https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/536 Wed, 26 Jun 2024 11:16:58 +0000 Abstract Background and objectives: Urinary tract infections remain one of the most common infections in the community and susceptibility of uropathogens to commonly used antimicrobials has declined over the years. It is important to periodically study the antibiogram of uropathogens, so that empiric treatment can be determined using recent data and thus improving patient outcomes. The present study evaluated the antibiotic resistance trend of prevalent Gram-negative uropathogens in urine samples received at the microbiology laboratory at a tertiary care hospital. Material and methods: The study was conducted at the Department of Microbiology, Sir Takhtsinhji Hospital, Bhavnagar for one year period from March 2021 to February 2022. All received urine samples for culture and sensitivity were included in the study. All samples were subjected to culture and sensitivity using standard methods. Results: During study period, 918 (18.6%) organisms were isolated from 4938 urine samples. Out of 918, 85.1% (781) was Gram-negative and 9.8% was Gram-positive bacteria while 5.1% was Candida spp. Escherichia coli was the most prevalent (61.7%) of the total Gram-negative isolates. Gram-negative isolates were most resistant to amoxicillin/clavulanic acid, quinolones, trimethoprim/sulfamethoxazole. The rate of resistance to aminoglycosides, nitrofurantoin, third generation cephalosporins and carbapenems was comparatively low. Conclusion: Antimicrobial resistance of the prevalent uropathogens should be monitored routinely to plan effective empirical therapy. July 2024; Vol. 18(2):007. DOI: https://doi.org/10.55010/imcjms.18.019 *Correspondence:Kairavi Desai, Department of Microbiology, Government Medical College, Sir Takhtasinhji Hospital, Bhavnagar, Gujarat, India-364001. E-mail:drkairavi@yahoo.in   Introduction Urinary tract infection (UTI) is a common bacterial infection encountered in the community and hospitals. UTI accounts for 35% of total hospital acquired infections (HAIs). It is a leading cause of morbidity and healthcare expenditures in people of all ages [1]. Predisposing factors for UTI are age, gender, race, nutrition, hygiene, and immune status of the patients [2]. Post-menopausal women have a higher incidence of UTI due to uterine prolapse, less estrogen activity, altered vaginal microbiota, and associated co-morbid conditions like diabetes mellitus [3,4]. Prolonged hospital stay due to other medical and surgical problems and urinary catheterization are the most important risk factors among older people of both sexes. It is important to know the trends of antimicrobial susceptibility patterns of bacteria causing UTI at a given locality or hospital to ensure effective treatment. First and second generation cephalosporins, nitrofurantoin and fluoroquinolones are the most effective drugs for community acquired UTIs. On the other hand, parenteral therapy with third generation cephalosporins and carbapenems are often needed to treat nosocomial UTIs as the causative bacteria exhibit a high degree of resistance to commonly used antimicrobial agents [5,6]. Since patterns of antibiotic resistance in a wide variety of pathogenic organisms vary even over short period of time and depend on the site of isolation and different environments, periodic evaluation of antibacterial susceptibility of pathogenic bacteria is always needed. In view of the above, the current study was planned to find out the prevalence of Gram-negative uropathogens and their antimicrobial susceptibility patterns at a tertiary care hospital in Gujarat, India.   Materials and methods The study was conducted, at a tertiary care hospital, Bhavnagar, Gujarat, India from March 2021 to February 2022.The study was approved by the Institutional Sub-Ethical Committee prior to commencement of study. Ethical approval letter No. 1050/2021. Date: 24/02/2021. All the urine samples received for culture and sensitivity in microbiology laboratory were included in the study. Repeat urine samples from the same admission were excluded. Samples were processed immediately to ensure maximum recovery of the pathogen. Culture was performed on cystine-lactose-electrolyte deficient (CLED) agar and plates were incubated overnight at 35-370C [7]. A sample was considered culture positive if the bacterial count was ≥ 105 and ≥ 103 colony forming unit/mL (CFU/mL) for non-catheterized and catheterized patient respectively. The isolates were identified by motility and standard bio-chemical tests. Antibiotic susceptibility of organisms was performed by Kirby-Bauer disk diffusion method on Mueller-Hinton agar plates with following antibiotics: trimethoprim/sulfamethoxazole (23.75/1.25µg), nitrofurantoin (30µg), gentamicin (10µg), tobramycin (10µg ), amikacin (30µg), tetracycline (30µg), amoxicillin-clavulanic acid (20/10µg), ciprofloxacin (5µg), ofloxacin (5µg), norfloxacin (10µg), ceftriaxone (30µg), ceftazidime (30µg), cefotaxime (30µg), cefepime (30µg), piperacillin (100µg), piperacillin/tazobatum (100/10µg), and meropenem (10µg). Diameters of the zones of inhibition were interpreted according to CLSI 2022 guideline [8].   Results   Detail rate of resistance of total isolated Gram-negative uropathogens to different antimicrobial agents is shown in Table-2. Out of 781 Gram-negative bacteria, 81.2% were resistant to amoxicillin/clavulanic acid while least resistance was observed against meropenem and 3rd generation cephalosporins except ceftriaxone (Table-2). Table-2: Pattern of resistance of total isolated Gram-negative uropathogens to different antimicrobial agents (N=781)     2026 Ibrahim Medical College. All rights reserved.