Escherichia coli was the predominant pathogen isolated (70.52%) from the urine cultures of 538 patients with urinary tract infections in Surat, India. Antibiotics like ampicillin showed high resistance rates of over 90% among isolated gram-negative pathogens. However, gram-negative pathogens demonstrated the highest sensitivity to amikacin, netromycin, piperacillin/tazobactum and cefoperazone/sulbactum with resistance rates below 5%. The study highlights the increasing antimicrobial resistance seen with commonly used antibiotics and identifies alternative antibiotic options for empirical therapy of urinary tract infections in the region.

1. PRESENTED BY
RAJANI D. P
MICROCARE LABORATORY, SURAT.
DESAI P. B
DIRECTOR & HEAD
DEPARTMENT OF MICROBIOLOGY,
SHREE RAMKRISHNA INSTI. OF COMP. EDU. & APPL. SCIENCES, SURAT.
“ANTIMICROBIAL RESISTANCE PATTERNS
OF THE ORGANISMS ISOLATED FROM
URINE CULTURE IN SURAT REGION”

2. INTRODUCTION
Urinary tract infection (UTI) is common both in the community and
hospitalized patients.
The widespread use of antimicrobial agents often leads to the
emergence of resistant microorganisms to one or several of them. [1]
Urinary tract infection (UTI) is a broad term that encompasses both
asymptomatic microbial colonization of the urine and symptomatic
infection with microbial invasion and inflammation of urinary tract
structures .

3. ETIOLOGY
Majority of UTI are due to a single pathogen.
The Enterobacteriaceae responsible for 90% of all UTI
- gram negative bacilli
- facultative anaerobic
- common intestinal flora
Escherichia coli most commonly isolated pathogen 80% of all UTI (1)
Apart from the outer one-third of the female urethra, the urinary tract
is normally sterile (2)
.

4. From a microbiologic perspective, urinary tract infection exists when
pathogenic microorganisms are detected in the urine, urethra, bladder,
kidney, or prostate.
In most instances, growth of more than 105
organisms per milliliter
from a properly collected midstream "clean-catch" urine sample
indicates infection.
However, significant bacteriuria is lacking in some cases of true UTI
Especially in symptomatic patients, a smaller number of bacteria (102
to 104
/ml) may signify infection.

5. colony counts of >105
/ml of midstream urine are occasionally due to
specimen contamination, which is especially likely when multiple
species are found (3).
Every female has a 20% life time risk of coming down with a UTI (5)
In children approximately 5% of girls and 1% of boys have a UTI by
11 years of age (6).
Antibiotics which have been recommended to treat UTIs include
Ampicillin, Trimethoprim-Sulfamethoxazole, Flouroquinolones and
Nitrofurantoin (7)
However due to incessant abuse and misuse of these antibiotics,
extensive resistance of micro-organisms to these antibiotics has
developed.

6. AIM OF STUDY
Identification and characterization of pathogen from UTI cases.
To find out Resistant Pattern from isolated pathogen.
Find out prevalence of UTI in South Gujarat region.

7. MATERIALS AND METHOD
 The present study was conducted during June., 2009 to Nov., 2009.
Only patients who have clinical symptoms of UTI were studied
Total 538 mid-stream urine specimens were obtained by clean – catch
method (Kunin, 1987).
The samples were collected in sterile universal containers and cultured
within 30 minutes of collection by standard method.

8. Samples that showed pure growth of isolate in a count of ≥105
colony-
forming units (CFU) per ml of urine after overnight incubation were
considered to indicate significant bacteriuria (Sleigh and Timbury, 1986;
Gerald et al, 1990).
Identification of organism was by standard methods and further tested
for drug susceptibility testing by disc diffusion method (as per CLSI
guideline). (8)

9. RESULT
Table-1: SEX WISE DISTRIBUTION :
SEX NO.OF PATIENTS
MALE 235
FEMALE 303
TOTAL 538
Table 1 shows that among 538
patients, majority are female
patients.

10. Table-2: SEX AND CULTURE POSITIVE:
SEX NO .OF POSITIVE
CULTURE
TOTAL NO.
PATIENTS
MALE 121 235
FEMALE 181 303
TOTAL 302 538
Table 2 shows that
total 302 positive
culture, significantly
high in female
patients.

11. TABLE-3: ISOLATED SPECIES WISE DISTRIBUTION:
Isolated pathogen No. of strain
E.coli 213
Klebsiella spp 42
Pseudomonas aeruginosa 15
Group D Enterococci 9
coagulase negative Staphylococci 8
Proteus spp 2
Candida albicans 16
Table 3 shows that predominant
organism was E.coli which was
responsible for 70.52% of the
infection.

12. TABLE-4 PERCENT RESISTANCE AGAINST EACH ANTIBIOTIC
Isolated pathogen E.coli Klebsiella
spp
Pseudomonas
aeruginosa
Group D
Enterococci
coagulase negative
Staphylococci
Proteus spp
No of Antibiotics @
Ampicillin10 95 97 99 10 6 92
Amikacin 30 1 0 2 3 2 0
Netromycin30 1 0 1 4 3 0
Nitrofuradantine 300 43 53 78 82 28 78
Cephaparazone
sulbactum 105
0 0 1 4 1 0
Piperacilin tazobactum
110
0 0 0 3 1 0
Table 4 shows that cephaparazone-sulbactum, piperacillin-tazobactum, amikacin
and netromycin are highly sensitive to gram negative pathogen.

14. DISCUSION
Our results demonstrate that drug resistance of Gram negative pathogen to
many antibiotics is high with the maximum prevalence of resistance being to
drugs that have been used for a long time, such as ampicillin.
Our results are similar to one other study that has been conducted in Iran.
They have reported Gram negative pathogen resistance to ampicillin of
96.8%. (11)
In this research, combination of two drug ccephaparazone-sulbactum, and
piperacillin-tazobactum were lowest resistant to all isolated pathogen compare
to other antibiotics.
Our result is similar to other study that has been conducted in Turkey. (12)
In present study also highly sensitive to amikacin and netromycin that is app.
(98-99%). Our result is some higher to other study that has been conducted in
Iran (13

15. CONCLUSION
The prevalence of UTI was significantly higher in women (56.32%)
than man with E.coli (70.52%) being the major isolated pathogen.
Gram negative pathogens were highly sensitive to amikacin,
netromycin, piperacillin/tazobactum and cefoperazone /sulbactum.

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Goldman E. editor. Cecil Textbook of Medicine 21st edition. W. B.
Saunders Company; 2000. p. 138
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