Antimicrobial Resistance Trends in Urinary Tract Infection at Secondary Care Centres in Central India: Carbepenem Resistance Crossing 20% in Community

Abstract

Background: Urinary tract Infection (UTI) is a significant global health burden, with high morbidity and mortality especially in developing nations. This study assessed the changing pattern of anti-microbial resistance (AMR) in UTI in secondary care centres of central India. Methodology: This was a prospective observational study conducted in 10 secondary care centres in smaller cities of Central India in the state of Madhya Pradesh. Result: Among the 8856 number of symptomatic urinary tract infections whose urine was sent for microbiological culture and sensitivity, 2409 (27.2%) showed significant pathological growth out of which 92.1% (2221/2409) showed bacterial growth and 7.8% (188/2409) showed fungal growth. Gram-negative bacteria accounted for 85.0% (1890/2221) and Gram-positive bacteria for 14.9% (331/2221). E. coli was the most prevalent Gram-negative isolate (57.4%), followed by K. pneumoniae (21.3%), Pseudomonas aeruginosa (12.1%). Third generation cephalosporin resistance was observed in 76.2% in E. coli and 71.6% in K. pneumonia. Carbapenem resistance was highest in P. aeruginosa (61.8%) followed by Acinetobacter spp (52.2%), Enterobacter spp. (50%), K. pneumoniae (35.4%) and E. coli (22.6%). Colistin resistance was observed in Enterobacter spp. (15.0%) followed by Acinetobacter spp (9.1%), K. pneumoniae (7.6%), E. Coli (6.9%) and P. aeruginosa (4.9%). Among the gram-positive isolates, 47.5% of Staphylococcus aureus were Methicillin resistant and 3.7% were resistance to vancomycin. Among the Enterococcus spp. 14.1% were resistance to vancomycin. Conclusion: It is of great concern, that 20% of Escherichia coli and Klebsiella pneumonia islates are resistant to carbpenems in community settings at smaller cities in India. Though negligible, UTI caused by VRSA and VRE cannot be neglected. There is definitely a rise the occurrence of UTI caused by Candida.