Susceptibility Pattern of Urinary Pathogens in a Tertiary Care Hospital

Abstract

Objective: To determine the susceptibility pattern of urinary pathogens in a tertiary care hospital of Pakistan.
Study Design: Laboratory based retrospective study.

Place and Duration of Study: Department of Pathology Combined Military Hospital Sialkot, from April 2016 to March 2018.
Methodology: Urine samples were submitted in laboratory. Identification of bacterial isolates was done by standard biochemical profile of the organisms. The antimicrobial susceptibility of culture positive bacterial isolates was performed by disk diffusion
method as recommended by Clinical Laboratory Standard Institute guidelines (CLSI).
Results: Out of 2668 urine samples submitted over a period of two years, 220 turned out to be culture positive. Out of these culture positives, 34.1% were from indoor patients and 65.9% from outdoor. Female patients constituted 151 (68.6%) urine samples, while 69 (31.4%) were from male. Male to female ratio was 1:2.2. Mean age of patients was 40 years. Gram negative bacteria accounted for 196 (89%) of the total isolates, Gram positive bacteria 17 (7.8%) while 7 (3.2%) were Candida spp. The most
prevalent bacterial isolate was Escherichia coli 145 (65.9%) followed by Klebsiella pneumoniae 26 (11.8%), Enterococcus spp17 (7.8%), Pseudomonas aeruginosa 08 (3.6%), Candida spp 07 (3.2%), Serratia spp 05 (2.3%) while 04 (1.8%) each for Enterobacter spp, Citrobacter spp and Proteus spp. E.coli showed highest susceptibility (96.5%) to fosfomycin, 95.2% followed by nitrofurantoin (92.4%) and imepenem(86.9%). The antibiogram of Klebsiella pneumoniae revealed 88.5% of the bacterial isolates sensitive to fosfomycin and 84.6% to imipenem. In case of P.aeruginsosa, sensitivity to imipenem turned out to be87.5% followed by amikacin (75%). Vancomycin, linezolid and fosfomycin were the most effective antimicrobials amongst the Enterococcus spp, showing 100%, 94.1% and 94.1% susceptibility respectively.
Conclusion: Majority of the bacterial isolates of Enterobacteriaceae family were sensitive to fosfomycin, nitrofurantoin, imepenem and amikacin. While in case of Gram positive isolates, vancomycin and linezolid showed good susceptibility in addition to fosfomycin and nitrofurantoin.

Key Words: Urinary tract infection, Antimicrobial susceptibility, Urinary pathogens.