A Cross-sectional Study on Microbiological Patterns Associated with Urinary Tract Infections in Hospitalised Women: Analysis of Their Antimicrobial Sensitivity and Clinical Risk Factors

Abstract

Introduction: Urinary Tract Infections (UTIs) are one of the most common infections, with a predominance in females. To overcome the menace of antibiotic resistance in UTIs, it is important to delineate and follow the local antibiotic resistance patterns of these pathogens. This helps in formulating institutional infection control policies and providing guidance for antibiotic therapy. Knowledge of risk factors for UTIs in hospitalised patients is used to formulate preventive measures for admitted patients. Aim: To study the microbiological patterns and antimicrobial sensitivity of UTIs in female patients admitted to a tertiary care centre. Materials and Methods: A cross-sectional study was conducted collaboratively between the Department of Microbiology and the Department of Obstetrics and Gynaecology at RKDF Medical College Hospital and Research Centre, Bhopal, Madhya Pradesh, India. Urine samples were collected from all admitted female patients who were prescribed culture and sensitivity testing by the treating clinicians from November 2020 to October 2022. Demographic and clinical data of patients were collected, and urine samples were sent for culture-sensitivity testing. Identification and antimicrobial susceptibility testing were done using the VITEK2-compact system. Results were analysed using Statistical Packages for the Social Sciences (SPSS) version 23.0. Results: Out of 508 urine samples sent for culture-sensitivity testing, a culture positivity rate of 16.31% was observed. Diabetes was associated with 25 out of 83 patients. Among all UTI cases, 57.8% (n=48) had a urinary catheter. In catheterised patients, the predominant associated conditions were pregnancy, cardiovascular failure, followed by respiratory issues. Gram- negative isolates constituted 77.1% of the total bacterial isolates, Gram-positive isolates formed 12%, and fungal isolates comprised 10.8% of the total cultures. E. coli was the most frequently encountered species, comprising 55.4% of the isolates. The study found carbapenems to be the most effective against E. coli. In the present study, Extended Spectrum Beta-Lactamase (ESBL) production was similar in uropathogenic E. coli and K. pneumoniae, 65.9% and 64.7%, respectively. The present study study showed that aminoglycosides and nitrofurantoin are the optimal drugs for ESBL-producing organisms. Conclusion: UTIs prevalent in hospitalised women are associated with prolonged catheterisation and co-morbidities such as diabetes and cardiovascular conditions. Gram-negative bacteria are the predominant species, and their susceptibility pattern is increasingly shifting towards higher antibiotics.