Background: Among the common morbid causes that are prevalent among all age groups, urinary tract infections top the list. In our country, most of the UTI patients visiting hospitals (OPD or IPD) are already on empirical antibiotics even before getting the sensitivity report in their hand. The purpose of this research was to examine the susceptibility patterns of commonly used antibiotics, particularly fosfomycin, against common uropathogens. Methodology: This was a prospective observational study conducted between January and March 2021 in four private tertiary hospitals in Dhaka, Bangladesh. All the urine samples referred to these four laboratories, obtained from patients of all ages and both genders, clinically diagnosed to have UTI, were included. Urine culture was performed by a semiquantitative method on blood agar media and MacConkey agar media. Following identification, antimicrobial sensitivity testing was performed using the modified Kirby Bauer disk diffusion method in accordance with CLSI standards. The data was put into Statistical Package for Social Sciences (SPSS) statistical software version 25 for the analysis. Results: A total of 5389 urine samples were received from four private hospitals in Dhaka over three months, and of these, 934 (17.33%) isolates were obtained from culture. About 95% of the isolates were gram-negative bacilli (GNBs). The most common isolate was Escherichia coli 615 (65.85%), followed by Klebsiella spp. 154 (16.49%), Pseudomonas spp. 64 (6.85%) and 51 (5.46%) isolates of Enterobacter. Among the gram-positive cocci, the most common were Enterococci fecalis 18 (1.93%) and Staphylococcus aureus 17 (1.82%). Of all the antibiotics tested, fosfomycin sensitivity was 98.4%, 88.88%, and 100% for Escherichia coli, Enterococci fecalis, and Staphylococcus aureus, respectively. All the isolates tested were susceptible to Meropenem (77% - 100%), Amoxiclav (78% - 100%) and Nitrofurantoin (45% - 94%). Sensitivity amongst all the uropathogens for ceftriaxone, ciprofloxacin, and cotrimoxazole was nearly 50% - 77%. Conclusion: The positivity of urinary isolates is 17.33%, with the most common pathogen being Escherichia coli. Common uropathogens show the highest in vitro susceptibility to fosfomycin. So, fosfomycin should be considered as a highly potent and promising alternative oral antibiotic treatment for UTI.
References
[1]
Hooton, T.M. (2001) Recurrent Urinarytract Infection in Women. International Journal of Antimicrobial Agents, 17, 259-268. https://doi.org/10.1016/S0924-8579(00)00350-2
[2]
Foxman, B. (2002) Epidemiology of Urinary Tract Infections: Incidence, Morbidity, and Economic Costs. The American Journal of Medicine, 113, 5-13. https://doi.org/10.1016/S0002-9343(02)01054-9
[3]
Pouwels, K.B., Visser, S.T. and Hak, E. (2013) Effect of Pravastatin and Fosinopril on Recurrent Urinarytract Infections. Journal of Antimicrobial Chemotherapy, 68, 708-714. https://doi.org/10.1093/jac/dks419
[4]
Foxman, B. and Frerichs, R.R. (1985) Epidemiology of Urinary Tract Infection: I. Diaphragm Use and Sexual Intercourse. American Journal of Public Health, 75, 1308-1313. https://doi.org/10.2105/AJPH.75.11.1308
[5]
Barrett, S.P., Savage, M.A., Rebec, M.P., Guyot, A., Andrews, N. and Shrimpton, S.M. (1999) Antibiotic Sensitivity of Bacteria Associated with Community Acquired Urinary Tract Infections in Britain. Journal of Antimicrobial Chemotherapy, 44, 359-365. https://doi.org/10.1093/jac/44.3.359
[6]
Jones, R.N., Kugler, K.C., Pfaller, M.A. and Winokur, P.L. (1999) SENTRY Surveillance Group: Characteristics of Pathogens Causing Urinary Tract Infections in Hospitals in North America: Results from the SENTRY Antimicrobial Surveillance Program, 1997. Diagnostic Microbiology and Infectious Disease, 35, 55-63. https://doi.org/10.1016/S0732-8893(98)00158-8
[7]
Manges, A.R., Natarajan, P., Solberg, O.D., Dietrich, P.S. and Riley, L.W. (2006) The Changing Prevalence of Drug-Resistant Escherichia coli Clonal Groups in a Community: Evidence for Community Outbreaks of Urinary Tract Infections. Epidemiology and Infection, 134, 425-431. https://doi.org/10.1017/S0950268805005005
[8]
Costelloe, C., Metcalfe, C., Lovering, A., Mant, D. and Hay, A.D. (2010) Effect of Antibiotic Prescribing in Primary Care on Antimicrobial Resistance in Individual Patients: Systematic Review and Meta-Analysis. BMJ, 340, Article No. c2096. https://doi.org/10.1136/bmj.c2096
[9]
Grabe, M., Bjerklund-Johansen, T.E., Botto, H., et al. (2011) EAU Guidelines on Urological Infections, Update March 2011. EAU Guidelines Office, Arnhem.
[10]
Zalmanovici, T.A., Green, H., Paul, M., Yaphe, J. and Leibovici, L. (2010) Antimicrobial Agents for Treating Uncomplicated Urinary Tract Infection in Women. Cochrane Database of Systemic Reviews, No. 10, Article No CD007182. https://doi.org/10.1002/14651858.CD007182.pub2
[11]
Gupta, K., Hooton, T.M., Naber, K.G., Wullt, B., Colgan, R., Miller, L.G., et al. (2011) International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Infectious Diseases, 52, e103-e120. https://doi.org/10.1093/cid/ciq257
[12]
Bonkat, G., Bartoletti, R.R., Bruyère, F., Cai, T., Geerlings, S.E., Köves, B., Schubert, S., Wagenlehner, F., Mezei, T., Pilatz, A., Pradere, B. and Veeratterapillay, R. (2019). EAU Guidelines on Urological Infections. European Association of Urology, Arnhem.
[13]
Therapeutic Guidelines Limited (2019) Acute Cystitis in Adults in ETG Complete. Therapeutic Guidelines Limited, Melbourne.
[14]
Mueller, L., Cimen, C., Poirel, L., Descombes, M.C. and Nordmann, P. (2019) Prevalence of Fosfomycin Resistance among ESBL-Producing Escherichia coli Isolates in the Community, Switzerland. European Journal of Clinical Microbiology & Infectious Diseases, 38, 945-949. https://doi.org/10.1007/s10096-019-03531-0
[15]
de Greeff, S.C., Mouton, J.W., Schoffelen, A.F. and Verduin, C.M. (2019) NethMap 2019: Consumption of Antimicrobial Agents and Antimicrobial Resistance among Medically Important Bacteria in the Netherlands. RIVM Report 2019-0038. National Institute for Public Health and the Environment, Bilthoven.
[16]
Quaegebeur, A., Brunard, L., Javaudin, F., Vibet, M.A., Bemer, P., Le Bastard, Q., Batard, E., Montassier, E. and EuroUTI 2010-2016 Study Group (2019) Trends and Prediction of Antimicrobial Susceptibility in Urinary Bacteria Isolated in European Emergency Departments: The EuroUTI 2010-2016 Study. Journal of Antimicrobial Chemotherapy, 74, 3069-3076. https://doi.org/10.1093/jac/dkz274
[17]
Karlowsky, J.A., Lagace-Wiens, P.R.S., Adam, H.J., Baxter, M.R., Laing, N.M., Walkty, A.J. and Zhanel, G.G. (2019) In Vitro Susceptibility of Urinary Escherichia coli Isolates to First- and Second-Line Empirically Prescribed Oral Antimicrobials: CANWARD Surveillance Study Results for Canadian Outpatients, 2007-2016. International Journal of Antimicrobial Agents, 54, 62-68. https://doi.org/10.1016/j.ijantimicag.2019.04.012
[18]
Falagas, M.E., Athanasaki, F., Voulgaris, G.L., Triarides, N.A. and Vardakas, K.Z. (2019) Resistance to Fosfomycin: Mechanisms, Frequency and Clinical Consequences. International Journal of Antimicrobial Agents, 53, 22-28. https://doi.org/10.1016/j.ijantimicag.2018.09.013
[19]
Zowawi, H.M., Harris, P.N.A., Roberts, M.J., Tambyah, P.A., Schembri, M.A., Diletta Pezzani, M., et al. (2015) The Emerging Threat of Multidrug-Resistant Gram-Negative Bacteria in Urology. Nature Reviews Urology, 12, 570-584. https://doi.org/10.1038/nrurol.2015.199
[20]
Flores-Mireles, A.L., Walker, J.N., Caparon, M. and Hultgren, S.J. (2015) Urinary Tract Infections: Epidemiology, Mechanisms of Infection and Treatment Options. Nature Reviews Microbiology, 13, 269-284. https://doi.org/10.1038/nrmicro3432
[21]
Hawkey, P.M., Warren, R.E., et al. (2018) Treatment of Infections Caused by Multidrug-Resistant Gram-Negative Bacteria: Report of the British Society for Antimicrobial Chemotherapy/Healthcare Infection Society/British Infection Association Joint Working Party. Journal of Antimicrobial Chemotherapy, 73, iii2-iii78. https://doi.org/10.1093/jac/dky027
[22]
Falagas, M.E., Kastoris, A.C., Kapaskelis, A.M. and Karageorgopoulos, D.E. (2010) Fosfomycin for the Treatment of Multidrug-Resistant, Including Extended-Spectrum Beta-Lactamase Producing, Enterobacteriaceae Infections: A Systematic Review. The Lancet Infectious Diseases, 10, 43-50. https://doi.org/10.1016/S1473-3099(09)70325-1
[23]
Sastry, S., Clarke, L.G., Alrowais, H., Querry, A.M., Shutt, K.A. and Doi, Y. (2015) Clinical Appraisal of Fosfomycin in the Era of Antimicrobial Resistance. Antimicrobial Agents and Chemotherapy, 59, 7355-7361. https://doi.org/10.1128/AAC.01071-15
[24]
Seroy, J.T., Grim, S.A., Reid, G.E., Wellington, T. and Clark, N.M. (2016) Treatment of MDR Urinary Tract Infections with Oral Fosfomycin: A Retrospective Analysis. Journal of Antimicrobial Chemotherapy, 71, 2563-2568. https://doi.org/10.1093/jac/dkw178
[25]
Shrestha, N. and Tomford, J.W. (2001) Fosfomycin: A Review. Infectious Diseases in Clinical Practice, 10, 255-260. https://doi.org/10.1097/00019048-200106000-00004
[26]
López-Montesinos, I. and Horcajada, J.P. (2019) Oral and Intravenous Fosfomycin in Complicated Urinary Tract Infections. Revista Española de Quimioterapia, 32, 37-44.
[27]
Clinical and Laboratory Standards Institute (2016) Performance Standards for Antimicrobial Susceptibility Testing. 26th Edition, M100-S26, Clinical and Laboratory Standards Institute, Wayne.
[28]
Maraki, S., Samonis, G., Rafailidis, P.I., Vouloumanou, E.K., Mavromanolakis, E. and Falagas, M.E. (2009) Susceptibility of Urinary Tract Bacteria to Fosfomycin. Antimicrobial Agents and Chemotherapy, 53, 4508-4510. https://doi.org/10.1128/AAC.00721-09
[29]
Collee, J.G., Miles, R.S. and Watt, B. (1996) Tests for the Identification of Bacteria. In: Collee, J.G., Fraser, A.G., Marmion, B.P. and Simmons, A. Eds., Mackie and Mc Artney Practical Medical Microbiology, Churchill Livingstone, London, 433.
[30]
Jan Hudzicki, A. (2009) Kirby-Bauer Disk Diffusion Susceptibility Test Protocol. American Society for Microbiology, Washington DC.
[31]
Rahman, S.R., Ahmed, M.F. and Begum, A. (2014) Occurrence of Urinary Tract Infection in Adolescent and Adult Women of Shanty Town in Dhaka City, Bangladesh. Ethiopian Journal of Health Sciences, 24, 145-152. https://doi.org/10.4314/ejhs.v24i2.7
[32]
Begum, N., Mamoon, A.B.A., Hossain, M., Begum, N., Chowdhury, S.A. and Rahman, M.F. (2006) UTI among Female Workers in a Selected Garment Industry of Dhaka City: A Cross Sectional Study. The ORION Medical Journal, 23, 325-327.
[33]
Singh, M.M., Devi, R., Garg, S. and Mehra, M. (2001) Effectiveness of Syndromic Approach in Management of Reproductive Tract Infections in Women. Indian Journal of Medical Sciences, 55, 209-214.
[34]
Bashar, M.A., Ahmed, M.F., Rahman, S.R. and Gomes, D.J. (2009) Distribution and Resistance Trends of Escherichia coli from Urinary Tract Infections Isolated in Dhaka City. Bangladesh Journal of Medical Science, 15, 93-98.
[35]
Rahman, F., Chowdhury, S., Rahman, M.M., Ahmed, D. and Hossain, A. (2009) Antimicrobial Resistance Pattern of Gram-Negative Bacteria Causing Urinary Tract Infection. Stamford Journal of Pharmaceutical Sciences, 2, 44-50. https://doi.org/10.3329/sjps.v2i1.5815
[36]
Yasmeen, B.H.N., Islam, S., Islam, S., Uddin, M.M. and Jahan, R. (2015) Prevalence of Urinary Tract Infection, Its Causative Agents and Antibiotic Sensitivity Pattern: A Study in Northern International Medical College Hospital, Dhaka. Northern International Medical College Journal, 7, 105-109 https://doi.org/10.3329/nimcj.v7i1.25704
[37]
Ahmed, S.M. and Avasaralam A.K. (2008) Urinary Tract Infections (UTI) among Adolescent Girls in Rural Karimnagar District, AP-K.A.P. Study. Indian Journal of Preventive & Social Medicine, 39, 67-70.
[38]
García-Morúa, A., Hernández-Torres, A., Salazar-de-Hoyos, J.L., Jaime-Dávila, R. and Gómez-Guerra, L.S. (2009) Community-Acquired Urinary Tract Infection Etiology and Antibiotic Resistance in a Mexican Population Group. Revista Mexicana de Urología, 69, 45-48.
[39]
Sood, S. and Gupta, R. (2012) Antibiotic Resistance Pattern of Community Acquired Uropathogens at a Tertiary Care Hospital in Jaipur, Rajasthan. Indian Journal of Community Medicine, 37, 39-44. https://doi.org/10.4103/0970-0218.94023
[40]
Ochei, J. and Kolhatkar, A. (2007) Medical Laboratory Science Theory and Practicereprint. 6th Edition, McGraw-Hill, New Delhi, India. Diagnosis of Infection by Specific Anatomic Sites/Antimicrobial Susceptibility Tests; pp. 615-643, 788-798.
[41]
Orrett, F.A. and Davis, G.K. (2006) A Comparison of Antimicrobial Susceptibility Profile of Urinary Pathogens for the Years, 1999 and 2003. West Indian Medical Journal, 55, 95-99.
[42]
Zakaria, M.M., Talukder, A.S. and Chowdhury, E.K. (2002) Prevalence and Drug Sensitivity of Microorganisms in Patients with Urinary Tract Infection Attending A Semi-Rural Hospital in Bangladesh. Bangladesh Journal of Medical Science, 8, 111-114.
[43]
Mehr, M.T., Khan, H., Khan, T.M., Iman, N., Iqbal, S. and Adnan, S. (2010) E coli Urine Super Bug and Its Antibiotic Sensitivity: A Prospective Study. Journal of Medical Sciences, 18, 110-113.
[44]
Naeem, M., Khan, M. and Qazi, S.M. (2010) Antibiotic Susceptibility Pattern of Bacterial Pathogens Causing Urinary Tract Infection in a Tertiary Care Hospital. Annals of Pakistan Institute of Medical Sciences, 6, 214-218.
[45]
Humayun, T. and Iqbal, A. (2012) The Culture and Sensitivity Pattern of Urinary Tract Infections in Females of Reproductive Age Group. Annals of Pakistan Institute of Medical Sciences, 8, 19-22.
[46]
Sheikh, D., Ashfaq, S., Sheikh, K. and Sheikh, M. (2005) Studies on Resistance/Sensitivity Pattern of Bacteria Related with Urinary Tract Infections. Medical Journal of Islamic World Academy of Sciences, 15, 129-133.
[47]
Shigemura, K., Tanaka, K., Okada, H., Nakano, Y., Kinoshita, S., Gotoh, A., Arakawa, S. and Fujisawa, M. (2005) Pathogen Occurrence and Antimicrobial Susceptibility of Urinary Tract Infection Cases during a 20-Year Period (1983-2002) at a Single Institution in Japan. Japanese Journal of Infectious Diseases, 58, 303-308
[48]
Saleh, A.A., Ahmed, S.S., Ahmed, M., Sattar, A.N.I. and Miah, M.R.A. (2000) Changing Trends in Uropathogens and Their Antimicrobial Sensitivity Pattern. Bangladesh Journal of Medical Microbiology, 3, 9-12. https://doi.org/10.3329/bjmm.v3i2.5320
[49]
Wattal, C., Sharma, A., Oberoi, J.K., Datta, S., Prasad, K.J. and Raveendr, R. (2005) ESBL—An Emerging Threat to Antimicrobial Therapy. Microbiology Newsletter of Sir Ganga Ram Hospital, 10, 1-8.
[50]
Manikandan, S., Ganesapandian, S., Singh, M. and Kumaraguru, A.K. (2011) Antimicrobial Susceptibility Pattern of Urinary Tract Infection Causing Human Pathogenic Bacteria. Asian Journal of Medical Sciences, 3, 56-60.
[51]
Falagas, M.E., Vouloumanou, E.K., Samonis, G. and Vardakas, K.Z. (2016) Fosfomycin. Clinical Microbiology Reviews, 29, 321-347. https://doi.org/10.1128/CMR.00068-15
[52]
Sultan, A., Rizvi, M., Khan, F., Sami, H., Shukla, I. and Khan, H.M. (2015) Increasing Antimicrobial Resistance among Uropathogens: Is Fosfomycin the Answer? Urology Annals, 7, 26-30. https://doi.org/10.4103/0974-7796.148585
[53]
Lorente-Garin, J.A., Placer-Santos, J., Salvado-Costa, M., Segura-Alvarez, C. and Gelabert-Mas, A. (2005) Antibiotic Resistance Transformation in Community-Acquired Urinary Infections. Revista Clínica Española, 205, 259-264. https://doi.org/10.1157/13076148
[54]
Maraki, S., Mantadakis, E., Michailidis, L. and Samonis, G. (2013) Changing Antibiotic Susceptibilities of Community-Acquired Uropathogens in Greece, 2005-2010. Journal of Microbiology, Immunology and Infection, 46, 202-209. https://doi.org/10.1016/j.jmii.2012.05.012
[55]
Haque, R., Laila Akter, M. and Salam, M.A. (2015) Prevalence and Susceptibility of Uropathogens: A Recent Report from a Teaching Hospital in Bangladesh. BMC Research Notes s, 8, Article No. 416. https://doi.org/10.1186/s13104-015-1408-1
[56]
Sorlozano, A., Gutierrez, J., De Dios Luna, J., Oteo, J., Liebana, J., Soto, M.J., et al. (2007) High Presence of Extended-Spectrum Beta Lactamases and Resistance to Quinolonesin Clinical Isolates of Escherichia coli. Microbiological Research, 162, 347-354. https://doi.org/10.1016/j.micres.2006.02.003
