Aetiological Profile and Antibiogram of Urinary Isolates Causing UTI in Patients Attending a Tertiary Care Hospital of Western Odisha

BACKGROUND Although UTI is a female disease, males are also susceptible during the neonatal period and old age. Asymptomatic bacteriuria, cystitis and acute urethral syndrome are the most common clinical type. Etiological profile is variable in different geographical areas, but E. coli is the most common agent worldwide. Klebsiella, Proteus, Pseudomonas are important causes of hospital acquired UTI. Culture sensitivity of early morning mid-stream urine collected by clean catch technique is the gold standard method of diagnosis of UTI. Sensitivity to 3rd generation cephalosporins and cotrimoxazole is variable in different areas but aminoglycoside, nitrofurantoin and carbapenem are almost sensitive worldwide. Resistance to nitrofurantoin and carbapenem has been reported in many areas of world. Before starting empirical therapy, physician should know the local etiological profile and antibiotic sensitivity pattern of uropathogens. We wanted to study the etiological profile and antibiotic sensitivity pattern of urinary isolates in a tertiary care hospital of Western Odisha. METHODS Early morning mid-stream urine samples of 730 clinically suspected UTI patients were collected by clean catch technique and sent to microbiology department. Cysteine lactose electrolyte deficient (CLED) agar media was seeded with urine with the help of 0.01 ml (4 mm) loop. After incubation for 24 hrs at 37 degrees C growth was observed and identified by Gram stain and biochemical tests. Antibiotic sensitivity was performed by disc diffusion method as per CLSI guidelines. Antibiotic sensitivity was performed for all Gram-negative bacteria, Enterococci and Staphylococcus. RESULTS Among 730 samples, 238 (33%) showed significant bacteriuria and 63 % of significant bacteriuria samples were from female. Middle age females (36-50 yrs.) were more affected (38%) followed by old age (>50 yrs.) male (19%) and old age (>50 yrs.) female (18%). E. coli was the most common bacteria (31%) followed by Enterococci (18%). Fluoroquinolones like nalidixic acid and norfloxacin showed high resistance rate (31%, 42% in case of Gram-negative bacteria and 12%, 25% in case of Staphylococcus species respectively). Nitrofurantoin showed excellent sensitivity to both Gram-positive cocci and Gram-negative bacilli. (80% for gram-negative bacilli and 87 % for Staphylococcus species and 78% for enterococci species). Aminoglycoside and carbapenem showed excellent sensitivity to Gram-negative bacteria (81% and 92% respectively). Third generation cephalosporins showed poor sensitivity (48% to 53%). CONCLUSIONS Enterococci rather than Klebsiella species was the 2nd most common uropathogen in our study. Aminoglycoside was still useful for UTI. Nitrofurantoin was the best option for empirical therapy.