1. health and fitness
2. disease

Maria Sindhura John, J Biosci Tech,Vol 6(1),2015,620-626
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Prevalence and antibiotic susceptibility pattern of bacterial
pathogens causing urinary tract infections in
humans at a tertiary care hospital in AP
N.Premanatham1, Maria Sindhura John*2, P.Muni Lakshmi3 and P.Sreenivasulu Reddy4
1. Associate Professor, 2. Tutor, 3. Assistant Professor 4. H.O.D
Dept. of Microbiology Narayana Medical College, Nellore, A.P.
*Corresponding author, E.Mail: sindhura .john @gmail.com.
ABSTRACT:
BACKGROUND: Urinary tract infections are most common infection caused by
bacterial pathogens seen mostly in developing countries. It is one of the common
clinical conditions in the patients presenting to the hospitals. A causative agent varies
from place to place. OBJECTIVE: Studies are done to know the most common
pathogen of urinary tract infections and its antibiotic susceptibility patterns, which is
helpful to the clinicians. MATERIAL AND METHODS: A total of 200 mid-stream
urine samples collected from the suspected UTI patients were tested microbiologically
on CLED agar and antimicrobial susceptibility test were performed for the isolated
pathogens using Kirby-Bauer disk diffusion method. RESULTS: The rate of culture
positivity in females was 91.6% and in males was 40.3%. E-coli was the most
frequently isolated urinary pathogen (42.8%), followed by Klebsiella(16.8%) and
Acinetobacter (12.9%).E-coli was highly sensitive to Nitrofurantoin(72.7%) and
followed by Gentamycin, Imipenam, Nalidixic acid. and it was highly resistant to
Ampicillin(3%). Klebsiella was highly sensitive to Impinem (92.3%) and it was highly
resistant to Ampicillin. CONCLUSION: Higher prevalence of UTI was seen in
females. Gram negative organisms were the most commonly isolated in UTI than gram
positive organisms. Among which E.coli is most commonly isolated orgaism showing
high sensitive to nitrofurantoin followed by Klebsiella and Acinitobacter.
1. INTODUCTION
A urinary tract infection, or UTI, is an
infection of the urinary tract. The infection
can occur at different points in the urinary
tract. An infection in the bladder is also called
cystitis or a bladder infection. An infection of
one or both kidneys is called pyelonephritis or
a kidney infection. The tubes that take urine
from each kidney to the bladder are only
rarely the site of infection. An infection of the
tube that empties urine from the bladder to the
outside is called urethritis.
Urinary tract infections are the most common
infections in clinical practice. (1) Urinary
tract infection (UTI) is one of the most
important causes of morbidity in the general
population, and is the second most common
cause of hospital visits. (2)
KEYWORDS:
Urinary tract infections,
Bacterial pathogens,
Midstream,
Nitrofurantoin,
CLED
Uncomplicated UTIs typically occur in the
healthy adult non-pregnant woman, while
complicated UTIs (cUTIs) may occur in all
sexes and age groups and are frequently
associated with either structural or functional
urinary tract abnormalities. Examples include
foreign bodies such as calculi (stones),
indwelling catheters or other drainage
devices, obstruction, immunosuppression,
renal failure, renal transplantation and
pregnancy.(3)
UTIs is described as a bacteriuria with urinary
symptoms (4). The lower UTI infection is
characterized by symptoms such as dysuria,
frequency,
urgency,
and
suprapubic
tenderness.(5).
UTI is more common in females than in males
as female urethra structurally found less
effective for preventing the bacterial entry (6).
It may be due to the proximity of the genital
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Maria Sindhura John, J Biosci Tech,Vol 6(1),2015,620-626
tract and urethra (7) and adherence of
urothelial mucosa to the mucopolysaccharide
lining (8). The other main factors which make
females more prone to UTI are pregnancy and
sexual activity (9). In pregnancy, the
physiological increase in plasma volume and
decrease in urine concentration develop
glycosuria in up to 70% women which
ultimately leads to bacterial growth in urine
(10). Also in the nonpregnant state the uterus
is situated over the bladder whereas in the
pregnant state the enlarged uterus affects the
urinary tract (11). Sexual activity in females
also increases the risk of urethra
contamination as the bacteria could be pushed
into the urethra during sexual intercourse as
well as bacteria being massaged up the
urethra into the bladder during child birth (12,
13).
Using a diaphragm also causes UTI as it
pushes against the urethra and makes the
urethra unable to empty the bladder
completely and the small concentration of
urine left in the bladder leads to the growth of
bacteria which ultimately causes UTI (14).
UTI is frequently encountered in patients with
diabetes and in those with structural and
neurological abnormalities, which interfere
with urinary flow. The prevalence in both out
and hospital patients with UTI is increasing
and can vary according to geographical and
regional location. (15)
The aim of the study is to determine the
prevalence of UTI in male and female patients
as well as the effect of gender and age on its
prevalence.
The
UTI-causing
microorganisms, their distribution among
different ages and genders, also be
determined.
The quantitative criterion appropriate for the
microbiological identification of significant
bacteriuria is generally considered to be at
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least 108 cfu/L. In some specific groups it is
less: for men ≥106 cfu/L; and for women with
symptoms of UTI it is ≥105 cfu/L. (16)
The most common pathogenic organisms of
UTI are Escherichia coli, Staphylococcus
saprophyticus and less common organisms are
Proteus
sp.,
Klebsiella
pneumoniae,
Pseudomonas aeruginosa, Enterococci and
Candida albicans.(17).Although a broad range
of pathogens can cause UTI, Escherichia
coli remains the most common; however,
even this organism is becoming resistant to
the agents that are normally prescribed.
Drugs commonly recommended for simple
UTIs are Sulfamethoxazole-trimethoprim
(Bactrim, Septra, others) Amoxicillin
(Amoxil, Augmentin, others) Nitrofurantoin
(Furadantin, Macrodantin, others) Ampicillin,
Ciprofloxacin
(Cipro),
Levofloxacin
(Levaquin)
Usually, symptoms clear up within a few days
of treatment. But you may need to continue
antibiotics for a week or more. Take the entire
course of antibiotics prescribed by your
doctor to ensure that the infection is
completely gone.
2. MATERIAL AND METHODS
This prospective study was conducted over a
period of six months. During this period a
total of 200 urine samples were collected in
sterile containers from suspected urinary tract
infected cases from different clinical
departments in Narayana Superspeciality
Hospital, Nellore, A.P. Work is carried out in
Department of Microbiology, Narayana
Medical College, Nellore, AP.
Mid-stream urine samples from the suspected
UTI patients referred by physicians are taken.
The urine samples were collected into labelled
20ml calibrated sterile bottles distributed to
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Maria Sindhura John, J Biosci Tech,Vol 6(1),2015,620-626
the patients by the attending physicians
suspected to have UTIs. In each container,
boric acid (0.2 mg) was added to prevent the
growth of bacteria in the urine. All patients
were instructed on how to collect the urine
samples aseptically and taken to the
laboratory immediately for culture.
The collected urine samples were inoculated
on CLED (cysteine lactose electrolyte
deficient agar) agar plates and cultured media
were incubated aerobically at 37°C. The urine
culture plates were examined for pure growth
determined by morphologically same type of
colonies and colony counts for determination
of significant and insignificant growth. A
growth of ≥105 colony forming units/ml was
considered as significant bacteriuria.
Identification of bacterial pathogens was
made on the basis of Gram reactions,
morphology, biochemical characteristics and
cultural characteristics. Gram staining was
performed to differentiate the Gram positive
and Gram negative organisms.
Antimicrobial sensitivity of the confirmed
micro-organisms was done by disc diffusion
method on Muler Hinton agar. Antibiotic
susceptibility tests and interpretations were
carried out for bacterial isolates by the KirbyBauer technique. The antibiotics tested were
Nitrofurantoin, Amikacin, Cotrimoxazole,
Gentamycin,
Ciprofloxacin,
Cefoxitim,
Nalidixic acid, Norfloxacin, Ampicillin and
Impinem for gram negative organisms For
gram positive organisms drugs tested were
penicillin,
amoxicillin,
Doxycyclin,
vancomycin, oxacillin, linezolid, cefoxitin.
3. RESULTS
The study was done from June 2014 to
December 2014 at the Department of
Microbiology, Narayana Medical College,
Nellore, AP, and India. The name, age, sex
and address of the patients was also recorded.
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Pathogenic bacteria were isolated in 200
samples with a prevalence rate of 77%.The
prevalence in females was 91.6% and the
prevalence rate in males was 40.3%,
theprevalence pattern in males and females
were shown.(Table-1)
A total of 200 samples were collected in the
study period.among which 143 (91.6%) were
from females and 57(40.3%) samples were
from males.131 samples are positive among
females and 23 samples are positive among
males. Highest no.of samples are collected
from females. (Table-1)
Based on age distribution maximum no.of
samples collected from 21-40 yrs age were
101 samples (50.5%). UTI was most
commonly seen in the age group. Minimum
no.of samples collected from age group >80
were 9 samples(4.5%).below age group 20 yrs
the
samples
collected
were
47
(23.5%).(Table-2)
Among the pathogenic bacteria isolated, Ecoli was the most frequently isolated urinary
pathogen (42.8%), followed by Klebsiella
(16.8%), Acinetobacter (12.9%) and candida
(11%). Pseudomonas and Proteus was isolated
as1.9%, 0.6% respectively(Table- 3)
Age and gender wise distribution of
pathogens causing urinary tract infection is
clearly shown. Among the age group 21-40
yrs 87 (86.1%) samples were shown positive.
Among them highest positivity is shown by
females, 80samples than males 7samples.
Least no.of samples were collected from >80
yrs,3 samples. Among them females showed
positivity of 2 samples, while men showed 1
sample. (Table-4)
E.coli was highly sensitive to Nitrofurantoin.
and it was highly resistant to Ampicillin.
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Maria Sindhura John, J Biosci Tech,Vol 6(1),2015,620-626
TABLES
1. SEX WISE DISTRIBUTION
S.NO
SEX
1
2
MALE
FEMALE
TOTAL
NO.OF
SAMPLES
PROCESSED
57
143
200
NO.OF
POSITIVE
SAMPLES
23
131
154
PERCENTAGE
%
40.3%
91.6%
77%
2. AGE DISTRIBUTION
AGE
TOTAL SAMPLES COLLECTED
<20
21-40
41-60
61-80
>80
TOTAL
47
101
27
16
9
200
PERCENTAGE
%
23.5%
50.5%
13.5%
8%
4.5%
100%
3. URINARY PATHOGENS ISOLATED
PATHOGENS
ISOLATED
E.coli
Klebsiella
Acinitobacter
Candida
Citrobacter
CONS
Staphylococcus
Pseudomonas
Proteus
TOTAL NO. OF
PATHOGENS
66
26
20
17
10
6
5
3
1
PERCENTAGE%
42.8%
16.8%
12.9%
11%
6.4%
3.8%
3.2%
1.9%
0.6%
4. AGE AND GENDER WISE DISTRIBUTION
OF URINARY TRACT INFECTION
AGE
<20
21-40
41-60
61-80
>80
TOTAL
NO.OF POSITIVE SAMPLES
MALE
FEMALE
9
28
7
80
5
13
1
8
1
2
23
131
TOTAL
PERCENTAGE%
37/47
87/101
18/27
9/16
3/9
154/200
78.7%
86.1%
66.6%
56.2%
33.3%
77%
623
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5. ANTIBIOTIC SUSCEPTIBILITY PATTERN OF
GRAM NEGATIVE ISOLATES
Maria Sindhura John, J Biosci Tech,Vol 6(1),2015,620-626
DRUGS
Nitrofurantoin
Amikacin
Cotrimoxazole
Gentamycin
Ciprofloxacin
Ceftriaxime
Nalidixic acid
Ampicillin
Imipenam
Amoxyclav
E.COLI
48/66 (72.7%)
20/66 (30.3%)
10/66 (15.1%)
32/66 (48.4%)
15/66 (22.7%)
12/66 (18.1%)
40/66 (60.6%)
2/66 (3%)
42/66 (63.6%)
6/66 (9%)
KLEBSIELLA
23/26 (88.4%)
16/26 (61.5%)
8/26 (30.7%)
6/26 (23%)
3/26 (11.5%)
2/26 (7.6%)
20/26 (76.9%)
0/26 (Nil)
24/26 (92.3%)
6/26 (23%)
ACINITOBACTER
8/20 (40%)
12/20 (60%)
6/20 (30%)
10/20 (50%)
4/20 (20%)
3/20 (15%)
13/20 (65%)
0/20 (Nil)
14/20 (70%)
8/20 (40%)
6. ANTIBIOTIC SUSCEPTIBILITY PATTERN OF
GRAM POSITIVE ISOLATES
DRUGS
Penicillin
Amoxicillin
Doxycyclin
Cefoxitin
Oxacillin
Vancomycin
Linezolid
ENTEROCOCCI
2/10 (20%)
4/10 (40%)
8/10 (80%)
4/10 (40%)
3/10 (30%)
8/10 (80%)
10/10 (100%)
Klebsiella and Acinitobacter were highly
sensitive to Impinem and Amikacin . The
sensitivity pattern to other antibiotics is shown
in (Table 5).
Among gram positive organisms commonly
isolated organism is enterococci showing
highest sensitivity to linezolid, vancomycin,
doxycyclin. (Table6)
4. DISCUSSION
Our study findings are contrary to the belief.
Therefore it is recommended that larger sample
based studies may be taken up in which may
throw better light on bacterial pathogens
causing UTI and its susceptibility patterns.
This prospective study was conducted over a
period of six months from June 2014 to
December 2014. During this period a total of
200 samples received from various clinical
departments were tested for patogenic bacteria.
CONS
3/6 (50%)
3/6 (50%)
4/6 (66.6%)
5/6 (83.3%)
4/6 (66.6%)
6/6 (100%)
6/6 (100%)
STAPHYLOCOCCI
0/5 (Nil)
2/5 (40%)
3/5 (60%)
4/5 (80%)
3/5 (60%)
4/5 (80%)
5/5(100%)
In our study the total no. of samples collected
was 200 samples. Prevalence rate of isolation
of urinary pathogen in our study was 77%. It is
similar to the study by (Das RN etal) isolation
rate was 71.6 %.( 18)
In our study UTI was more in females when
compared to males. This was seen with other
studies by Bashir MF etal.(19) and GetenetB.
etal (20) Women are more prone to UTIs than
men because, in females, the urethra is much
shorter and closer to the anus.(21)
Several reports have indicated that females are
more prone to having UTIs than males
(Kolawaleetal, 2009), (22)
Womens propensity to develop UTIs has also
been explained on the basis of certain
behavorial factors, including delays in
micturation, sexual activity, the use of
diaphragms and spermicides (both of which
promote colonization of the periurethral area
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Maria Sindhura John, J Biosci Tech,Vol 6(1),2015,620-626
with bacteria). Also, the length of the urethea
(urethra), the dried environment surrounding
the meatus, and the antibacterial properties of
prostatic fluid contribute to a lower rate of
infection in males.
Higher proportions of patients were seen in the
age group between 20-40 years followed by <
20 years age group. This was in consistent with
a study by Beyene G et al (23) 12 in which
53.5% were in the age group between 19-39
years.
Susan AMK (24) who concluded that most
uncomplicated urinary tract infections occur in
women who are sexually active, with far fewer
cases occurring in older women, those who are
pregnant, and in men. The incidence of UTI
increases in males as the age advances because
probably because of prostate enlargement and
other related problems of old age.
E-coli was the most common isolated organism
in our study with percentage of (42.8%). This
was in seen in other studies by Gupta et al (25),
Moges et al(26) , Sibi et al(27). The second
most common isolated pathogen was Klebsiella
in our study accounting for 16.8%.This was in
agreement by Khameneh etal(28).
In our study E-coli was most resistant to
Ampicillin
and
smost
sensitive
toNitrofurantoin (72.7%). The similar findings
were seen in a study by (Bashir MF et
al).Among gram positive organisms our study
showed susceptibility pattern of enterococci as
Linezolid> vancomycin = doxycycline
Our study provides a bacteriological profile of
pathogens causing UTI and its susceptibility
pattern. It is recommended that it should be
included in the proper diagnosis of UTI, so that
timely and adequate treatment may be given to
patient as delay in treatment is associated
complicated UTI.
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