PATTERN OF ANTIBACTERIAL RESISTANCE IN URINARY TRACT INFECTIONS

Abstract

INTRODUCTION:
Urinary Tract Infections (UTIs) represent one of the most prevalent bacterial infections encountered in clinical practice worldwide, affecting individuals of all ages and demographics 1. Despite advancements in science and healthcare, the management of UTIs continues to pose substantial challenges, primarily due to the emergence and proliferation of antibiotic-resistant strains of bacteria. The rise in antimicrobial resistance (AMR) not only compromises the efficacy of traditional treatment regimens but also underscores the urgent need for a deeper understanding of the evolving patterns of antibacterial resistance in UTIs 2.
The misuse and overuse of antibiotics have facilitated the proliferation of resistant bacterial strains, rendering once-effective treatment options ineffective 3. Understanding the specific patterns of antibacterial resistance in UTIs is paramount for guiding clinical decision-making and formulating effective therapeutic strategies. Analysis of surveillance data reveals varying resistance profiles across different geographical regions and patient populations4,5, highlighting the dynamic nature of antimicrobial resistance and the importance of tailored treatment approaches.
Moreover, the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains poses a grave threat to public health6,7, limiting treatment options and increasing the risk of treatment failure and disease complications8,9. A study done by Mortazavi et al1 showed that the most common pathogens causing UTIs were E. coli, Klebsiella, Staphylococcus, and Streptococcus with a frequency of 62%, 13%, 12%, and 11%. Other bacteria such as Citrobacter and Pseudomonas had a marginal role in UTI with a combined frequency of 2%.
The rationale of this study is to determine bacterial etiologic agents responsible for urinary tract infection and to evaluate their in vitro susceptibility pattern to commonly used antimicrobial agents. This study is important for clinicians to facilitate the effective treatment and management of patients with symptoms of urinary tract infection and to avoid unnecessary judicious use of these drugs to preserve their efficacies. Development of unusual resistance among such strains could easily be detected, and thus, will help in better treatment and management of those infected by these pathogens.

OBJECTIVE:
1. To determine the frequency of the most common gram-positive and gram-negative organisms causing urinary tract infections
2. To measure the frequency of their sensitivity/resistance to different antibiotics in patients admitted through OPD/Emergency.

MATERIAL AND METHODS
STUDY DESIGN: Cross-sectional study

SETTING: Department of Medicine, Railway Hospital, Rawalpindi

DURATION OF STUDY: Six months after approval of synopsis.

SAMPLE SIZE:
● The WHO Sample Size Calculator was used to calculate the sample size.

● ​A study done by Mortazavi et al 1 was taken as a reference

● Absolute precision = 6%

● Confidence level = 95%

● The sample size comes out to be = 105 patients

SAMPLING TECHNIQUE: Non-probability, consecutive sampling

SAMPLE SELECTION:

Inclusion criteria:

1)​Patients with UTI proven by positive growth of microorganisms on urine culture.
2)​Patients between 12-75 years of age.

Exclusion criteria: All potential factors behaving as confounders will be included in the exclusion criteria

1)​Patients with tubo-ovarian disorders, sexually transmitted diseases, appendicitis, prostatitis, and epididymitis.
2)​Patients already taking antibiotics before hospital presentation.
3)​Pregnant patients

DATA ANALYSIS:
Data will be entered and analyzed using SPSS v22.0. Frequency and percentage will be presented for qualitative variables like sex, co-morbids, type of organisms, urine R/E and antibiotics to which these organisms are sensitive/resistant. Mean ± SD will be calculated for age and BMI. Data will be stratified for age, BMI and gender to control effect modifiers. Post-stratification, the chi-square test will be applied. A p-value of ≤0.05 will be considered significant.

RESULTS & CONCLUSIONS: This study demonstrates high rates of fluoroquinolone and third-generation cephalosporin resistance among uropathogens in our setting, with preserved susceptibility to aminoglycosides, carbapenems, fosfomycin, and nitrofurantoin. These findings underscore the urgent need for antimicrobial stewardship, routine susceptibility surveillance, and adherence to evidence-based treatment guidelines. Future research should focus on molecular epidemiology of resistance, longitudinal resistance trends, and evaluation of stewardship interventions to preserve the efficacy of available antimicrobials.

REFERENCES:

1. Mortazavi-Tabatabaei SAR, Ghaderkhani J, Nazari A, Sayehmiri K, Sayehmiri F, Pakzad I. Pattern of Antibacterial Resistance in Urinary Tract Infections: A Systematic Review and Meta-analysis. Int J Prev Med. 2019;10:169.
2. Khademi F, Sahebkar A. A systematic review and meta-analysis on the prevalence of antibiotic-resistant Listeria species in food, animal and human specimens in Iran. J Food Sci Technol. 2019;56(12):5167-5183.
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4. Ali SA, Mandal S, Georgalas A, Gilani SAD. A Pattern of Antibiotic Resistance in Gram-Negative Rods Causing Urinary Tract Infection in Adults. Cureus. 2021;13(1):e12977.
5. Vazouras K, Velali K, Tassiou I, Anastasiou-Katsiardani A, Athanasopoulou K, Barbouni A et al. Antibiotic treatment and antimicrobial resistance in children with urinary tract infections. J Glob Antimicrob Resist. 2020;20:4-10.
6. Bakhtiari S, Mahmoudi H, Seftjani SK, Amirzargar MA, Ghiasvand S, Ghaffari ME et al. Antibiotic resistance pattern and phylogenetic groups of the uropathogenic Escherichia coli isolates from urinary tract infections in Hamedan, west of Iran. Iran J Microbiol. 2020;12(5):388-394.
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8. Pałka A, Kujawska A, Hareza DA, Gajda M, Wordliczek J, Jachowicz-Matczak E et al. Secondary bacterial infections & extensively drug-resistant bacteria among COVID-19 hospitalized patients at the University Hospital in Kraków. Ann Clin Microbiol Antimicrob. 2023;22(1):77.
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