Characteristics and Antibiotic Resistance of Urinary Tract Pathogens Isolated from Indoor Cases of A Tertiary Care Hospital

Abstract

Objective: To determine the antimicrobial sensitivity of uropathogens among inpatients at a tertiary care hospital in Pakistan. Study Design: Cross-sectional study Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi; Pakistan Apr to Jun 2023. Methodology: After ethics approval, male and female adult patients from medical wards were included. Non-probability, consecutive sampling was used. Patients with clinical and/ or urinalysis findings of urinary tract infection were included, excluding those unwilling or unable to provide informed consent. Demographic variables and clinical history were collected. 1,339 Urine cultures were sent to the Department of Microbiology, Army Medical College, Rawalpindi. Antimicrobial susceptibility testing was performed via the disc diffusion method for isolates. Results: The mean age of the participants was 51.00 (34.00-67.00) years with 795(59.37%) females. The most common primary diagnosis was neurological disease (n=177 [13.22%]). Positive growth was identified in 1,294 (96.64%), with 27(2.02%) fungal infections. Of the 1,267 bacterial isolates, 1,055(83.27%) were Gram-negative. Escherichia coli was the most frequently isolated pathogen, with 846 cases (66.78%), followed by Enterococcus faecalis with 178(14.05%). High sensitivity for E. coli was observed for Imipenem (99.44%), Meropenem (98.19%), and Amikacin (97.92%), while Ampicillin (6.73%) and Erythromycin (16.38%) exhibited low sensitivity. E. faecalis exhibited susceptibility to Nitrofurantoin (97.19%) and Fosfomycin (91.57%) but showed lower susceptibility to Ampicillin (38.20%) and doxycycline (17.98%). Conclusion: Antibiotics exhibiting higher efficacy across various uropathogens should be considered for the first-line empirical treatment for UTIs. Local antimicrobial resistance patterns exist and susceptibility testing is recommended for inpatient UTIs.