ABSTRACT
Background and Objectives : Routine surveillance and monitoring studies pose a constant need to update clinicians on prevalent pathogens and rational and empirical treatment in Urinary Tract Infection (UTI). Escherichia coli (E coli) is the most commonly isolated uropathogen globally. Extended-Spectrum ?-Lactamase (ESBL) production and ?-Lactamase Inhibitor Resistance (BLIR) among these pathogens together with their uro-virulence determinants further complicate treatment approaches. This study investigated the clinico-microbiological pattern of UTI and determined the antibiotic sensitivity pattern, the phylogenetic background, and virulence determinants of E coli, the most commonly isolated uropathogen. Methods : Uropathogens isolated by urine culture from community and hospitalized patients were biochemically speciated. Antibiotic susceptibility was tested by Kirby-bauer disk diffusion method. Phylogenetic background and virulence determinants of E coli isolates were identified by PCR. SPSS 16.0 was used for statistical interpretation. Results : 45% of the urine samples showed growth positivity. 44% amongst them were E coli. All isolates were multidrug-resistant. 50% and 40% were ESBL producers and BLIR respectively. Former showed highest resistance to quinolone, fluoroquinolones, cotrimoxazole, and latter were resistant against all drugs tested except nitrofurantoin. Significant correlation existed between the ?-lactams, quinolone, fluoroquinolones, cotrimoxazole (p<0.05) resistance pattern. BLIR and ESBL E coli recorded highest prevalence of pathogenic phylogroup B2 and D respectively. Varied prevalence of fimbrial (fimH, papC, papEF, papG, GII) and toxin genes (iroN, hlyA, cnfI, i ucD, cdtBU) in ESBL, BLIR and non-ESBL isolates were observed. Their distribution was statistically significant (p=0.05). Interpretation and Conclusions : Nitrofurantoin is the drug of choice in empirical treatment of uncomplicated UTI. Aggressive and consistent investigation and health education are highly recommended for effective clinical management in UTI.
ABSTRACT
Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disease. Infections are the most common complications. Early detection, proper management of infection and its differentiation from Lupus flare are of paramount importance. Objective : To find out the prevalence of infections with various etiologic agents among on-treatment SLE patients who were hospitalized for suspected infections and to differentiate infections from disease flare. Methods : This was a cross-sectional observational study with 50 patients of more than 16 years of age of both sexes fulfilling the Systemic Lupus International Collaborating Clinics (SLICC) 2012, classification criteria of SLE who were admitted for suspected infection as manifested by fever and systemic symptoms. Specific tests to identify etiological agent for infection were performed and the condition was differentiated from lupus flare with the help of the tests such as Total Leucocyte Count (TLC), C-reactive Protein (CRP), Anti-ds DNA, complements-C3 and C4. Result : Infections were evident in 42 patients (84%) with predominant monoinfection being pneumonia in 13 patients (30.9%) followed by Urinary Tract Infection (UTI) in 8 patients (19%). Streptococcus pneumoniae was the major cause of Pneumonia while Escherichia coli caused most of UTIs. The infection markers were fever, CRP and TLC. Of the 42 patients, 40 patients (95%) had fever, 28 (66.7%) had Leukocytosis and 35 (83%) had CRP 10 mg/L or more indicating infection. Anti-ds DNA antibody was raised in 4 patients out of total 6 patients with Lupus flare. The complements C3 and C4 values were low in all the 6 patients. No patient of disease flare had raised CRP or Leukocytosis Conclusion : Among 50 on-treatment SLE patients who were admitted in two Tertiary Care Hospitals of Kolkata with suspected infection it was found that 42 patients were having infections and 6 patients were suffering from Lupus flare. The predominant monoinfection was Pneumonia followed by UTI.