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

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.