Antibiotic Sensitivity and Resistance Patterns of Uropathogens in Peshawar, Pakistan
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Abstract
Background: Urinary tract infections (UTIs) are a major global health issue, primarily caused by bacteria invading the urinary system. Escherichia coli is the most common pathogen, with increasing resistance to antibiotics posing treatment challenges.
Objective: This study evaluated the antibiotic sensitivity and resistance patterns of uropathogens from UTI patients in Peshawar, Pakistan, to guide effective therapy and inform local healthcare practices.
Methods: A cross-sectional study was conducted from January 1 to May 30, 2023, at the Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar. The study included patients aged 16 years and older diagnosed with UTIs. Urine samples were cultured, and significant bacteriuria was defined as growth of ≥10<sup>5</sup> CFU/mL. Uropathogens were tested for antibiotic sensitivity using the disk diffusion method and VITEK-2 compact system. Data were analyzed using IBM SPSS version 25.
Results: Of 137 samples, 80.3% were gram-negative, and 19.7% were gram-positive. Escherichia coli was the most prevalent pathogen (57.7%). Among gram-negative bacteria, Fosfomycin had 91.2% sensitivity, while Cefixime showed 85.5% resistance. For gram-positive bacteria, Piperacillin/Tazobactam had 100% sensitivity, while Cefixime and Moxifloxacin had 100% resistance.
Conclusion: The study identified Escherichia coli as the predominant uropathogen, with significant resistance to common antibiotics like Ciprofloxacin and Cefixime. Fosfomycin, Meropenem, and Imipenem were more effective against resistant strains. Routine susceptibility testing and updated treatment protocols are essential to combat antibiotic resistance and improve patient outcomes.
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References
McDaniel CE, Ralston S, Lucas B, Schroeder AR. Association of Diagnostic Criteria With Urinary Tract Infection Prevalence in Bronchiolitis: A Systematic Review and Meta-analysis. JAMA Pediatr. 2019;173(3):269-277. doi:10.1001/jamapediatrics.2018.5091.
Al-Badr A, Al-Shaikh G. Recurrent Urinary Tract Infections Management in Women: A Review. Sultan Qaboos Univ Med J. 2013;13(3):359-367. doi:10.12816/0003256.
John AS, Mboto CI, Agbo B. A Review on the Prevalence and Predisposing Factors Responsible for Urinary Tract Infection Among Adults. Eur J Exp Biol. 2016;6:7-11.
Amali O, Indinyero M, Umeh E, Awodi N. Urinary Tract Infections Among Female Students of the University of Agriculture, Makurdi, Benue State, Nigeria. Int J Microbiol. 2009;7:1–5.
Beyene G, Tsegaye W. Bacterial Uropathogens in Urinary Tract Infection and Antibiotic Susceptibility Pattern in Jimma University Specialized Hospital, Southwest Ethiopia. Ethiop J Health Sci. 2011;21:141–146. doi:10.4314/ejhs.v21i2.69055.
Foxman B. The Epidemiology of Urinary Tract Infection. Nat Rev Urol. 2010;12:653-660. doi:10.1038/nrurol.2010.190.
Huysal K, Budak YU, Karaca AU, Aydos M, Kahvecioğlu S, Bulut M, Polat M. Diagnostic Accuracy of UriSed Automated Urine Microscopic Sediment Analyzer and Dipstick Parameters in Predicting Urine Culture Test Results. Biochem Med (Zagreb). 2013;23:211-217. doi:10.11613/bm.2013.025.
Chakupurakal R, Ahmed M, Sobithadevi DN, Chinnappan S, Reynolds T. Urinary Tract Pathogens and Resistance Pattern. J Clin Pathol. 2010;63:652-654. doi:10.1136/jcp.2009.074617.
Rudramurthy KG, Kumaran R, Geetha RK. Etiology and Antimicrobial Susceptibility Pattern of Bacterial Agents from Urinary Tract Infection in a Tertiary Care Centre. Int J Sci Stud. 2015;2:125-127.
Gupta V, Yadav A, Joshi RM. Antibiotic Resistance Pattern in Uropathogens. Indian J Med Microbiol. 2002;20:96-98.
Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary Tract Infections: Epidemiology, Mechanisms of Infection and Treatment Options. Nat Rev Microbiol. 2015;13:269-284.
Moue A, Aktaruzzaman SA, Ferdous N, Karim MR, Khalil MM, Das AK. Prevalence of Urinary Tract Infection in Both Outpatient Department and Inpatient Department at a Medical College Setting of Bangladesh. Int J Biosci. 2015;7(5):146–152. doi:10.12692/ijb/7.5.146-152.
Khatoon I, Khanam S, Azam A, Qadeer S, Naz S, Hassan NU. Incidence Pattern, Antibiotic Susceptibility Pattern and Associated Risk Factors of Bacterial Uropathogens Among General Population of Pakistan. Infect Drug Resist. 2023;16:4995-5005. doi:10.2147/IDR.S418045.
Frequency Pattern and Antibiogram of Organisms in Patients with Urinary Tract Infection [Internet]. Khyber Journal of Medical Sciences. Available from: https://kjms.com.pk/old/node/1931.
Ahmad S, Ali F, Qureshi SA, Uzma B, Shakeela Q, Sabir MS, Ahmad S, Haq I, Rasheed A, Ahmed S, Farooq M. The Evaluation of Antibiotic Susceptibility Pattern and Associated Risk Factors of UTI in Tertiary Care Hospital of Peshawar. Pak J Pharm Sci. 2022;35(3(Special)):897-903. PMID: 35791585.
Cullen IM, Manecksha RP, McCullagh E, et al. An 11-Year Analysis of the Prevalent Uropathogens and the Changing Pattern of Escherichia coli Antibiotic Resistance in 38,530 Community Urinary Tract Infections, Dublin 1999-2009. Ir J Med Sci. 2013;182:81-89. doi:10.1007/s11845-012-0834-5.
Afridi FI, Farooqi BJ, Hussain A. Frequency of Extended Spectrum Beta Lactamase Producing Enterobacteriaceae Among Urinary Pathogen Isolates. J Coll Physicians Surg Pak. 2011;21(12):741-744. PMID: 22166694.
Mamuye Y. Antibiotic Resistance Patterns of Common Gram-negative Uropathogens in St. Paul's Hospital Millennium Medical College. Ethiopian journal of health sciences. 2016;26(2):93-100.
Akhavizadegan H, Hosamirudsari H, Pirroti H, Akbarpour S. Antibiotic resistance: a comparison between inpatient and outpatient uropathogens. East Mediterr Health J. 2021;27(2):124-30.
Hrbacek J, Cermak P, Zachoval R. Current antibiotic resistance patterns of rare uropathogens: survey from Central European Urology Department 2011-2019. BMC urology. 2021;21(1):61.
Abdel Gawad AM, Ashry WMO, El-Ghannam S, Hussein M, Yousef A. Antibiotic resistance profile of common uropathogens during COVID-19 pandemic: hospital based epidemiologic study. BMC microbiology. 2023;23(1):28.
Cai T, Verze P, Arcaniolo D, Pandolfo SD, Smarrazzo F, Manfredi C, et al. Antibiotic Resistance Patterns Among Uropathogens in Female Outpatients Affected by Uncomplicated Cystitis: Focus on Fosfomycin Trometamol. International journal of antimicrobial agents. 2023;62(5):106974.
Iqbal Z, Sheikh AS, Basheer A, Hafsa HT, Ahmed M, Sabri AN, et al. Antibiotic Drug Resistance Pattern of Uropathogens in Pediatric Patients in Pakistani Population. Antibiotics (Basel, Switzerland). 2023;12(2).