EC Pharmacology and Toxicology

Introduction: Urinary tract infection (UTI) is the presence of multiplying bacteria within the urinary tract with a threshold number of pathogenic bacteria (10⁵ CFU/mL) in urine. Despite the presence of different host defense mechanisms against microbial infection in urinary tract [1].

Methodology: A retrospective record review of culture results of all types of wound swabs referred to this private major hospital from 1 June 2020 to 31 December 2020 was conducted. The hospital is considered one of the few hospitals in Khartoum that conduct microbiological procedures. This is a study based on bacteriological laboratory records review in which we have extracted a total of 134 urine culture reports using data extraction sheet. We considered all records documented during the stated time period.

Results: A total of 134 isolated organisms were considered pathogens from urine samples, 103 (77%) of which were multidrug resistant with a display of resistance to a minimum of four drugs most notably amoxiclav and cefepime. Gram negative representing the majority of isolated bacteria. E. coli was the most frequently isolated bacteria with 53; 44 (83%) of which were MDR, showing high level of resistance to amoxiclav (90%), cefepime (85%), piperacillin (86%) and co-trimoxazole (84%), a level of carbapenem resistance was also observed to aztreonam, imipenem and meropenem showing (69%), (12%) and (18%) respectively. The lowest resistance rate was observed with colistin (2%). K. pneumoniae appeared highly resistant to piperacillin (93%), amoxiclav (95%) and cefepime (83%), along with third generation cephalosporins ceftazidime and ceftriaxone (75%) and (65%) respectively. Carbapenem resistance was also present for meropenem (40%), imipenem (52%) and aztreonam (69%). With (10%) resistance rate to colistin; P. aeruginosa appeared multidrug resistant in 20 out of 22 isolates, the highest being against cefepime (100%), amoxiclav (88%), ceftriaxone (78%), piperacillin (73%) and ciprofloxacin (72%). Carbapenem resistance was observed to meropenem (53%), (46%) for imipenem and aztreonam (31%).

Conclusion: Out of the several isolated organism from UTI, 85% were gram negative and amongst them E. coli was the most common followed by K. pneumoniae and P. aeruginosa. A large number of those bacteria displayed MDR due to increasing use of antibiotics randomly and irrationally. The involvement of such amount of multidrug resistant bacteria in urinary tract infections is a very serious problem and should not be neglected. Serious steps should be taken by the authorities to improve or at least avoid the worsening of the situation with the hope that it’s not too late.

Keywords: Multidrug Resistance; E coli; K. pneumoniae; S. aureus; Antimicrobial Therapy; Urinary Tract Infections; Uropathogenic Bacteria

1. Leigh DA., et al. “Topley and Wilson's principles of bacteriology, urology and immunology”. Bacterial diseases, 8^th edition, frome and London; Butter and Tanner Ltd 3 (1990): 197-214.
2. Shaikh N., et al. “Does this child have a urinary tract infection?” The Journal of the American Medical Association 298 (2007): 2895-2904.
3. Hersh AL., et al. “Antibiotic prescribing in ambulatory paediatrics in the United States”. Pediatrics 128 (2011): 1053-1061.
4. Hooton TM., et al. “Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the infectious diseases society of America”. Clinical Infectious Diseases 50 (2010): 625-663.
5. Wiedemann B., et al. “Uncomplicated urinary tract infections and antibiotic resistance-epidemiological and mechanistic aspects”. Antibiotics 3 (2014): 341-352.
6. Simmering JE., et al. “The Increase in hospitalizations for urinary tract infections and the associated costs in the United States, 1998–2011”. Open Forum Infectious Diseases 4 (2017): ofw281.
7. Calzi A., et al. “Resistance to oral antibiotics in 4569 Gram-negative rods isolated from urinary tract infection in children”. European Journal of Pediatrics 175 (2016): 1219-1225.
8. Stefaniuk E., et al. “Etiology and antibiotic susceptibility of bacterial pathogens responsible for community-acquired urinary tract infections in Poland”. European Journal of Clinical Microbiology and Infectious Diseases 35 (2016): 1363-1369.
9. Tek Raj Awasthi., et al. “Prevalence of Multidrug Resistant Bacteria in Causing Community Acquired Urinary Tract Infection Among the Patients Attending Outpatient Department of Seti Zonal Hospital, Dhangadi, Nepal”. Nepal Journal of Biotechnology1 (2015): 55-59.
10. Khanal S. “A study on Microbiology of urinary infection at Tribhuvan University Teaching Hospital, Kathmandu, Nepal”. MSc thesis. Tribhuvan University, Central Department of Microbiology (2006).
11. Raza S., et al. “Microbiological Analysis of the Urine Isolates in Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal”. Kathmandu University Medical Journal4 (2011): 295-297.
12. Patel S., et al. “Urinary Tract Infections (UTI) Among Patients at G.G. Hospital and Medical College, Jamnagar”. National J Community Medicine1 (2012): 138-141.
13. Khanal S. “A study on Microbiology of urinary infection at Tribhuvan University Teaching Hospital, Kathmandu, Nepal”. MSc thesis. Tribhuvan university, central department of Microbiology (2006).
14. Upadhyay G., et al. “Comparative evaluation of urine isolates among kidney transplanted and other UTI suspected patients visiting National Public Health Laboratory, (NPHL) Teku, Nepal”. International Journal of Biomedical and Advance Research6 (2013): 369-375.
15. Tuladhar NR., et al. “Antimicrobial resistant bacterial strains from inpatients of Tribhuvan University teaching hospital Kathmandu”. Journal of Institute of Medicine Nepal 25 (2003): 19-26.
16. Mohammed MA., et al. “Prevalence and antimicrobial resistance pattern of bacterial strains isolated from patients with urinary tract infection in Messalata Central Hospital, Libya”. Asian Pacific Journal of Tropical Medicine 9 (2016): 771-776.
17. Muhammad Imran Khan., et al. “Assessment of multidrug resistance in bacterial isolates from urinary tract-infected patients”. Journal of Radiation Research and Applied Sciences1 (2020): 267-275.