Abstract
Urinary Tract Infection (UTI) is very common in our day-to-day clinical practice. Among all the organisms <i>Escherichia coli</i> (<i>E coli</i>) is the most common but antimicrobial resistance becomes an alarming issue for UTI management now a days. Aim of this study is to assess the pattern of antimicrobial resistance to <i>E coli</i> among the UTI patients in Jashore, Bangladesh. This observational study was conducted from February, 2017 to January, 2018 in the district of Jashore, Bangladesh. We recruited 696 patients of both sex with UTI only infected by <i>E coli</i>. We had excluded the patients with UTI caused by other than <i>E coli</i>, female during menstruation, pregnancy, history of taking antibiotics within last 21 days, catheterization within 1 month and pelvic organ & genito urinary tract surgery within 6 months. Evaluation of antimicrobial resistance was done according to the standard bacteriological methods. Mean age of our study cases was 41.46±17.21 years with the range from 15 to 91 years. More than 85% participants were female with a sex ratio was 8:1.5. Reproductive age group ranged from 21 to 50 years was affected most commonly which constituted approximately two-third of our study. Our study revealed that the maximum antimicrobial resistance to <i>E coli</i> was Cotrimoxazole (95.0%), followed by Ceftazidime (75.7%), Gentamicin (70.3%), Amikacin (69.0%), Imipenam (58.9 %,), Cefixime (58.0%), Ciprofloxacin (57.3%), Azithromycin (56.0%), Cefuroxime (46.6%), Cefotaxime (37.4%), Ceftriaxone (35.2%), Meropenem (32.2%), Nitrofurantion (4.7%). With the high magnitude of antimicrobial resistance to <i>E coli</i> among the UTI patients even with extended generation of Cephalosporins, Carbapenams, Ciprofloxacin, Cotrimoxazole, Azithromycin and Aminoglycosides, our recommendation as first line empirical treatment option in UTI should be Nitrofurantoin due to low resistance pattern.
Highlights
[6] Urinary tract infection (UTI) is a common scenario in our daily clinical practice, but the increasing antimicrobial resistance is associated with treatment failure and overburden of healthcare cost around the globe
After identification of Escherichia coli (E coli) in the urine sample we further demonstrated for antimicrobial susceptibility testing by Mueller-Hinton (MH) agar using Kirby-Bauer disc diffusion method against a panel of 13 antibiotics; Imipenum (10mcg), Ceftriaxone (30mcg), Ciprofloxacin (5mcg), Cotromoxazole (25mcg), Ceftazidime (30mcg), Cefotaxime (30mcg), Gentamycin (10mcg), Nitrofurantoin (300mcg), Azithromycin (15mcg), Cefixime (5mcg), Cefuroxime (30mcg), Meropenem (10mcg), Amikacin (30mcg)
A total 696 eligible patients of both sex aged above 15 years whose urine culture grown E coli were included in the our study
Summary
Urinary tract infection (UTI) is one of the most common infectious diseases in the community practice with approximately 150 million people affected in the world each year accounting for nearly 25% of all infections. [1,2] Among all organisms E coli causes 80-90% in uncomplicated UTIs. [3] A retrospective analysis using The Surveillance Network®, USA in 2012 reported the most common pathogen isolated from female who visited U.S outpatients in 2012 was E coli (64.9%). [4] Urinary tract infection causes morbidities includingGoutam Kumar Acherjya et al.: Pattern of Antimicrobial Resistance to Escherichia Coli Among the Urinary Tract Infection Patients in Bangladesh pyelonephritis and cystitis which are resulted by presence of microorganisms in the urinary tract. [5] Though UTIs are related to minimum morbidity, the annual financial burden of the US alone costs at around 2 billion dollar. [6] UTI is a common scenario in our daily clinical practice, but the increasing antimicrobial resistance is associated with treatment failure and overburden of healthcare cost around the globe. [7] Evidence shows that antimicrobial resistance pattern to urinary E coli is growing gradually in the developing countries and in the developed countries. After evaluation of resistance trend in 3498 E coli induced UTI between 2010 to 2014 and found ExtendedSpectrum Beta-lactamase (ESBL) phenotype increasing (7.8– 18.3%, P < 0.0001) in US and susceptibility to Cephalosporins and Fluoroquinolones was significantly lower. By retrospective study using The Surveillance Network®, USA in 2012 with a comparison with 2003 reports showing increasing resistance against Ciprofloxacin (3.6% to 11.8%) and TrimethoprimSulfamethoxazole (17.2% to 22.2%) with a lower resistance against Nitrofurantoin (from 0.7% to 0.9%). As antimicrobial resistance is increasing all over the world even in the developed countries, so we have designed this study with the aim to see the effectiveness of different antimicrobials used against urinary tract infection with E coli in terms of antimicrobial resistance in Jashore, Bangladesh
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