How to Reverse the Course of Resistance? A Study of our Local Antibiogram

Shafiullah Khan, Muhammad Fazle-Wahab, Noorul - Hayat, Muhammad Ziauddin Khan, Syed Arif, Fazle Subhan

Abstract


Background: Urinary Tract Infection are classified as complicated and uncomplicated UTI. Uncomplicated UTIS include urinary
tract infections without structural and neurological abnormalities. They are further classified as lower and upper UTIs (Cystitis and Pyelonephritis respectively)
Objective: To determine UTI causative organisms and antibiotic resistance with respect to commonly used antibiotics.
Material & Methods: A descriptive case study was conducted at the department of Urology, Nawaz Shareef Kidney Hospital Swat
for duration of 6 months (March 2017-August 2017). Sample size of 172 patients was calculated with 95% confidence interval, 32.8% prevalence (E.coli) and 7% margin of error. Participants were selected with simple random sampling. Ethical approval and Consent forms were taken. Urine cultured samples were tested within an hour after sampling. Data was analyzed using SPSS version 22.0. Correlation and fisher's exact test was applied. P value =0.05 was considered significant.
Results: Total 172 patients were included in study. Mean age of patients was 41.6 years±11.6 SD. There were 56(32.6%) males
and 116(67.4%) females. Causative agents were E.Coli in 132(76.7%), Klebsiella spp in 17(9.9%), Staphylococcus saprophyticys in 11(6.4%) and Pseudomonas aeruginosa in 12(7%) patients. Overall resistance patterns were, Ciprofloxacin, Levofloxacin, Nalidixic acid, ceftriaxone & Trimethoprim-sulfomethoxazole 47.7%, 16.3%, 11.6%, 16.9% and 7.6% respectively. Quinolones & Cephalosporins showed resistance in 68( 97.1%) in complicated UTIs.In more than 95%(67) of cases urine cultures showed sensitivities to Nitrofurantoin & Fosfomycin in oral antibiotics & Tazobactum ,Imipinem,cepoperazone/sulbactum, & Amikacin
among parenteral antibiotics.30(42.8%) patients with UTI were diabetics,25(35.7%) having urolithiasis & 15(21.4%) cases had
some urological intervention. 50(71.42%) cases had used empirical antibiotics prescribed by local physicians & quacks .
A negative correlation between diabetes mellitus & UTI was observed. Statistically significant association between antibiotics and antibiogram patterns is reported (p=0.000).
Conclusion: Escherichia coli and Klebsiella spp were predominant pathogens for UTI development. However, variable antimicrobial resistance patterns were seen followed by high resistance of E.coli towards quinolones & ceftriaxone. Routine surveillance and monitoring are required for updating clinicians regarding most prevalent pathogens and empirical treatment of UTI.

Keywords


Urinary tract infection (UTI), Antibiotics Resistance, Urine culture & sensitivity(C/S)

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