Vol. 7, Issue 12 (2018)

Background and Objective: Among the many bacterial infections that can be found in public environments, urinary tract infections (UTIs) rank high. Uropathogens are becoming increasingly resistant to antibiotics, which is a major obstacle to empirical treatment. To better understand how to treat patients with community-acquired UTIs empirically and to aid in antimicrobial stewardship initiatives in the area, this study set out to identify patterns of antibiotic resistance in urine culture isolates.

Material and Methods: This cross-sectional investigation was performed over a one-year duration in a tertiary care institution. This research was performed in the Department of General Medicine, Velammal Medical Hospital and Research Institute, Anuppanadi, Madurai, Tamil Nadu, India, from October 2017 to September 2018. Sixty patients with clinically suspected community-acquired urinary tract infections were enrolled. Midstream urine specimens were obtained and analyzed using standard microscopy and cultured on CLED and MacConkey agar. Isolates exhibiting substantial bacteriuria (≥10⁵ CFU/mL) were detected by conventional biochemical assays. Antibiotic susceptibility testing was conducted with the Kirby-Bauer disc diffusion method in compliance with CLSI recommendations.

Results: Significant increase was seen in 48 out of 60 urine samples (80%). Among the isolates, Escherichia coli accounted for 62.5%, Klebsiella pneumoniae for 16.7%, Proteus mirabilis for 8.3%, and Enterococcus spp. for 6.3%. As many as 75 percent of the samples tested resistant to ampicillin, 60 percent to ciprofloxacin, and 58 percent to cotrimoxazole. When tested against E. coli, nitrofurantoin had a sensitivity rate of 83.3% and fosfomycin of 81.2%. Of the isolates tested, 43.7% showed signs of multidrug resistance.

Conclusion: The study emphasizes that uropathogens in community-acquired UTIs, particularly E. coli, have a high rate of antibiotic resistance. The alarmingly high rate of resistance to routinely used antibiotics calls into question the validity of current recommendations for empirical treatment. When looking for a first-line treatment, nitrofurantoin and fosfomycin are still good choices. In order to maximize antibiotic use and minimize the spread of resistance, it is necessary to regularly monitor resistance patterns.