MICROBIOLOGY AND DRUG RESISTANCE PATTERN IN CLINICALLY SIGNIFICANT ISOLATES OF URINE FROM MEDICAL WARDS OF A TERTIARY CARE HOSPITAL IN NORTH INDIA.
Authors: Rishi Saqib , Nahvi Nahid , Rasool Wani Arshid , Majid Iqra 
Published: February 2022

Urinary tract infections (UTIs) are one of the most common bacterial infections encountered in clinical practice both in
community and hospital settings in all age groups. It is the second most frequently occurring infection in general
population after upper respiratory tract infection .Urinary tract infections (UTIs) are the leading cause of Gram negative
sepsis in hospitalized patients and are the origin for about half of all hospital acquired infections caused by urinary
catheters and are associated with considerable cost in terms of morbidity and economic and research expenditure.
Material And Methods: This prospective cross sectional study was carried out in the Department of Microbiology of
Government Medical College, Srinagar. A total of 800 patients were taken up for the study. The sample falling under the
set inclusion criteria were selected from the urine specimen received in the laboratory for urine culture and sensitivity
from Hospitalized patients (IPD). Culture and sensitivity reports and patient data obtained from hospital records was
analyzed for this study. Out of 800 samples taken up for the study 208 (26%) were culture positiv Results: e and 592
(74%) were negative. 208 positive samples 125(60.10%) were females and 83(39.90%) were males. female
predominance was observed with 71% whereas 29% males were affected by UTI. UTI was predominantly in females of
age group (21-40 yrs). most common organism isolated on culture was Escherichia coli(43.26%) both in short stay
patients (<48hrs hospital stay) /OPD 22.59% as well as in IPD (>48hrs hospital stay) 20.67%.E.coli was isolated from
patients of both uncomplicated and complicated UTI. The second most common organism isolated in our study was
Enterococcus faecalis(22.59%), the rate of isolation was much higher 18.75% in inpatients (>48hrs hospital stay) and
only 3.84% in OPD/short stay patients (<48hrs hospital stay). In our study Enterococcus spp ranked second amongst
uropathogens, in IPD patients isolation rate was almost 5 times higher. Pseudomonas spp was 1 isolate in OPD (0.48%)
and 6 (2.88%) in IPD, Acinetobacter 3 (1.44%), Proteus 1 (0.48%) found only in hospitalized patients (stay >48hrs).
E.coli showed following sensitivity pattern 96.7% to nitrofurantoin, 93.3% to imipenem, 90.0% to amikacin, 75.6% to
gentamycin, 73.3% to cefoperazone-salbactam and meropenem both, 68.9% to pipercillin tazobactam.The sensitivity to
TMP-SMX was 45.6%, and to ceftriaxone and cefipime was only 22.2% and 21.1% respectively. The organism also
showed resistance to drugs like levofloxacin 82.2% and ciprofloxacin 76.7%.Enterococcus faecalis isolated in our study
was sensitive to Vancomycin 95.74% followed by Linezolid (93.6%), Nitrofurantoin (78.7%), HL-Amikacin (74.5%),HLGentamycin (70.2%). Enterococcus faecalis showed resistance to drugs commonly used to treat UTI i.e. 91.5% resistant
to Ciprofloxacin and 89.4% resistant to Levofloxacin. Gram negative bacteria were most predominant Conclusion:
microorganisms resulting in more than 50% infections causing urinary tract infection. In our study we have seen that
Gram positive cocci especially Enterococcus result in UTI in a significant proportion of patients. In our study
Enterococcus spp ranked second amongst uropathogens, in IPD patients isolation rate was almost 5 times higher. The
implementation of antibiotic stewardship programs is crucial to minimize resistance. Appropriate antibiotics need to be
prescribed based on the antibiotic susceptibility testing which will be narrow spectrum, effective and less expensive
with least side effects.