A Cross-Sectional Study to Evaluate Antimicrobial Susceptibility of Uropathogens from South Punjab, Pakistan

Background: Urinary tract infections (UTIs) are a common infection caused by uropathogenic bacteria. Drug resistance against common antibiotics is a leading cause of treatment failure in UTIs.

Objective: This study was conducted to check the prevalence of antimicrobial susceptibility against uropathogens and identify the best treatment option against UTIs.

Methods: In this cross-sectional study, urine samples (n = 1000) were collected and cultured for pure bacterial growth by using cysteine-lactose-electrolyte-deficient (CLED) media. After physical and biochemical characterization, antibacterial susceptibility was performed by the Kirby-Bauer disk diffusion method.

Results: Uropathogenic bacteria were successfully isolated in 57% (n = 572) of total tested samples (n = 1000). Escherichia coli 51.2% (n = 293/572), Klebsiella species 15.4% (n = 88/572), Enterococcus species 15.4% (n = 88/572), Pseudomonas species 9.4% (n = 54/572), Staphylococcus aureus 3.2% (n = 18/572), coagulase-negative Staphylococci (CoNS) 3.0% (n = 17/572) and Proteus species 2.4% (n = 14/572) were the most prevalent organism in UTIs. Prevalence of Gram-negative rods (GNRs) was 78.5% (n = 449/572) among UTI patients as compared to Gram-positive cocci (GPCs) 21.5% (n = 123/572). Escherichia coli 65.3% (n = 293/449), Klebsiella species 19.6% (n = 88/449), Pseudomonas species 12.0% (54/449) and Proteus species 3.1% (n = 14/449) were the most prevalent GNRs in UTIs, while Enterococcus species 71.5% (n = 88/123), Staphylococcus aureus 14.6% (n = 18/123) and coagulase-negative Staphylococci (CoNS) 13.8% (17/123) were the most prevalent GPCs in UTIs. The majority of isolated uropathogens showed resistance against routinely used antibiotics. However, teicoplanin and linezolid were the most effective drugs against GPCs and piperacillin/tazobactam, meropenem and imipenem were the most effective drugs against GNRs. Nitrofurantoin and fosfomycin were shown to be most effective against both GNRs and GPCs.

Conclusion: In conclusion, Escherichia coli (GNRs) and Enterococcus species (GPCs) are the most prevalent organisms among UTIs patients, which are shown to be antibiotic-resistant to the most commonly used antibiotics. However, nitrofurantoin and fosfomycin are the most effective drugs against uropathogens in UTIs.