8 posi ve.Study done by Shah LJ et al reported 49% female and 11% male posi ve samples.
The prevalence in female is higher due to the anatomical structure and lack of secre on produced from prostate 7 which has bactericidal property.
In the most studies done ll today, the commonest organism 9 responsible for UTI was found to be E. coli.The most common pathogenic microorganism isolated in our study was E. coli.Out of 239 posi ve samples, E.coli was isolated in 189 (79.1%) cases.The second most common pathogenic microorganism was Klebsiella comprising 11.7%, followed by Citobacter 8.0 % and Proteus 7.0 %.This finding is similar to other studies where E. coli are the most frequently isolated The improper use and easy access of an bio cs as well as poor monitoring of an bio c sensi vity pa ern during the management of UTI in clinical prac ce, results in high 9,13 percentage of resistance to commonly prescribed drugs.
In our study the most resistance drug to E. coli was found to be Nalidixic Acid followed by Co-Trimoxazole.Somashekara

CONCLUSION
Urinary tract infec on is a commonly encountered case in general prac ce.Females are commonly affected than men with E. coli being the most common uropathogen.
. Females are more affected compared to men.UTIs can be categorized as acquired or nosocomial.E.coli is the most common organism responsible for UTI in both community acquired and nosocomial.Klebsiella and Proteus are other responsible pathogens responsible in community acquired infec on and in nosocomial are Pseudomonas, 3 Proteus, and Enterobacter.Increasing resistance has become the main concern due to misuse of an bio cs.General Prac oners should take into account about the microbiological profile and the an bio c 4 sensi vity pa ern during management.So, it is necessary to look for the most sensi ve an bio cs for proper treatment 5 for the UTIs in general prac ce.This study was carried out to find out the prevalence of urinary tract infec on and suscep bility pa ern of an bio cs among bacterial pathogens isolated in pa ents a ending Kathmandu Medical College Teaching Hospital, Duwakot.METHODOLOGY This is a cross-sec onal study carried out in Kathmandu Medical College Teaching Hospital, Duwakot Hospital for a period of 2 years from January 2015 to December 2016.All the pa ents suspicious to have urinary tract infec on with the history of burning micturi on, increased frequency, lower abdominal pain and fever were subjected to urine culture.Bacterial pathogen isolated with an bio c sensi vity pa ern were taken into account and the findings were correlated.Permission was obtained from the ins tu onal review commi ee.

Figure 1 :
Figure 1: Gender distribu on of posi ve urine culture isolates

Figure 2 :Figure 3 :
Figure 2: An bio c sensi ve pa ern of isolated pathogenic microorganism

14 SC
et al also reported the resistance of E Coli to Co-15 trimoxazole in 68.8%.Another study done by Haque R et al showed high frequency of resistance to Co-Trimoxazole and 16 Ciprofloxacin.In contrast to our study, Humayun T et al study showed an bio c sensi vity pa ern of Co-trimoxazole was 81%.The resistance profile in the study done by Behera 12 PK et al were Ciprofloxacin 88.0 % and Ce riaxone 80.0 %.The results draw a en on to frightening development of resistance to commonly used drugs.