Antimicrobial resistance pattern of urinary tract pathogens from tertiary care hospitals in Bangladesh

Abstract

Background: In Bangladesh, urinary tract infection (UTI) patients usually self-medicate or receive empirical treatment from physicians to start immediate treatment or to avoid expensive medical care. A study of 2016 in Bangladesh showed resistance to antibiotics like quinolones (52%), 3rd generation cephalosporin (51.1%), cotrimoxazole (47%) and imipenem (1%) in UTI. To understand the national situation of antimicrobial resistance (AMR), Institute of Epidemiology, Disease Control and Research (IEDCR), the national institute of epidemiology of Bangladesh, started a surveillance in ten tertiary care hospitals since 2017 from six types of specimens including urine of UTI patients. Objectives of this study were to determine the distribution and antibiotic resistance patterns of UTI pathogens. Methods and materials: We analyzed data of UTI patients enrolled in five initially started sites of AMR surveillance in 2018. UTI patient was defined as >5 years old patient attending outdoor, with abrupt onset of frequency of micturition & urgency with fever, chill or burning sensation of urine or loin pain. Epidemiological data and urine sample were collected. Sample were tested for routine microscopy examination and antimicrobial susceptibility test (AST). AST was performed by disc diffusion method following Clinical and Laboratory Standard Institute (CLSI) guideline. We included intermediate and resistant zone in calculation of resistance. Results: In 2018, a total of 1779 UTI patients reported, 439 (24%) had growth in culture. Culture positivity was more in UTI with >5 pus cells/high power field (HPF) (54/439, 80%) on microscopy than <5 pus cells/HPF (85/439, 19%). About 8% patient took antibiotics previously. Culture positive UTI was more in female 323 (73%) than male 116 (26%). Common pathogens were Escherichia coli (57.4%), Klebsiella (17.3%) and Staphylococcus aureus (10.93%). Escherichia coli was resistant 57% to quinolones, 55% to 3rd generation cephalosporin, 54% to cotrimoxazole and 5% to imipenem; Klebsiella was resistant 37% to third generation cephalosporin, 57% to quinolones, 54% to cotrimoxazole and 8.6% to imipenem. Gram negative bacteria also showed resistance to imipenem. Conclusion: Urinary pathogens showed higher resistance against commonly used antibiotics like quinolone, 3rd generation cephalosporin and cotrimoxazole. We recommend to conduct studies on prescription pattern and physicians should be aware about resistance pattern to treat accordingly.