BACTERIAL PROFILE AND ANTIBIOTIC SUSCEPTIBILITY PATTERN OF UROPATHOGENS CAUSING URINARY TRACT INFECTIONS: OBSERVATIONSINA NEW TERTIARY CARE INSTITUTE OF A RURAL AREA OF NORTHERN INDIA
Authors:   Assistant Professor, Department of Microbiology, AIIMSRaebareli., Gupta Shefali , Shakya Akhalesh ,   Senior Resident, Department of Microbiology, AIIMSRaebareli., Gupta Shruti ,   Assistant Professor, Department of Pathology and Laboratory Medicine, AIIMSRaebareli., Islahi Sana ,   Assistant Professor, Department of Microbiology, AIIMSRaebareli., Nag Soumyabrata ,   Associate Professor, Department of Microbiology, AIIMSNagpur., Mishra Amit ,   Assistant Professor, Department of Urology, AIIMS Raebareli., Mukherjee Anirudh ,   Assistant Professor, Department of Medicine, AIIMS Raebareli.
Published: October 2023

Introduction: Urinary tract infections (UTIs) are among the most common and burdensome diseases affecting outpatients and hospitalized patients, Escherichia coli being the most commonly implicated bacterium. UTIs have been treated empirically in locations where microbiological facilities are either non-existent or too expensive. This study was conducted to fill in our lack of knowledge regarding the bacterial composition and antimicrobial susceptibility patterns of uropathogens in Raebareli (Uttar Pradesh), India, and to help formulate an antibiotic policy. Materials and Methods: This retrospective study was conducted at a 600-bed tertiary care hospital in rural India, from 11th August 2021 to 10th July 2022. The study excluded patients who were on antibiotic therapy and had been hospitalized a week before their OPD visit. Midstream urine samples collected aseptically were cultured semi-quantitatively. Organisms with significant colony counts were identified using routine biochemical techniques and antimicrobial susceptibility was tested against various antibiotics as per CLSI guidelines. The data was condensed and analyzed using SPSS version 23 softwares descriptive statistics feature. Results: A total of 5,982 urine samples were considered eligible during the study period. Most of the patients were 19-39 years old (40.67%), and the majority were females (55.25%). Most of the samples were received from General Medicine (32.77%). 056 (17.65%) samples showed significant bacterial growth. 258 (4.31%) samples were not considered for further analysis due to contamination during collection. E. coli was the most common organism isolated (53.5%), followed by Enterococcus faecalis (21.4%). E. coli isolates exhibited good sensitivity to Fosfomycin (90.97%), Gentamicin (80.71%), and Imipenem (80%). Vancomycin and Linezolid showed >90% susceptibility to all the gram-positive isolates. 71.79% of the Staphylococcal isolates were MRSA. Discussion: This study marks the primary investigation into the susceptibility patterns displayed by bacterial strains causing urinary tract infections in Raebareli, Uttar Pradesh (UP) and enables a comparison with other areas of the nation. Age, sex and pyuria were all crucial factors in the incidence of UTI, and must be considered when assessing and managing UTI patients. There was no significant difference in the prevalence of UTI among various departments. E. coli is the leading cause of UTI worldwide, as in our study. The bacterial isolates exhibited noteworthy resistance to the first-line therapeutic agents which are commonly employed for treating UTIs. Our results indicate that fosfomycin, gentamicin, and nitrofurantoin are viable options for treating E. coli infections, while carbapenems and piperacillin-tazobactam can potentially manage other Gram-negatives. Vancomycin, linezolid and nitrofurantoin were the available options for Gram-positive isolates, Conclusion: Our study has revealed a significant number of Gram-negative bacterial isolates, with Escherichia coli being the main cause of UTIs. We have also conducted a comprehensive analysis of antibiogram data. Based on our findings, Nitrofurantoin and Fosfomycin are recommended to initially treat UTIs in our region. These results will apply to our inpatient and outpatient facilities and other departments within our organization.