Kalyan Koganti
Help Hospitals, India
Title: Alarming multidrug resistance in community acquired urinary tract infections
Biography
Biography: Kalyan Koganti
Abstract
Background: Urinary tract infections are common illness in the community. In India and many other low and middle income countries presumptive antibiotic therapy is given to majority of patients without performing urine cultures. This is leading to alarming antibiotic resistance and significant economic burden to the patients when the initial presumptive antibiotic treatment fails.
Objective: To assess antimicrobial resistance pattern of uropathogens in community acquired urinary tract infections.
Methods: A prospective study was conducted at a hospital in South India over 12 months from August, 2015 to July, 2016. We collected isolates of E.coli, Klebsiella spp., and Proteus spp., from patients with community acquired urinary tract infection. Identification of bacteria and antibiotic susceptibility testing were performed on Vitek 2 (automated identification and sensitivity equipment based onCLSI guidelines). Multi drug resistant uropathogens were defined as strains resistant to at least two groups of antibiotics in addition
to extended spectrum beta lactamase (ESBL) positivity.
Results: A total of 366 isolates (318 E.coli, 38 Klebsiella spp., and 10 Proteus spp.) were included in the study. Of these 235 (73.8%) E.coli, 26 (68.4%) Klebsiella spp., and 3 (30%) Proteus spp., isolates were ESBL positive. Further 51 (16%) E.coli and 2 (5.2%) Klebsiella spp., isolates were multidrug resistant. The most frequently encountered comorbidity is diabetes, seen in 117 (31.9%) patients.Tigecycline and Colistin appeared to be the most effective antibiotics in multidrug resistant cases.
Conclusion: There is an alarming increase of ESBL producing isolates in the last few years. Presumptive antibiotic therapy in urinary tract infections is to be based on regular community acquired resistance pattern analysis within a given centre. Rising multidrug resistance is a serious concern in countries like India due to significant economic burden. Urine cultures must be done in all the patients before starting presumptive antibiotic treatment.