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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 11
| Issue : 4 | Page : 356-361 |
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Uropathogens and their antibiotic susceptibility pattern in rural population: A cross-sectional observative study
Mahesh B Mekala, M S. S Pradeep, Vishnuvardhana R Kakumanu
Department of Microbiology, Dr. PSIMS&RF, Chinaoutapalli, Andhra Pradesh, India
| Date of Submission | 26-May-2022 |
| Date of Decision | 13-Jun-2022 |
| Date of Acceptance | 14-Jun-2022 |
| Date of Web Publication | 17-Mar-2023 |
Correspondence Address:
Dr. Mahesh B Mekala
Department of Microbiology, Dr. PSIMS&RF, Chinaoutapalli, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdrntruhs.jdrntruhs_104_22
Introduction: Urinary tract infections (UTIs) are one of the widespread human microbial disorders affecting all the age groups, which may involve the whole part of the urinary tract from the urethra to kidneys and are associated with a significant burden of mortality and morbidity. Although various microorganisms, including viruses, fungi, and parasites, are responsible for UTIs, bacteria are the leading cause. The prevalence of uropathogens in cases of UTI varies according to demographic features, community or hospital-based and also due to the use of different antibiotics in the community and hospital settings.
Aim of the Study: To determine the prevalence of uropathogens and their antibiotic susceptibility pattern in rural populations.
Study Design: This is a cross-sectional observational study conducted at the Department of Microbiology, Dr.PSIMS & RF, Chinaoutapalli, Andhra Pradesh.
Materials and Methods: A total of 1378 clean-catch midstream urine samples from clinically suspected cases of UTI which were received from outpatient and inpatient set-up of various clinical departments were processed according to standard protocol and guidelines and the isolated pathogens were subjected to antibiotic susceptibility testing by Kirby-Bauer disc diffusion method and interpreted according to CLSI guidelines.
Results: In the present study, the prevalence of UTI is 29.53%, where Escherichia coli is the predominant isolate (56.06), followed by Klebsiella spp (16.95%) and among Gram-positives, Enterococcus faecalis is the predominant isolate (10.81%) followed by Staphylococcus aureus (2.70%).
Conclusion: As the prevalence of bacterial uropathogens as well as their antibiotic sensitivity pattern varies in different geographical locations and time to time it is important that the diagnosis of UTI is not only dependent on the clinical signs and symptoms, it should be correlated with the positive urine culture and the antibiotic susceptibility pattern of the uropathogen isolated. Without having knowledge about the prevalence of uropathogens in that particular area and their susceptibility pattern, starting empirical antibiotic therapy will not only prolong the disease and lead to complications in the patients, and a negative consequence will also be added in the form of the development of multidrug resistance (MDR).
Keywords: Antibiogram, gram-negative bacilli, gram-positive cocci, uropathogens, UTI
How to cite this article:
Mekala MB, Pradeep M S, Kakumanu VR. Uropathogens and their antibiotic susceptibility pattern in rural population: A cross-sectional observative study. J NTR Univ Health Sci 2022;11:356-61 |
How to cite this URL:
Mekala MB, Pradeep M S, Kakumanu VR. Uropathogens and their antibiotic susceptibility pattern in rural population: A cross-sectional observative study. J NTR Univ Health Sci [serial online] 2022 [cited 2023 Apr 1];11:356-61. Available from: https://www.jdrntruhs.org/text.asp?2022/11/4/356/371743 |
| Introduction | |  |
Urinary tract infections (UTIs) are one of the widespread human microbial disorders affecting all age groups occurring from neonates to geriatric age group, race, ethnicity, and sex which may involve are part of the urinary tract from the urethra to kidneys and are associated with a significant burden of mortality and morbidity where nearly 150 million people are affected each year throughout the world and are responsible for more than 7 million medical visits and nearly about 100,000 hospitalizations annually.[1],[2],[3]
According to the European association of urology, UTIs are classified into complicated UTI, which is due to anatomical or functional abnormalities in the urinary tract, catheterization etc., and uncomplicated UTI, which occur in healthy individuals without any alterations in the urinary tract.[4]
Based on the setting of acquiring UTI, it is classified into the community-acquired, which occurs within the first 48 hours of hospitalization and hospital-acquired UTI which occurs 48 hours after hospitalization or 3 days after discharge from the hospital.[5]
Although various microorganisms, including viruses and fungi and parasites are responsible for UTIs, bacteria are the leading cause where 90% of these infections are caused by Gram-negative bacteria like Escherichia More Details coli, Klebsiella spp, Proteus spp, Pseudomonas aeruginosa, Acinetobacter spp etc., and 10% are caused by Gram-positive bacteria like Enterococcus spp, Staphylococcus aureus, and coagulase-negative Staphylococci.[6],[7]
Diagnosis of UTI depends not only on the clinical evaluation of the patient who may present with symptoms like burning micturition, dysuria, suprapubic pain or discomfort, pyuria etc., and also on laboratory examination of urine.[8]
The prevalence of uropathogens in cases of UTI varies according to demographic features, community or hospital-based and also due to the use of different antibiotics in the community or hospital settings.[9]
This study was carried out at our institution which to know the prevalence of uropathogens in cases of UTI and the antibiotic susceptibility pattern to provide a database for reference in the rural area (Gannavaram and Unguturu mandals) which have a population of around 1.5 lakh in order to control and manage the cases of UTI in our area where without knowledge of prevalent uropathogens and their antibiotic susceptibility pattern, giving empirical therapy by broad-spectrum antibiotics may head to the emergence of antimicrobial resistance (AMR) and such patients may develop a negative outcome after antibiotic therapy and may encounter serious clinical complications.
| Materials and Methods | | |
The present study was carried out in the Bacteriology Laboratory in the Department of Microbiology at Dr.PSIMS & RF, Chinaoutapalli, Andhra Pradesh from January 2021 to December 2021.
A total of 1378 clean-catch midstream urine samples from clinically suspected cases of UTI, which were received from the outpatient and inpatient set up of various clinical departments of the attached tertiary care hospital in sterile universal containers, were processed within 2 hours of collection and, if in case of delay they were stored at 2-8°C in a refrigerator for a maximum of 6 hours.
Direct microscopy was performed for all the samples for which a wet film preparation was made with 50 μl of well-mixed uncentrifuged urine, and after placing a coverslip, it was observed under high power objective to appreciate the presence of microorganisms, pus cells, epithelial cells etc.[10]
The samples were plated onto Cysteine-Lactose-Electrolyte Deficient agar (CLED agar), and isolation was performed by surface streak procedure by using calibrated loop technique for semi-quantitative method and incubated aerobically at 35-37°C for 24 hours and those cultures which were negative were further incubated for other 24 hours.[11]
Pure growth of an isolate in culture media was considered significant if there was a count of ≥105 cfu/ml of urine (significant bacteriuria).
The isolates from cases of significant bacteriuria were further identified by Gram stain and conventional biochemical tests.[12]
All the isolates were subjected to antibiotic sensitivity testing by Kirby-Bauer disk diffusion method with a broth culture inoculum of the isolate with turbidity equivalent to McFarland 0.5 standard and lawn cultured on to Mueller-Hinton agar (Hi-media, Mumbai) and are allowed to dry and the antibiotic discs (Hi-media, Mumbai) were placed on to the surface by using sterile forceps and incubated overnight, and the interpretation was done according to the CLSI guidelines M100 31st Ed-2021.[13]
Escherichia coli (ATCC 25922), Klebsiella pneumoniae (70063), Staphylococcus aureus (25923), Pseudomonas aeruginosa (ATCC 27853), and Enterococcus faecalis (ATCC 29212) are used as control strains.
Statistical analysis
Continuous data were summarized, and the categorical data were summarized as a percentage.
Ethical clearance
Ethical approval for the study (Ethical committee CDSCO Reg No: ECR / 804 / Inst / AP/ 2016 – RR-19) was provided by the Institutional Ethics Committee, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation, Chinna Avutapalli, Krishna District, A.P. India on 20 March 2021.
| Results | | |
A total of 1378 non-duplicate clean-catch midstream urine samples [Table 1] have been received to the bacteriology laboratory in the department of microbiology from OPDs and IPDs of different clinical departments from the attached tertiary care hospital at our institute from suspected cases of UTI in which 407 (29.53%) satisfied the Kass concept with significant bacteriuria by using semi-quantitative standard loop technique (≥105 cfu/ml), and the remaining samples were either sterile or had non-significant bacteriuria.
| Discussion | | |
Urinary tract infection is one of the most common infections encountered in medical practice, which varies from place to place depending on the demography, community or hospital-acquired, use of different antibiotics in various hospital settings without a pre-formed antibiotic policy and this affects all age groups of the population even with adequate preventive measures and also advances in therapy and it still is one of the commonest infections encountered in both inpatient and outpatient settings.
Although UTIs are caused by different microorganisms majority of the infections are due to bacteria. The present study was undertaken at our institution to know the prevalence of uropathogens and their antibiotic susceptibility pattern as it differs from place to place and proper management of the patients with bacterial UTIs relies on the infecting pathogen and their antibiotic susceptibility pattern in order to treat the patients.
In the present study, a total of 1378 [Table 1] midstream urinary samples from suspected cases of UTI received from various departments of our attached hospital have been processed according to standard protocol and guidelines wherein these samples 407 (29.53%) were culture positive isolates satisfying the Kass concept which were further processed for their identification and antibiotic susceptibility pattern. This finding is in support of the findings of Agarwal et al.[14]
The majority of the isolates were from the samples related to female patients [Table 2] 260 (63.88%), and the remaining 147 (36.12%) were the samples received from the male patients, this finding is in correlation with the findings of Syed Suhail et al., Abay khan et al., & Yadav K et al.[15],[16],[17]
Among 407 bacterial isolates, 352 (86.48%) were Gram-negative bacilli [Table 3] which were found to be the vital causative agents of UTI followed by 55 (13.52%) Gram-positive cocci, which correlate with the findings of Singhal et al.[18]
Among the Gram-negatives [Table 4] Escherichia coli was the predominant isolate (56.02%), followed by Klebsiella spp (16.95%), Pseudomonas aeruginosa (8.35%), Enterobacter spp (4.42%), Proteus mirabilis (0.25%), Citrobacter freundii (0.25%), Acinetobacter baumannii (0.25%) and among Gram-positives Enterococcus faecalis (10.81%) was the predominant isolate followed by Staphylococcus aureus (2.70%). Their findings correlate with the observations of Mehrishi et al., Agarwal et al., & Singhal et al.[9],[14],[18]
The antibiotic susceptibility pattern of Escherichia coli isolates [Table 5] and [Table 6] showed the highest susceptibility to polymyxin-B (100%), followed by meropenem (92.98%), nitrofurantoin (84.21%), amikacin (83.33%) and least susceptibility was seen against norfloxacin (32.01%), ceftriaxone and Ceftazidime (27.26%) which correlate with the findings of Gharavi MJ et al.[19] | Table 5: Showing Antibiotic Susceptibility Pattern of Gram-Negative Bacterial Isolates (%)
Click here to view |
 | Table 6: Showing Antibiotic Susceptibility Pattern of Gram-Negative Bacterial Isolates (%) Continued
Click here to view |
Klebsiella spp isolates showed the highest susceptibility to polymyxin-B (100%) followed by amikacin (92.75%), gentamicin (86.95%), meropenem (73.91%) and the least susceptibility was seen against norfloxacin and cotrimoxazole (46.37%), ceftazidime (36.23%) and ceftriaxone (34.78%), which are correlating with Agarwal et al. & Baveja et al.[14],[20]
Enterobacter spp showed the highest sensitivity to polymyxin-B (100%) followed by amikacin (88.88%), gentamicin (83.33%), and meropenem (72.22%) and least susceptibility to norfloxacin, ceftriaxone, ceftazidime and cotrimoxazole (44.44%) which is In correlation with Ahmed et al.[15]
Proteus mirabilis showed good susceptibility against meropenem, piperacillin-tazobactam, cefoperazone-sulbactam, gentamicin and norfloxacin (100%) correlating with Ahmed et al.[15]
Citrobacter freundii showed susceptibility only to polymyxin-B (100%) and was resistant to all other antibiotics.
Among the Gram-negative non-fermenters, Pseudomonas aeruginosa showed the highest sensitivity to polymyxin-B (85.29%) followed by meropenem (67.64%), piperacillin-tazobactam (64.70%), amikacin (58.82%) and least susceptibility to norfloxacin (50%), ceftazidime (35.29%) and nitrofurantoin (17.64%) and Acinetobacter baumannii isolates were sensitive to polymyxin-B, meropenem, imipenem, amikacin, gentamicin, norfloxacin, (100%) and are resistant to ceftriaxone, ceftazidime, cotrimoxazole, norfloxacin most of them are in correlation with Singhal et al. & Bhaveja et al.[18],[20]
Among the Gram-positive isolates [Table 7] and [Table 8], Enterococcus faecalis showed the highest sensitivity to linezolid (100%), followed by vancomycin (77.27%), nitrofurantoin (50%), piperacillin-tazobactam (47.72%), imipenem (45.45%) and least susceptibility to penicillin (38.63%), tetracycline (22.72%), norfloxacin (18.18%), erythromycin and cotrimoxazole (9.09%) which are in correlation with Mehrishi et al., Agarwal et al. & Baveja et al. and Staphylococcus aureus isolates showed the highest sensitivity to vancomycin and linezolid (100%) followed by norfloxacin and cotrimoxazole (54.54%), tetracycline and clindamycin (44.45%) and least susceptibility to erythromycin (27.27%), penicillin and norfloxacin (18.18%) correlating with Mehrishi et al. & Agarwal et al.[9],[14],[20] | Table 7: Showing Antibiotic Susceptibility Pattern of Gram-Positive Bacterial Isolates (%)
Click here to view |
 | Table 8: Showing Antibiotic Susceptibility Pattern of Gram-Positive Bacterial Isolates (%) Continued
Click here to view |
| Conclusion | | |
As the prevalence of bacterial uropathogens as well as their antibiotic sensitivity pattern varies in different geographical locations and time to time, it is important that diagnosis of UTI is not only dependent on the clinical signs and symptoms, it should be correlated with the positive urine culture and the antibiotic susceptibility pattern of the uropathogen isolated.
Without having knowledge about the prevalence of uropathogens in that particular area and their susceptibility pattern, starting empirical antibiotic therapy will not only prolong the disease and lead to complications in the patients a negative consequence will also be added in the form of the development of multidrug resistance (MDR).
This study helps the clinicians in our area to exaltate the existing knowledge about UTIs and the choice of empirical antibiotic therapy to be started in these cases and also helps the institution to establish guidelines for the appropriate use of antibiotics in the form of antibiotic policy.
We also here with suggest that awareness should be created in the local population especially females to maintain proper personal hygiene in order to reduce the rate of UTIs and maintain good health.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]
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