Evaluation of the spectrum of uropathogens, prevalent antimicrobial resistance and prospects of the newbie “fosfomycin”
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 9
Abstract
Introduction: Urinary tract infections (UTIs) are among the commonest infections impinging morbidity in all age groups. Emergence of antimicrobial resistance is a global problem among the uropathogens, which results in therapeutic failure. Objectives: To investigate the spectrum of uropathogens, their in vitro susceptibility to the commonly used antibiotics and to fosfomycin, and also to determine the prevalence of various antibiotic resistance patterns among the cultured uropathogens. Materials and Methods: The study was conducted prospectively in the department of Microbiology of a tertiary care hospital from April 2017 to July 2017. A total of 1797 non-duplicate urine samples obtained from clinically suspected UTI patients were included in the study and were processed for bacterial culture and antibiotic sensitivity testing (AST). AST and detection of various resistance phenotypes was done as per Clinical Laboratory Standards Institute (CLSI) guidelines. Results: Bacteriological culture of urine samples yielded 406 (93.33%) gram-negative isolates and 61 (17%) gram-positive isolates. The 406 gram-negative isolates represented 388 (95.97%) Enterobacteriaceae isolates, 321 (82.73%) of which were Escherichia coli. Pseudomonas spp. constituted 4.14% of bacterial isolates including 3 metallo beta-lactamase (MBL) producers. Amongst the gram-negative bacteria tested, 153 (34.93%) were extended spectrum beta-lactamase (ESBL) producers. Twenty-seven (6.96%) Enterobacteriaceae isolates were carbapenem resistant Enterobacteriaceae (CRE). Among the Gram positive cocci (GPC) vancomycin, teicoplanin, linezolid and nitrofurantoin were reported highly sensitive. Among the Enterobacteriaceae, colistin (except Proteus spp & Morganella spp.) was 100% sensitive, cefoperazonesulbactum and piperacillin-tazobactam were sensitive in 89% of isolates approx., while amikacin was 85.57% sensitive. Nitrofurantoin showed 91% (291) sensitivity to E.coli. E.coli and Enterococcus spp. showed 94.39% and 100% susceptibility to fosfomycin respectively. 91.5% (130/142) ESBL- E.coli were sensitive to fosfomycin. Conclusion: E.coli is the most common urinary isolate. Among uropathogens, resistance mechanisms like ESBL production, CRE and other multi drug resistant (MDR) mechanisms are prevalent. Fosfomycin has remarkable sensitivity among E.coli and also in Enterococcus spp. and may be considered an effective oral empirical anti- UTI antibiotic against many superbugs.
Authors and Affiliations
DR. Nandita Pal, DR. Bhuban Majhi
Keywords
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- EP ID EP262825
- DOI 10.9790/0853-1609115459
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