MULTIPLE DRUGS RESISTANCE AMONG URINARY TRACT INFECTION PATIENTS IN DUHOK CITY –KURDISTAN REGION –IRAQ
Background:Anti-microbial resistance could be a major public-health problem worldwide and universal endeavors are required to counteract its rise and the moment most common reason for observational antibiotic treatment. Optimal treatment seems diminish mortality and morbidity in surgical patients and play a crucial part in combating the continuous emergencies of expanding antibiotic resistance. The aim of this study is to study the pathogens and their antibiotic susceptibility in urinary cultures to Central laboratory in Duhok City and to study the rationality of antibiotic treatment urinary tract infection.
Patients and Methods:One hundred fifty-one UTI urine samples (culture positive) were collected from patient of central laboratory. Identified and isolated bacteria were determined by biochemical tests like Gram staining, Indole, oxidase, catalase, methyl red, Voges-Proskauer, citrate utilization, hemolysis, motility; and urea; fermentation and utilization tests of glucose, lactose and sucrose. Sensitivity pattern of isolates was determined against some traditional and conventional antibiotics.
Results:Staphylococcus aureus was the most common bacteria (40.4 %) followed by E.coli (31.8%). The overall levels of resistance to commonly used antibiotics were moderate in all pathogens. Amikacin and Nitrofurantoin were generally the antibiotics with lowest rates of resistance. Aminoglycosides and Fluoroquinolones were the most often used antibiotics. In first-line treatment, only 55 % of cases were given at least one antibiotic to which the bacteria were sensitive. A statistically significant higher resistant to both Amoxicillin and Erythromycin were found in cultures from UTI patients (P = 0.02 and P = 0.002).
Conclusions:Commonly encountered bacteria in this study which are Staphylococcus, Escherichia coli and Klebsiella were found to be highly sensitive to Nitrofurantoin, Amikacin and, to lesser extent, to ciprofloxacin, while low sensitivity pattern was recorded against Amoxicillin and Gentamicin, pointing to that antibacterial misuse is the leading cause for their resistance. The most commonly prescribed antibacterial Trimethoprim.
2- Sobeland JD. Urinary Tract infections in Mandell. Douglas and Bennett’s Principles and Practice of Infectious Diseases. Churchill Livingstone, Philadelphia, Pa, USA, 7th edition; 2010. Pp.(957–985).
3- Sabra SM, Abdel-Fattah MM. Epidemiological and microbiological profile of nosocomial infection in Taif hospitals KSA. In: World Journal of Medical Sciences. 2012;vol.(7), no.(1), pp.1–9.
4- Okonko IO, Ijandipe LA, Ilusanya OA, Donbraye-Emmanuel OB, Ejembi J, Udeze AO, Egun OC, Fowotade A, Nkang AO. Incidence of urinary tract infection (UTI) among pregnant women in Ibadan South-Western Nigeria. African Journal of Biotechnology. 2009; vol.(8), no.(23), pp.6649–6657.
5- Al-Badr A, Al-Shaikh G. Recurrent Urinary Tract Infections Management in Women. In: Sultan Qaboos University Medical Journal. 2013; Aug; 13(3): 359–367.
6- Al´os JI, Epidemiology and etiology of urinary tract infections in the community,Antimicrobial susceptibility of the main pathogens and clinical significance of resistance. Enfermedades Infeciosasy Microbiology´ıaCl´ınica. 2005; vol.(23), no.4, pp.3–8.
7- McNulty CA, Richards JM ,Livermoreetal DM. Clinical relevance of laboratory-reported antibiotic resistance in acute uncomplicated urinary tract infection in primary care . Journal of Antimicrobial Chemotherapy. 2006; vol. (58), no. 5, pp. 1000–1008.
8- Car J. Urinary tract infections in women: diagnosis and management in primary care. British Medical Journal. 2006; vol.(332), no.7533,pp.94–97.
9- Tambekar DH, Dhanorkar DV, Gulhane SR, Khandelwal VK, Dudhane MN. Antibacterial susceptibility of some urinary tract pathogens to commonly used antibiotics. African Journal of Biotechnology; 2006; vol. (5), no. 17, pp. 1562–1565.
10- Okeke IN, FayinkaST,LamikanraA. Antibiotic Resistance in Escherichia coli from Nigerian Students 1986-1998. Emerging Infectious Diseases. 2000; 6:393–396.
11- Chakraborty SP, KarMahapatra S, Roy S. Biochemical characters and antibiotic susceptibility of Staphylococcus.aureus isolates. Asian Pacific Journal of Tropical Biomedicine. 2011; 1(3): 192-196.
12- Al Benwan K, Al SweihN, Rotim VO. Etiology and antibiotic susceptibility patterns of community- and hospital-acquired urinary tract infections in a general hospital in Kuwait. Medical Principles and Practice.2010; vol. (19), no. 6, pp. 440–446.
13- Devan P, Ramchandra SS. Distribution and Antimicrobial Susceptibility Pattern of Bacterial Pathogens Causing Urinary Tract Infection in Urban Community of Meerut City, India. International Scholarly Research Notices microbiology .2013; Volume 2013, Article ID 749629, (13) page.
14- Sood S, Gupta R. Antibiotic resistance pattern of community acquired uropathogens at a tertiary care hospital in Jaipur, In: Rajasthan. Indian Journal of Community Medicine; 2012 vol. 37, no.1, pp. 39–44.
15- Ochei J, Kolhatkar A. Diagnosis of infection by specific anatomic sites/antimicrobial susceptibility tests.in Medical Laboratory Science Theory and Practice reprint .6th edition. New Delhi, India :McGraw-Hill; 2007 .p. 615–643,788–798.
16- Orrett FA, Davis GK. A comparison of antimicrobial susceptibility profile of urinary pathogens for the years, 1999a and 2003. In: West Indian Medical Journal; 2006, vol. 55, no. 2, pp. 95–99.
17- Kolawole AS, Kolawole OM, Kandaki-Olukemi YT, Babatunde SK, Durowade KA, Kolawole CF. Prevalence of urinary tract infections (UTI) among patients attending Dalhatu Araf Specialist Hospital .In: Nigeria. International Journal of Medicinal Medical Sciences.2009; vol. 1, no.5, pp. 163–167.
18- Akram M, Shahid M, Khan AU. Etiology and antibiotic resistance patterns of community-acquired urinary tract infections in J N M C Hospital Aligarh, India. In: Annuals of Clinical Microbiology and Antimicrobials. 2007; vol. 6), article 4.
19- Shaifali. I, Gupta U, Mahmood. S. E, and Ahmed J .Antibiotic susceptibility patterns of urinary pathogens in female out patients. In: North American Journal of Medical Sciences. 2012; vol. 4, no(4), pp. 163–169.
20- Rana M Kh. Antibacterial susceptibility of commonly encountered uropathoens in Alhussain teaching hospital –Thi-Qar province: retrospective study.Thi-Qar In: Medical Journal (TQMJ).2010 ;Vol (4) No(2):(74-81).
21- Abubakar EM. Antimicrobial susceptibility pattern of pathogenic bacteria causing urinary tract infections at the Specialist Hospital, Yola, Adamawa State. In: Nigeria. Journal of Clinical Medicine Research .2009; vol. 1, no. 1, pp. 001–008.
22- Sabharwal. ER. Antibiotic susceptibility patterns of uropathogens in obstetric patients. In: North American Journal of Medical Sciences. 2012;vol. 4, pp. 316–319.
23- Gobernado M, Vald´es L,Al´os JI,Garc´ıa –Rey C, Dal-R´e R, Garc´ıa-de-Lomas J. Antimicrobial susceptibility of clinical Escherichia coli isolates from uncomplicated cystitis in women over a 1-year period in Spain. In: Revista Espa˜nola de Quimioterapia.2007; 20, no. 1, pp. 68–76.
24- Kahlmeter G. An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS project. In: Journal of Antimicrobial Chemotherapy. 2003; vol. 51, no. 1, pp. 69–76.
25- Goossens H, Ferech M, Vander Stichele R, Elseviers M. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. The Lancet. 2005;vol.() 365, no. 9459, pp. 579–587.
26- Manjunath GN, Prakash R, AnnamV, Shetty K. The changing trends in the spectrum of the antimicrobial drug resistance pattern of uropathogens, which were isolated from hospitals and community patients with urinary tract infections in Tumkur and Bangalore. In: International Journal of Biological and Medical Research. 2011 ;vol. (2), no. 2, pp. 504–550.
27- Nasim K, Gholamreza E D, Sahba S. Antimicrobial susceptibility patterns of community-acquired uropathogens in Tehran, Iran. The Journal of Infection in Developing Countries. 2010; 4(4):202-206.