Changing Patterns of Antimicrobial Susceptibility of Uro-pathogens in Community-acquired Urinary Tract Infections in Central India: Two Year Prospective Surveillance Report

Infectious diseases diagnosis & treatment Pub Date : 2023-09-26 DOI:10.29011/2577-1515.100234

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Abstract

Introduction: Antimicrobial resistance (AMR) is a global health crisis. Urinary tract Infection (UTI) are one of the most commonly encountered infections and its management is becoming increasingly difficult in view of AMR. The present study was conducted to determine the epidemiology of causative agents and their susceptibility antibiogram. Methods: The study was a prospective longitudinal study of UTI patients from 2020 to 2021 at AIIMS Bhopal, India. Patients presenting to outpatient department (OPD) or hospitalized to low priority area (LPA) like general ward or high priority area (HPA) like Intensive Care Unit (ICU) or High Dependency Unit (HDU) with symptoms of UTI and whose urine sample was sent for microbiological culture sensitivity test were included in the study. Urine samples were collected and processed in the department of microbiology using standard protocols. Antimicrobial susceptibility test was carried out using the Kirby-Bauer disc diffusion method as per the Clinical Laboratory Standards Institute (CLSI) guidelines on Muller Hinton agar. Samples growing more than two organisms were discarded as contaminant. Urine samples were collected and analyzed using standard protocols. Results: Out of 14526 patients of symptomatic UTI cases (58.0% from OPD, 35.9% from LPA and 6.0% from HPA), whose urine sample was sent for microbiological culture sensitivity test, 2222 (15.2%) showed positive growth. Among the 2222 number of positive growth, 1510 (67.9%) were community acquired, 186 (8.3%) was Health care Associated UTI and 526 (23.6%) cases could not be differentiated into either group. Among 1510 community acquired UTI cases, Gram Negative Bacilli (GNB) were identified in 88.7%, Gram Positive Cocci (GPC) in 10.1% and Candida in 1.0% cases. Among 1510 community acquired UTI cases, E. coli were identified in 58.9%, K. pneumonia in 15.4%, Enterococcus in 8.5% and P. aeruginosa in 4.2% cases. Among the E. coli isolates 3rd generation cephalosporin resistance was identified in 84% in OPD vs. 92% in LPA vs. 100% in HPA, fluroquinolone resisatnce was in 82% in OPD vs. 94% in LPA vs. 1000% in HPA, piperacillin resistance in 38% in OPD vs. 63% in LPA vs. 67% in HPA, carbapenem resistance in 13% in OPD vs. 40% in LPA vs. 47% in HPA. Among the K. pneumoniae isolates 3rd generation cephalosporin resistance was identified in 78% in OPD vs. 91% in LPA vs. 100% in HPA, fluroquinolone resisatnce was in 64% in OPD vs. 86% in LPA vs. 80% in HPA, piperacillin resistance in 53% in OPD vs. 75% in LPA vs. 56% in HPA, carbapenem resistance in 14% in OPD vs. 67% in LPA vs. 55% in HPA. Among the Enterococcus isolates, vancomycin resistance was observed in 21% in OPD Vs. 24% in hospitalized cases. Conclusion: E. coli and K. pneumoniae together accounted for about two third microbiologically confirmed cases. Carbapenem resistance of about 10% in OPD cases and 50% in hospitalized patients seems alarming. Customized Anti microbial stewardship program (AMSP) at each health care facility is need of the hour.

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印度中部社区获得性尿路感染中尿路病原体抗菌药物敏感性的变化模式:两年前瞻性监测报告

抗菌素耐药性(AMR)是一个全球性的健康危机。尿路感染(UTI)是最常见的感染之一，鉴于抗生素耐药性，其治疗变得越来越困难。本研究旨在确定病原体的流行病学及其药敏抗生素谱。方法:该研究是对印度博帕尔AIIMS医院2020年至2021年尿路感染患者的前瞻性纵向研究。出现尿路感染症状的门诊(OPD)或低优先区(LPA)如普通病房或高优先区(HPA)如重症监护病房(ICU)或高依赖病房(HDU)的患者，其尿液样本被送去进行微生物培养敏感性试验，均被纳入研究。尿液样本在微生物科按照标准规程收集和处理。根据临床实验室标准协会(CLSI)指南，采用Kirby-Bauer圆盘扩散法对Muller Hinton琼脂进行抗菌药敏试验。生长超过两种生物的样品被作为污染物丢弃。尿液样本采集和分析采用标准方案。结果:14526例有症状的尿路感染患者(OPD 58.0%， LPA 35.9%， HPA 6.0%)尿样进行微生物培养敏感性试验，2222例(15.2%)阳性。2222例阳性增长病例中，社区获得性尿路感染1510例(67.9%)，卫生保健相关尿路感染186例(8.3%)，526例(23.6%)无法区分为两组。1510例社区获得性UTI中检出革兰氏阴性杆菌(GNB)占88.7%，革兰氏阳性球菌(GPC)占10.1%，念珠菌(Candida)占1.0%。1510例社区获得性尿路感染中，大肠杆菌占58.9%，肺炎克雷伯菌占15.4%，肠球菌占8.5%，铜绿假单胞菌占4.2%。第三代头孢菌素耐药性在OPD组为84%，LPA组为92%，HPA组为100%，氟喹诺酮类药物耐药性在OPD组为82%，LPA组为94%，HPA组为1000%，哌西林耐药性在OPD组为38%，LPA组为63%，HPA组为67%，碳青霉烯类耐药在OPD组为13%，LPA组为40%，HPA组为47%。OPD组第三代头孢菌素耐药率为78%，LPA组为91%，HPA组为100%，OPD组为64%，LPA组为86%，HPA组为80%，OPD组为53%，LPA组为75%，HPA组为56%，OPD组为14%，LPA组为67%，HPA组为55%。在分离的肠球菌中，门诊患者中有21%对万古霉素耐药，住院患者中有24%对万古霉素耐药。结论:大肠杆菌和肺炎克雷伯菌共占微生物学确诊病例的2 / 3。碳青霉烯耐药性在门诊病例中约为10%，在住院患者中约为50%，这似乎令人担忧。定制的抗微生物管理程序(AMSP)在每个卫生保健机构是需要的时间。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Infectious diseases diagnosis & treatment

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