ABSTRACT
Background: Urinary tract infections (UTIs) are amongst the most common bacterial infections, affecting about 150 million individuals per year.Urinary tract infection (UTI) is one of the most common diseases in human societies which occur in women more than men. Women of all ages are more likely to experience such an infection than men, while half of them may be affected by a uropathogen once in their lives, and 25-30% may develop recurrent UTIs not associated with any functional or anatomical abnormality. The aim of this study was to explore the prevalence of antibiotic resistance of urinary tract infections in immunocompromised patients. Material & Methods: This was a retrospective observational study and was conducted in the Department of Medicine of Dhaka Central International Medical College and Hospital, and National Institute of Kidney Diseases & Urology, Dhaka, Bangladesh during the period from June, 2021 to June, 2022. We included 70 immunocompromised patients with UTI. Results: In our study we found 44% patients were aged between 18-30 years old and 83% of our patients were female. Among all respondents, 58 patients were culture positive. We found 38% & 62% and 33% & 67% had history of upper & lower UTI in female and male patients respectively, 29% & 36% and 17% & 25% had urethritis & cystitis in female and male patients respectively. We found culture positive patients with E. coli (41%), Klebsiella spp.(19%), Enterobacter spp.(16%) and 12% with Pseudomonas spp in our study. We found amoxicillin showed resistance to E. coli (58.3%), Staphylococcus (75%), & Klebsiella (36.4%) and amikacin showed resistance mostly to E. coli(50%), Klebsiella (54.5%) & Pseudomonas (42.9%). Conclusion: In our study, we found the most common MDR pathogen among patients with UTI in our institution was E. coli & Staphylococcus. We discovered that being above 40 years old, having DM, CKD and previously received antibiotic medication inappropriately were risk factors for the development of MDR infection. Given the high prevalence of multidrug resistant uropathogens among immunocompromised patients, the growth in Penicillin resistance is alarming. We discovered the significant incidence of MDR bacterial strains, adherence to currently suggested empiric therapy is extremely challenging and is linked with high failure rates.
ABSTRACT
Background: Tuberculosis (TB) is a common condition all over the world but more common in developing countries like Bangladesh38. This is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent. In 2013, 9 million people fell ill with TB and 1.5 million died from the disease globally. Approximately 15-20 % of total TB cases are extrapulmonary in non-HIV patients. Among extrapulmonary TB, abdominal tuberculosis (ATB) accounts for 11%-16%. Abdominal TB is difficult to diagnose because of its lack of specific symptoms, low yield of acid-fast bacilli (AFB) on smear and culture due to paucibacillary lesion; and variable manifestations depending upon anatomical localization of the disease. The diagnosis of abdominal TB classically requires histopathological, microbiological and culture confirmation of Mycobacterium tuberculosis. Investigations like Imaging (Ultrasound, Barium X-Rays, and CT scan) and the Mantoux test have only supportive value. Aim of the study: The aim of the study was to diagnose modalities and antimicrobial susceptibility in abdominal tuberculosis patients.Material & Methods:This cross-sectional hospital-based observational study was carried out among 73 adult patients with the diagnosis of abdominal TB who met the selection criteria and attended in Gastroenterology department of DMCH through either admission or referral from May 2015 to April 2016.Results:The most frequent symptoms were weight loss (96.9%), abdominal pain (75%), and fever (75%). The most frequent signs were anaemia (34.4%), followed by ascites (27.9%). Basis of diagnosis in abdominal tuberculosis was histolopathogy in 37.5%, Gene Xpert in 28.1%, Positive AFB on culture in 9.4%, ADA value in ascitic fluid (Cutoff >40 IU/L) in 25%, and good clinical response (Based on weight gain and general improvement in wellbeing) to a therapeutic trial of anti-TB treatment in 18.7% patients. Drug sensitivity pattern was analyzed in all three AFB culture-positive patients; resistance was detected in one which showed multidrug resistance (MDR TB).Conclusions:The result of this study highlighted the diagnostic yield of various investigation modalities, particularly newer modalities (Gene Xpert, culture sensitivity in Bactec MGIT 960) and basis of diagnosis in abdominal TB. This study also determined the MTB culture positivity from tissue biopsies in patients with abdominal TB and demonstrated drug-resistant MTB in culture-confirmed abdominal TB.