Urinary Tract Infection among Inpatients: An Insight into Risk Factors and Antimicrobial Resistance

Background: Gram negative organisms are the leading cause of Urinary tract infections with increasingly prevalent antimicrobial resistance. Thereby an observational cross sectional study was conducted to determine the rate of isolation, evaluation of the risk factors and antimicrobial resistance pattern of these organisms. Methods: In the prospective analysis, 72 urine samples with significant bacteriuria and culture positive for gram negative bacteria confirmed biochemically, among inpatients were taken into consideration. In addition presence of risk factors was evaluated. Antibiotic susceptibility test was performed using Kirby Bauer’s disk diffusion method. Results: E. coli accounted for 56.9% followed by Klebsiella species (23.6%). Enterobacter, Pseudomonas and Acinetobacter species were 5-8% prevalent. The risk factors like diabetes mellitus and pregnancy were 20.8% and 13.8%. Other risk factors like recurrent UTI, renal stones, presence of indwelling catheter, smoking, use of OCP/IUCD and post menopausal oestrogen deficiency were 1-7%. The antimicrobial resistance for Enterobacteriaceae group of organisms were 70-90% for cefuroxime, ceftriaxone, cefepime and co-trimoxazole, 50-53% for ciprofloxacin and norfloxacin, 32.2% for ampicillin-sulbactum, 19.3% for nitrofurantoin, 8.1% for amikacin, 20.9% for piperacillin-tazobactum and 14.5% for imipenem. The antimicrobial resistance for Pseudomonas and Acinetobacter species was 50% for ceftazidime and cepepime, 20% for amikacin, piperacillin-tazobactum and imipenem, and 0% for meropenem. Conclusion: The present study confers Escherichia coli as the predominant bacterial isolate and diabetes mellitus as the predominant risk factor causing UTI. Amikacin, piperacillin-tazobactum and imipenem are the most sensitive drugs.

Emergence of Salmonella Paratyphi A and Submergence of Salmonella Typhi and Their Trend Over Four Years.

Background: Enteric fever is classically caused by Salmonella enterica serotype Typhi. There has been increase in enteric fever cases from different parts of India caused by Salmonella enterica serotype Paratyphi A. Thereby a retrospective study was conducted to determine the rate of isolation and antimicrobial susceptibility pattern of Salmonella Paratyphi A in comparison to Salmonella Typhi. Methods: A retrospective analysis of laboratory records was carried out from January 2011-December 2014. Conventional blood culture method was used. Salmonella were confirmed by serotyping using group and type specific anti-sera. Antibiotic susceptibility was performed for ampicillin, cotrimoxazole, ciprofloxacin, chloramphenicol and ceftriaxone, using Kirby Bauers disk diffusion method. Results: Out of 258 Salmonella isolates, 127 (49.2 %) were Salmonella Typhi and 131 (50.8 %) were Salmonella Paratyphi A. Salmonella Paratyphi A cases increased from 23.4% in 2011-2013 to 91.3% in 2014. Salmonella Typhi were 98.4 % sensitive to ampicillin and ceftriaxone and 99.2% sensitive to chloramphenicol and cotrimoxazole. Only 29.9% were sensitive to ciprofloxacin. Similarly, Salmonella Paratyphi A isolates were 99.2 % sensitive to ampicillin and 100 % sensitive to cotrimoxazole and ceftriaxone and 96.9 % sensitive to chloramphenicol and only 14.5 % sensitive to ciprofloxacin.Conclusion: The present study confers Salmonella Paratyphi A as the rapidly emerging pathogen of enteric fever. The antibiogram of Salmonella Typhi and Salmonella Paratyphi A showed decreased susceptibility to fluoroquinolones and a notable decrease in the multi drug resistant strains of Salmonella isolates with re-emergence of susceptibility to first line antibiotics.