A Study on the Current Trend in Susceptibility Pattern of Uropathogens to Nitrofurantoin in a Tertiary Care Hospital
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2019, Vol 18, Issue 3
Abstract
Introduction: Urinary tract infection (UTI) is the most common health problems in the community as well as in nosocomial set up affecting all age groups from Neonates to Geriatric[1,7]. Widespread use of antibiotics for these highly predictable susceptibility pattern of the common uropathogens has led to the emergence of resistant microorganisms [5]. Nitrofurantoin,a Nitrofuran antimicrobial is a cost effective, well tolerated,oral broadspectrum bactericidal antibiotic .It acts at multiple site hence is effectively used to treat urinary tract infections (UTIs) caused by E. coli, Klebsiella sp., Enterobacter sp., Enterococcus sp. and Staphylococcus aureus.[4]. But most Proteus species,Serratia marcescens,Morganella morgagni, Pseudomonas species and Acinetobacter species are naturally resistant[2,9].Unfourtunately Nitrofurantoin is an underused antimicrobial agent for empirical therapy for community acquired and nosocomial lower UTIs. Hence this study was undertaken to assess the effect of Nitrofurantoin currently against the gram-positive and gram-negative uropathogens. Materials & Methods: A Crosssectional study was done for one year period (Jan2017-Dec2017)in a tertiary care hospital. A clean catch mid stream urine collected in proper sterile manner were inoculated in CLED agar and incubated at 37 0C for 18-24hrs.The Antibiotic susceptibility testing for the identified uropathogens by standard methodology was done by Kirby Bauer Disc Diffusion Method. The reports of positive urine culture and zone diameter of inhibition of <14mm of uropathogens to Nitrofurantoin were recorded for E.coli,Klebsiella species,Citrobacter species,Enterobacter species,Staphylococcus aureus,CONS and Enterococcus species. Phenotypic screening for different beta-lactamase producers like extended spectrum beta-lactamases ,Carbapenem resistant Enterobactericaea, methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCONS) were also recorded. Results: Out of 15918 urine samples received and processed ,2880 sample showed growth of uropathgens.Among the isolates,E.coli 1288 (44.7%) was the most common followed by Klebsiella species 658(22.8%) and Enterococcus species 311(10.79%).The Antibiotic susceptibility pattern of the isolates to Nitrofurantoin among the GNB were E.coli 91%,Klebsiella species 78%,Citrobacter species 69% and among GPC, Enterococcus species 93%,Staphylococcus aureus and CONS 100%.Moreover ESBL producing uropathogens were E.coli 519(40%),Klebsiella species 241(36%),Citrobacter species 28(45%). Carbapenem resistant Enterobactericiae were E.coli 105(8.1%),Klebsiella species30(4.5%) and Citrobacter species 3(4.8%). Among the GPC ,MRSA 7(41%) and MRCONS 26( 53%). However ESBL producing E.coli 404(77%),Klebsiella species 97(40%) and Citrobacter species 9(32%) and Carbapenem resistant Enterobactericiae mainly E.coli 10(9%) were susceptible to Nitrofurantoin. Among the Gram Positive cocci all the MRSA and MRCONS were 100% susceptible to Nitrofurantoin.
Authors and Affiliations
Dr. P. Ponnammal, Dr. B. Shanthi, Dr. R. Selvi
Keywords
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- EP ID EP557233
- DOI 10.9790/0853-1803124852.
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