Bacteriological profile and antibiotic susceptibility pattern of urine isolantes with reference to extended spectrum β-lactamase producers.

Thesis Report.

ABSTRACT: Urinary tract infection (UTI) is the most common bacterial infection occurs both in the hospital and community settings. The prevalence of Extended Spectrum Beta Lactamases (ESBL), the major causes of resistance towards the broad spectrum of β-lactams among uropathogenic bacteria which upheaval a worldwide concern in the therapeutic management. Infections caused by ESBL-producers are associated with severe adverse outcomes and may be related to increased virulence of these strains. With the objective to determine the antibiotic susceptibility pattern of uropathogens with reference to ESBL producing bacteria, a prospective study was carried out in the Nepal Police Hospital, Maharajgunj, Kathmandu from 15th April to 18th October 2013 among suspected UTI patients. Information regarding various characteristics was obtained and urine specimen was processed for isolation of bacteria, using standard microbiological techniques, antibiotic susceptibility test by Kirby Bauer disc diffusion method and ESBL confirmatory test was done by combination disc method following Clinical and Laboratory Standard Institute (CLSI) guidelines. Among the total 1248 mid stream urine samples, 285 (22.8%) were found to be significant bacterial growth, among these 125 (17.7%) were from male patients and 160 (17.9%) from female patients, highest from age group 15-30 yrs. Escherichia coli was found to be the most predominant (69.5%) UTI causative organism followed by Klebsiella pnemoniae (9.1 %), Proteus vulgaris (2.8%), Staphylococcus saprophyticus (2.1%). Majority of ESBL producers showed resistance to Ampicillin (100%), Cotrimoxazole (81.6%) followed by Ciprofloxacin (79%). Whereas Imipenem (100%), Tigecycline (98.7%), Piperacillin/tazobactum (97.47%) and Amikacin (97.47%) seemed to be the drug of choice for ESBL producers. The results of present study indicated that a great need to follow the hospital antibiotic policy in order to prevent the emergence and dissemination of MDR and ESBL producing bacteria as they are associated with the treatment failure of UTI. Keywords: Urinary Tract Infection (UTI), Extended Spectrum Beta Lactamases (ESBL), and Multi Drug Resistant (MDR).

Eng.