Escherichia coli as uropathogen: antibiotic susceptibility profiling
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20180655Keywords:
Antibiogram, NCDC guidelines, UTIAbstract
Background: Empirically chosen antibiotics based on the local resistance pattern of uropathogens remain the principle treatment of urinary tract infections (UTI).
Methods: Antibiogram of most frequent uropathogen was determined. Based on the antibiogram result, authors compared effectiveness of drugs recommended for UTI by National centre for disease control (NCDC), India, and assessed age and gender based variability in the effectiveness of these drugs.
Results: 1278 urine samples were accounted, of which 405 samples showed significant growth. E. coli was the most common uropathogen (n=146, 36%) followed by enterococcus species (31%) and Klebsiella pneumoniae (10%). Using McNemar’s test authors found that nitrofurantoin (90% sensitivity) was statistically the most effective drug among drugs recommended by NCDC for uncomplicated cystitis. Furthermore, authors used Fisher’s exact test on adults and paediatrics and found that significant difference in effectiveness was observed for nitrofurantoin (p-value <0.001) and cotrimoxazole (p-value 0.034). Using logistic regression, authors found that with age, effectiveness of ciprofloxacin and cotrimoxazole deteriorate significantly (p-value 0.021 and 0.002 respectively). Additionally, authors observed that cotrimoxazole has significantly better efficacy in males compared to females (p-value 0.022).
Conclusions: In accordance with present study, nitrofurantoin can be used as first line treatment for uncomplicated cystitis. Age and gender should be considered while prescribing empirical treatment for UTI. Periodic surveillance should be carried out to identify the on-going pattern of antibiogram to update the guideline for empirical therapy.
References
Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature reviews. Microbiol. 2015;13(5): 269-84.
Stamm WE, Norrby SR. Urinary tract infections: disease panorama and challenges. J Infect Dis. 2001;18:1-4.
Schappert SM, Rechsteiner EA. Ambulatory medical care utilization estimates for 2006. National Health Statistics Reports. Available at: http://www.cdc.gov/nchs/data/nhsr/nhsr008.pdf. Accessed 6,8 August 2008.
Brusch JL, Bavaro MF, Cunha BA, Tessier JM. Medscape, 2017. Available at: http://emedicine.medscape.com/article/233101-overview. Accessed 17 July 2017.
Lloyd AL, Rasko DA, Mobley HL. Defining Genomic Islands and Uropathogen-Specific Genes in Uropathogenic Escherichia coli. J Bacteriol. 2007;189(9):3532-46.
Ninama AB, Shah PD. Comparison of various screening methods for presumptive diagnosis of significant bacteriuria. Int J Med Sci Public Health. 2016;5(6):1066-9.
National Centre for Disease Control. National Treatment Guidelines for Antimicrobial Use in Infectious Diseases, 2016. Available at http://www.ncdc.gov.in/writereaddata/mainlinkfile/File622.pdf. Accessed 5 September 2017.
Shanmugapriya S, Saravanan T, Janani K. Antibiotic sensitivity pattern to urinary tract infections in a tertiary care hospital in South India. Int J Basic Clin Pharmacol. 2017;6(6):1445-50.
Joshi S, Rashid MK, Joshi HS. Study of antibiotic sensitivity pattern in urinary tract infection at a tertiary hospital. National J Inte Res Med. 2011;2(3):43-6.
Mariraj J, Begum SS, Krishna S, Saba Q. Nitrofurantoin Susceptibility in Urinary Tract Infections (UTIs) in an Era of Drug Resistance. Int J Curr Microbiol App Sci. 2016;5(7):206-9.
Minnesota department of health. About Antibiograms, 2014. Available at: http://www.health.state.mn.us/divs/idepc/dtopics/antibioticresistance/abx/antibiograms.pdf. Accessed 10 September 2017.
Annane D, Aegerter P, Jars-Guincestre MC, Guidet B. Current epidemiology of septic shock: the CUB-Rea Network. Am J Respi Crit Care Med. 2003;168(2):165-72.
Dromigny JA, Nabeth P, Juergens-Behr A, Perrier-Gros-Claude JD. Risk factors for antibiotic-resistant Escherichia coli isolated from community-acquired urinary tract infections in Dakar, Senegal. J Antimicrobial Chemotherapy.2005;56(1):236-9.
Sood S, Gupta R. Antibiotic resistance pattern of community acquired uropathogens at a tertiary care hospital in Jaipur, Rajasthan. Indian J Community Med. 2012;37(1):39-44.
Badhan R, Singh DV, Badhan LR, Kaur A. Evaluation of bacteriological profile and antibiotic sensitivity patterns in children with urinary tract infection: A prospective study from a tertiary care center. Indian J Urol. 2016;32(1):50-6.
Chan RK, Lye WC, Lee EJ, Kumarasinghe G. Nosocomial urinary tract infection: a microbiological study. Ann Acad Med, Singapore. 1993;22(6):873-7.
Ananthanarayan R, Paniker CKJ. Enterobacteriacae I: Coliforms-Proteus. In Paniker CKJ ed. Ananthnarayan and Paniker’s Textbook of Microbiology. 9th Ed. Universities Press, Hyderabad; 2015.271-284.
Fraser SL, Donskey CJ, Salata RA. Enterococcal Infections. 2016. Available at: https://emedicine.medscape.com/article/216993-overview. Accessed 3 September 2017.
Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-20.
Fluit AC, Jones ME, Schmitz FJ, Acar J, Gupta R, Verhoef J. Antimicrobial resistance among urinary tract infection (UTI) isolates in Europe: results from the SENTRY Antimicrobial Surveillance Program 1997. Antonie Van Leeuwenhoek. 2000;77(2):147-52.
Akhtar N, Rahman R, Sultana S. Antimicrobial sensitivity pattern of Escherichia coli causing urinary tract infection in Bangladeshi patients. Am J Microbiol Res. 2016;4(4):122-5.
Shortliffe LMD, McCue JD. Urinary tract infection at the age extremes: pediatrics and geriatrics. Am J Med. 2002;113(1):55-66.
Gaspari RJ, Dickson E, Karlowsky J, Doern G. Antibiotic resistance trends in paediatric uropathogens. Int J Antimicrob Agents. 2005;26(4):267-71.
Gupta K, Trautner BW. Urinary tract infections, Pyelonephritis, and Prostatitis. In Kasper DL, Fauci AS, Hauser SL, Longo DL, Jamson JL, Loscalzo J, eds. Harrisonś Principle of Internal Medicine.19th Ed. New York, NY: Mc Graw Hill education; 2015:861-868.
William A, Petri J. Sulfonamides, Trimethoprim-Sulfamethoxazole, Quinolones, And Agents Used for Urinary Tract Infections. In Brunton LL, editor. Goodman & Gilman’s The Pharmacological Basis of Therapeutics.12th ed. New York, NY: McGraw-Hill; 2011.1463-1476.
