Multidrug resistant Escherichia coli isolated from urinary tract infections in a tertiary care hospital, Bangalore, South India

Abstract

Background: Escherichia coli is the most common etiological agent in both community acquired and hospital acquired urinary tract infections (UTI). Emergence of multidrug resistance (MDR) among E.coli isolates is quite alarming. The goal of the study was to define the current prevalence and phenotypes of MDR E. coli among UTI samples in our hospital. Methods: Urine samples from 1225 patients received in the microbiology department of our hospital were processed. Wet mount to detect presence of pus cells and bacteria was done. All the samples were inoculated on to Hi Media Hi chrome agar and plates incubated at 370 C for 18-24 hours. Growth showing significant bacteriuria (≥ 105 cfu/ml) was identified by the colour imparted by the colonies. Further identification was done by the standard biochemical procedures. Antibiotic sensitivity was performed by disc diffusion method as per CLSI guidelines. Various classes of antibiotics were included in the sensitivity panel. Results: Out of 1225 samples processed, significant bacterial isolates were obtained in 357 (29.1%) The total number of E.coli isolated were 179(50.1%). More number of females (56.9%) had significant UTI due to E.coli compared to males (43%). The total number of samples received in pediatric age group was 60. E.coli comprised 58.3% of the pediatric isolates. Total numbers of multidrug resistant E.coli isolates were 148 (82.6%). High degree of resistance was observed to amoxycillin (93.2%) and amoxycillin -clavulanic acid (90.5%). More than 80% sensitivity was seen only to imipenem (98.4%), amikacin (83.3%) and nitrofurantoin (86.6%). Conclusion: Multidrug resistant strains of E.coli are widely prevalent and isolation of the same in the community acquired urinary tract infections is a matter of grave concern. Antibiotics like imipenem and amikacin require hospitalization, parentral administration, drug monitoring for toxicity, all of which incurs high cost to the patient and cannot be used as the first line of treatment. Judicious use of antibiotics is the need of the hour to prevent spread of the multidrug resistant strains in the community