|Year : 2015 | Volume
| Issue : 1 | Page : 40-43
Urinary tract infection, its causative microorganism and antibiotic susceptibility in Nagaland
Sedevi Angami1, Nungsangmeren Jamir2, Pratap Chandra Sarma3, Akshay Chandra Deka2
1 Department of Microbiology, Christian Institute of Health Sciences and Research, Dimapur, Nagaland, India
2 Department of Pathology, Down Town College of Allied Health Sciences, Assam Down Town University, Guwahati, Assam, India
3 Principal Consultant, Down Town College of Allied Health Sciences, Assam Down Town University, Guwahati, Assam, India
|Date of Web Publication||13-Apr-2015|
Akshay Chandra Deka
College of Allied Health Sciences, Assam Down Town University, Gandhinagar, Panikhaiti, Guwahati - 781 026, Assam
Source of Support: None, Conflict of Interest: None
Aim: We studied the causative microorganisms and antibiotic susceptibility of urinary tract infections (UTI) for both male and female in Nagaland, North-Eastern India. Materials and Methods: This is a retrospective study done at Christian Institute of Health Sciences and Research, Dimapur, where urinary samples received for culture and sensitivity in the laboratory from January 2012 to June 2013 were included. Organisms were identified by doing standard culture method, and antibiotic sensitivity was done by Kirby-Bauer Disc diffusion method from mid-stream clean catch urine sample. Results: A total of 1789 samples were analyzed in this study, where 502 (28.1%) showed significant growth, 330 (18.4%) showed insignificant growth, and the rest 957 (53.5%) showed no growth. The most commonly isolated bacterium was Escherichia coli both in an outpatient department (31%) and in-patient department (38%) patients followed by Klebsiella pneumonia, Pseudomonas sp., Enterococcus, Staphylococcus aureus, Candida, and Proteus. Analysis of the samples showed that UTI was more common in females (60%) as compared to males (40%). It was also observed that the samples responded effectively to chloramphenicol (29%), gentamicin (28%), imipenem (26%), and amikacin (21%). High degree of resistance was shown for nalidixic acid, ciprofloxacin, norfloxacin, amoxyclav, and ofloxacin. Conclusion: Antibiotics have been in use for a long period and more often the misuse of antimicrobial drugs has today led to a general rise in the emergence of resistant bacteria. This study may aid health professionals in choosing the appropriate treatment for patients in North-Eastern India.
Keywords: Antibiotic, bacteria, susceptibility, urinary tract infection
|How to cite this article:|
Angami S, Jamir N, Sarma PC, Deka AC. Urinary tract infection, its causative microorganism and antibiotic susceptibility in Nagaland. Arch Med Health Sci 2015;3:40-3
|How to cite this URL:|
Angami S, Jamir N, Sarma PC, Deka AC. Urinary tract infection, its causative microorganism and antibiotic susceptibility in Nagaland. Arch Med Health Sci [serial online] 2015 [cited 2020 Mar 31];3:40-3. Available from: http://www.amhsjournal.org/text.asp?2015/3/1/40/154943
| Introduction|| |
Urinary tract infection (UTI) is a significant health problem, both in community and hospital based settings. It is also a serious health problem affecting millions of people each year.  UTIs are the most frequent bacterial infection in women. They occur most frequently between the ages of 16 and 35 years, with 10% of women getting an infection at some point in their lives. Recurrences are common, with nearly half of people getting a second infection within a year. UTIs occur 4 times more frequently in females than males. Antibiotics are the typical treatment for a UTI though resistance to antibiotics is highly prevalent in bacterial isolates all over the world, particularly in developing countries. 
Urinary tract infection is defined as bacteriuria along with urinary symptoms. It may involve only the lower urinary tract or may involve both the upper and lower tract. 
In almost all cases of UTI, empirical antimicrobial treatment initiates before the laboratory results of urine culture are not available; thus, antibiotic resistance may increase in uropathogens due to frequent use of antibiotics. Increasing resistance in patients with UTI is increasing and can vary according to geographical and regional location. ,,
Current management of UTIs is usually empirical, without the use of a urine culture or susceptibility testing to guide therapy. There is growing concern regarding antimicrobial resistance worldwide, particularly to Escherichia More Details coli, which are the dominant causative agent of UTI.
This study is designed to determine the profile of organisms causing UTI and their respective drug sensitivity patterns at a secondary level hospital in Dimapur, Nagaland, India.
| Materials and Methods|| |
The present study is a retrospective study, which was carried out in the central clinical microbiology laboratory of a secondary care hospital which is located in Dimapur, Nagaland, India. The duration of the study was one and half year period from January 2012 to June 2013.
A total of 1789 samples with or without signs to symptoms of UTI who attended the outpatient department (OPD), and in-patient department (IPD) of our hospital were recruited for this study. They consist of 1518 OPD and 271 IPD patients. Unsterile specimen, time delayed specimen for culture (after 30 min of collection), which were not kept refrigerated at 4°C and inadequate sample for urine culture were excluded from the study.
Freshly voided, clean-catch midstream urine was collected from each patient into sterile screw-capped universal container. The specimen was labeled and transported to the microbiology laboratory for processing within 2 h.
Semi quantitative urine culture was done using a calibrated loop. A loopful (0.001 mL) of well mixed un-centrifuged urine was inoculated onto the surface of MacConkey and blood agar. All plates were then inoculated at 37°C aerobically for 24 h. The plates were then examined macroscopically for bacterial growth. A significant growth is considered if the number of colony is >10 5 CFU.
Biochemical test included a series of tests, that is, mannitol, motility, triple sugar iron, and peptone water (MMTP) followed by citrate, urease, methyl red Voges-Proskauer, indole, nitrate, etc.
Antimicrobial susceptibilities of the bacteria isolates were performed according to the criteria of Clinical and Laboratory Standards Institute using the Kirby-Bauer Disc diffusion method on Muller-Hinton agar. Plates were inoculated for 24 h after inoculation with organisms and placements of disc. After 24 h the inhibition zones were measured. The following standard antibiotics discs for the isolates were used: Ampicillin, cotrimoxazole, nalidixic acid, amikacin, gentamicin, ciprofloxacin, norfloxacin, cefuroxime, cefotaxime, ceftazidime, Imipenem, nitrofurantoin, gatifloxacin, cefpodoxime, cefepime, amoxyclav, ofloxacin, chloramphenicol, cefoperazone, oxacillin, penicillin, linezolid, vancomycin, erythromycin, cefoxitin, teicoplanin, polymyxin B, and piperacillin.
| Results|| |
A total of 1789 samples were analysis, out of which 1518 (84.8%) were from OPD and 271 (15.2%) from IPD. Of these, 832 (47%) sample showed growth and 957 (53.5%) showed no growth. Out of all growth 502 (28.1%) showed significant growth, 330 (18.4%) showed insignificant growth. 690 (45.45%) specimen showed growth of 1518 OPD samples and 142 (52.39%) showed growth of 271 IPD samples.
The most commonly isolated bacterium was E. coli in both OPD and IPD samples with a frequency rate of 31% for OPD and 38% for IPD comprising overall (53%) followed by Klebsiella pneumonia (8.8%), Pseudomonas sp. (4.1%), Enterococcus (3.8%), Staphylococcus aureus (1.4%), Candida (1.4%), Proteus (1.4%), for OPD samples and Enterococcus (6.3%), Pseudomonas (5.6%), Klebseiella (4.2%), Candida (2.8%), Proteus (0.7%) [Table 1]. It was also observed that the samples responded effectively to chloramphenicol (29%), gentamicin (28%), imipenem (26%), and amikacin (21%) [Table 2]. Chloramphenicol appears to be a useful drug for UTI since it has not been used for many years, and a large number of organisms are sensitive to this drug at present. Amikacin was found to have intermediate sensitivity in most samples and ciprofloxacin, nalidixic acid, ofloxacin, norfloxacin, and amoxyclav penicillin was found to be resistant in most cases. There is a wide fluctuation to the sensitivity patterns of organisms to drugs, and there does not seen to be an upward or downward trend during the last 18 months. Higher prevalence of UTI was seen among females (60%) than male (40%).
| Discussion|| |
The UTI problem in hospitalized patients could be symptomatic or asymptomatic. Apart from the promotion of UTI from fecal matter, it occurs more readily in females than in males.  Catheter-associated UTIs in both males and females are extensive.  UTI which rank today at highest peak are one of the most common types of bacterial infections occurring in humans.  It has been usually observed that UTI most commonly occurs in females and up to one-third of all women experience a UTI at some point during their lifetimes. Our study showed female comprising 60%, and 715 were male comprising 40%, which is most commonly seen worldwide. ,,, The percent of positivity for urinary cultures was found to be 46.5% (832 out of 1789 samples). One possible explanation behind such low positive isolation rate may be that a screening urinalysis like microscopy, dipstick or nitrate test which will detect. Bacteriuria were not done for the patients which may help to choose only positive specimens to be sent for culture. The patterns of antimicrobial resistance of the micro-organisms causing UTI infections vary in their susceptibility to antimicrobials from place to place and from time to time.  UTIs are caused by a variety of microorganisms, including both Gram-positive and Gram-negative ones. In our study, Gram-negative bacilli are more commonly isolated than Gram-positive organism. The most commonly isolated bacterium was E. coli with a frequency rate of 53% which is similar to study conducted in Assam  and other parts of the World. ,, K. pneumonia (8.8%) is the second most common organism isolated, whereas another study from Assam, Northeast India isolated S. aureus. The other organisms isolated are Pseudomonas sp., Enterococcus, S. aureus, Candida, Proteus, etc. It was also observed that the samples responded effectively to chloramphenicol (29%), gentamicin (28%), imipenem (26%), and amikacin (21%). Although chloramphenicol appears to be a useful drug for UTI but due to resistance and safety concerns, it is no longer a first-line agent for any infection in developed nations, it has serious toxicity by binding to human serum albumin.  The most serious adverse effect associated with chloramphenicol treatment is bone marrow toxicity, which may occur in two distinct forms: bone marrow suppression, which is a direct toxic effect of the drug and is usually reversible, and aplastic anemia, which is idiosyncratic and generally fatal.  Amikacin was found to have intermediate sensitivity in most samples. Ciprofloxacin, nalidixic acid, ofloxacin, norfloxacin, and amoxyclav penicillin were found to be resistant in most cases. Most of the conventional antibiotics were found to be mostly resistant to most of the bacteria's. The possible explanation behind the resistance showed to these antibiotics, may be because of these antibiotics are being prescribed by physician although not really indicate, and these antibiotics have been in use for a long period, as a result, of the organisms must have developed mechanisms of circumventing their mode of action. Studies showed that the ofloxacin, nalidixic acid, and norfloxacin are the drugs most commonly used for inpatients, which is reflected by the noticeable resistance shown by E. coli isolates to these antibiotics. Antibiotic resistance is a serious and growing phenomenon in contemporary medicine and has emerged as one of the preeminent public health concerns of the 21 st century, in particular as it pertains to pathogenic organisms. In the simplest cases, drug-resistant organisms may have acquired resistance to first-line antibiotics, thereby necessitating the use of second-line agents. In general, a first-line agent is selected on the basis of several factors including safety, availability, and cost; a second-line agent is usually broader in spectrum, has a less favorable risk-benefit profile, and is more expensive or, in dire circumstances, may be locally unavailable. Bacteria's can gain resistant by preventing the antibiotic from getting to its target, changing target or by destroying the antibiotic. Knowledge on UTI infection causative organism and antibiotic spectrum is limited as there was no study from Nagaland. This study may help clinicians for the treatment of the disease.
| Conclusion|| |
The knowledge of antimicrobial pattern and antibiotic sensitivity of routinely isolated urinary pathogens in this area may provide guidance to clinicians regarding the empirical treatment of UTI.
| References|| |
Sharma I, Paul D. Prevalence of community acquired urinary tract infections in Silchar Medical College, Assam, India and its antimicrobial susceptibility profile. Indian J Med Sci 2012;66:273-9.
Dash M, Padhi S, Mohanty I, Panda P, Parida B. Antimicrobial resistance in pathogens causing urinary tract infections in a rural community of Odisha, India. J Family Community Med 2013;20:20-6.
Shaifali I, Gupta U, Mahmood SE, Ahmed J. Antibiotic susceptibility patterns of urinary pathogens in female outpatients. N Am J Med Sci 2012;4:163-9.
Demilie T, Beyene G, Melaku S, Tsegaye W. Urinary bacterial profile and antibiotic susceptibility pattern among pregnant women in North West Ethiopia. Ethiop J Health Sci 2012;22:121-8.
Parameswarappa J, Basavaraj VP, Basavaraj CM. Isolation, identification, and antibiogram of enterococci isolated from patients with urinary tract infection. Ann Afr Med 2013;12:176-81.
Tantry BA, Rahiman S. Antibacterial resistance and trend of urinary tract pathogens to commonly used antibiotics in Kashmir Valley. West Indian Med J 2012;61:703-7.
Iosifidis E, Antachopoulos C, Tsivitanidou M, Katragkou A, Farmaki E, Tsiakou M, et al.
Differential correlation between rates of antimicrobial drug consumption and prevalence of antimicrobial resistance in a tertiary care hospital in Greece. Infect Control Hosp Epidemiol 2008;29:615-22.
Wagenlehner FM, Wagenlehner C, Savov O, Gualco L, Schito G, Naber KG. Clinical aspects and epidemiology of uncomplicated cystitis in women. German results of the ARESC Study. Urologe A 2010;49:253-61.
Kolawale AS, Kolawale OM, Kandaki-Olukemi YT, Babatunde SK, Durowade KA, Kplawale CF. Prevalence of urinary tract infections among patients attending Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State, Nigeria. Int J Med Medical Sci 2009;1:63-7.
Banerjee S. The study of urinary tract infections and antibiogram of uropathogens in and around Ahmadnagar, Maharashtra. Int J Infect Dis 2011;9.
Farah NB, Murshidi MS. Urinary tract infections in adult and adolescent females of a developing community: Pattern, bacteriology and genitourinary predisposing factors. Int Urol Nephrol 1996;28:319-25.
Arslan H, Azap OK, Ergönül O, Timurkaynak F. Urinary Tract Infection Study Group. Risk factors for ciprofloxacin resistance among Escherichia coli
strains isolated from community-acquired urinary tract infections in Turkey. J Antimicrob Chemother 2005;56:914-8.
Valiquette L. Urinary tract infections in women. Can J Urol 2001;8(Suppl 1):6-12.
Chen H, Rao H, He P, Qiao Y, Wang F, Liu H, et al.
Potential toxicity of amphenicol antibiotic: Binding of chloramphenicol to human serum albumin. Environ Sci Pollut Res Int 2014. [Epub ahead of print].
Rich ML, Ritterhoff RJ, Hoffmann RJ. A fatal case of aplastic anemia following chloramphenicol (chloromycetin) therapy. Ann Intern Med 1950;33:1459-67.
[Table 1], [Table 2]