A prospective study of antibiotic susceptibility pattern of uropathogens in a tertiary care hospital

Corresponding author: Andrea Assuez. Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0. A prospective study of antibiotic susceptibility pattern of uropathogens in a tertiary care hospital Andrea Assuez 1, *, Amrutha Murali 1, Athul K Rajan1, Cijo George 2, Chitra C Nair 3 and Beena P 4 1 Pharm D Intern, KVM College of Pharmacy, Cherthala, Kerala, India. 2 Associate Professor, KVM College of Pharmacy, Cherthala, Kerala, India. 3 Professor and HOD, KVM College of Pharmacy, Cherthala, Kerala, India. 4 Principal, KVM College of Pharmacy, Cherthala, Kerala, India. World Journal of Biology Pharmacy and Health Sciences, 2025, 21(01), 589-597 Publication history: Received on 10 December 2024; revised on 23 January 2025; accepted on 26 January 2025 Article DOI: https://doi.org/10.30574/wjbphs.2025.21.1.0063 Abstract Background: Urinary tract infection (UTI) is a frequent condition encountered in primary care. Treatment is usually empirical without urine culture and susceptibility testing because the causative uropathogens and their antimicrobial susceptibility profiles are considered to be predictable. However, there is increasing evidence of antimicrobial resistance in communityacquired uropathogens. This study aimed to assess the prevalence and antimicrobial susceptibility pattern of uropathogens causing UTI. Methods: A prospective study was conducted over a period of six months in a tertiary care hospital in Kerala, India. A total of 100 patient case records satisfying the inclusion criteria were analysed to determine the prevalence of uropathogens causing UTI and also to determine antibiotic sensitivity pattern of uropathogens to various antibiotics. All the relevant and necessary data of the patient were collected from patient’s case record and microbiology department to study the rational prescribing of antibiotics before and after culture sensitivity test. Data analysis was conducted using Chi-squared test and descriptive statistics. Result: In this study, we observed a higher incidence of UTIs in females, particularly among individuals aged over 70 years. The primary microorganisms isolated from these cases were Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Upon conducting culture sensitivity tests, approximately half of the initially prescribed antibiotics were altered. Penicillin class of antibiotic was frequently substituted, predominantly with drugs from the carbapenem class. Our analysis of antibiotic sensitivity revealed that Imipenem exhibited the highest sensitivity, followed by meropenem and colistin within our study cohort. Furthermore, a chi-square test was conducted, yielding a chi-square value of 12.25 with a p-value less than 0.001, implies that there is a significant difference between drugs given before and after C/S was done. These findings underscore the importance of tailored antibiotic selection based on microbial sensitivity profiles, especially in elderly female patients, to ensure effective treatment outcomes for UTIs. Conclusions: According to the research, UTIs are the most common public health issue, primarily affecting women. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosawere the most common isolated organisms in our study that caused UTIs in IndiaMost isolates exhibited resistance to widely used antibiotics.Thus, regular surveillance and monitoring are essential for improved patient care. Keywords: Antibiotic susceptibility; E. coli, Multidrug resistance; Urinary tract infection; Uropathogens World Journal of Biology Pharmacy and Health Sciences, 2025, 21(01), 589-597 590 1. Introduction A urinary tract infection (UTI) is defined as a medical disorder in which the presence of pathogenic bacteria in the urine, bladder, urethra, kidney, and prostate is linked to clinical signs and symptoms [1]. The second most prevalent bacterial illness that affects people of all ages globally is a urinary tract infection (UTI) [2] . UTIs are thought to affect 50% of women worldwide at least once in their lifetime, and they are more prevalent in those between the ages of 16 and 64 [3]. Although UTIs are extremely rare in males, they can occur during the first year of life, especially in those with functional or structural abnormalities [4]. Additionally, UTI recurrence rates are greater, primarily due to treatment gaps or discontinuations. As a result, reinfection with the same or distinct microbes may happen [5]. There are two types of UTIs: uncomplicated and complicated. While complicated UTIs affect people of all ages and sexes, uncomplicated UTIs are more common in healthy adult non-pregnant women [2]. Renal calculi, renal failure, indwelling catheters, renal transplantation, immunosuppression, blockage, and pregnancy are risk factors for complicated UTIs [6]. Although bacteria are responsible for over 95% of UTIs, other microbes such viruses, fungi, and parasites can also cause UTIs.[7]. Gram-negative bacteria including Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Citrobacter species, Enterobacter species, and Proteus species are the most common bacterial pathogens that cause urinary tract infections. The most frequent causes of UTIs among Gram-positive bacteria are Staphylococcus aureus, Staphylococcus saprophyticus, and Enterococcus species [8]. Of all the bacteria, E. coli is responsible for 75% to 95% of UTI cases [9]. Broad-spectrum antibiotics are frequently used for empirical treatment since they have proven to be highly effective in the management of UTIs. The improper use of antibiotics and their over-the-counter availability have led to the emergence of antibiotic resistance against prevalent infections worldwide [10]. Multidrug-resistant (MDR) uropathogens have become more common in both community and hospitalized patients during the past few years [11]. According to a study conducted by the European Survey of Antibiotic Consumption, MDR bacterial strains in complex UTIs cause over 25,000 deaths nationwide each year [12]. Therefore, it is crucial to prevent the improper and excessive use of antibiotics, which can result in multidrug resistance. Suitable medicines should be chosen for the empirical treatment of urinary tract infections. The pattern of antibiotic susceptibility among bacteria varies from hospital to hospital and within different geographical locations [13]. To track changes in antibiotic susceptibility trends, the Infectious Disease Society of America recommends conducting regional monitoring in a particular area [14] In the current scenario, there is a rise in morbidity and mortality due to the alarming emergence of MDR bacterial infections and the frequent changes in antibiotic susceptibility patterns. Understanding the causative agents of urinary tract infections (UTIs) and their susceptibility to antibiotics is essential for both empirically treating UTIs and halting the development of antibiotic resistance. This study aimed to determine the prevalence of the UTI-causing pathogens, and their antimicrobial susceptibility pattern among individuals with suspected UTIs [15] 2. Methods • Study design: Present study was prospective, observational, single centre study. • Study centre and duration: Study was conducted on inpatient of General Medicine department at SH medical centre, Kottayam, Kerala for a period of 6 months. • Study design: A total of 100 patient case records satisfying the inclusion criteria were analyzed to determine the prevalence of uropathogens causing UTI and also to determine antibiotic sensitivity pattern of uropathogens to various antibiotics. • Inclusion criteria: Patients of either sex admitted in hospital with UTI. Also received at least one antibiotic for treating UTI. • Exclusion criteria: Patients with negative culture report or having infection other than UTI. UTI caused by other than bacteria are excluded from our study. • Procedure: All the relevant and necessary data of the patient were collected from patient’s case record and microbiology department to study the antibiotic susceptibility pattern of uropathogens and also to study the rational prescribing of antibiotics before and after culture sensitivity test. World Journal of Biology Pharmacy and Health Sciences, 2025, 21(01), 589-597 591 3. Results and discussion 3.1. A total of 100 patients were met with the inclusion criteria Table 1 Frequency and percentage distribution according to age group Age Frequency (n) Percentage (%) <50 31 31 50 – 70 19 19 >70 50 50 It indicates that half of the UTI patients are over 70 years old The increased vulnerability to UTIs in this age group is caused by a number of factors, including hormonal changes, bladder dysfunction, catheter use, mobility challenges, chronic health disorders like diabetes mellitus kidney disease, and urine incontinence. Table 2 Distribution of patients according to gender. Gender Frequency (n) Percentage (%) Female 53 53 Male 47 47 Based on this distribution, it may be inferred that a greater proportion of UTI patients are female (57%) than male (47%) for a variety of reasons, such as females shorter urethras and their close proximity to the anus, as well as hormonal changes during menstruation, pregnancy, and menopause. Table 3 Frequency and percentage distribution according to type of organism N= 100 Organism Frequency (n) Percentage (%) Gram – ve 83 83 Gram – ve 17 17 This distribution indicates that the majority of UTIs are caused by Gram-negative bacteria, which account for 83% of the cases, while Gram-positive bacteria are responsible for 17% of the cases. This suggests that Gram-negative bacteria are the predominant pathogens in UTI infections. Table 4 Frequency and percentage distribution of uropathogens. N=100 Organism Frequency (n) Percentage (%) Escherichia coli 41 41 Klebsiella pneumoniae 20 20 Pseudomonas aurogenosa 8 8 Beta hemolytic streptococci 7 7 Acinetobacter 6 6 Staphylococcus aureus 6 6 Citrobacter diversus 4 4 Citrobacter freundi 4 4 Non hemolytic streptococci 3 3 Alpha hemolytic streptococci 1 1 World Journal of Biology Pharmacy and Health Sciences, 2025, 21(01), 589-597 592 This indicates that E. coli was the most prevalent bacteria. Table 5 Percentage distribution of antibiotics changed and not changed after C/S. N=100 Antibiotics Frequency (n) Percentage (%) Changed after c/s 50 50 Not changed after c/s 50 50 The table indicates that 50% of the cases, the antibiotics were changed after conducting C/S. This suggests that the results of the C/S indicated a need to alter the antibiotic treatment. In the other 50% of the cases, the antibiotics were not changed after conducting C/S. This implies that the initial antibiotic treatment were appropriate based on the C/S results. Table 6 Use of antibiotics pre and post C/S done Class Drug given to the patients Frequency (n) BEFORE C/S AFTER C/S 1 Meropenem Faropenem 4 2 Piperacillin tazobactum Nitrofurantoin 3 2 Piperacillin tazobactum Meropenem 3 2 Piperacillin tazobactum Imipenem 3 3 Cefpodoxime Cefotaxim 2 4 Moxifloxacin Ceftriaxone 2 2 Piperacillin tazobactum Faropenem 2 3 Ceftriaxone sulbactum Imipenem 2 2 Piperacillin tazobactum Cefpodoxime 2 3 Cefuroxime Piperacillin tazobactum 2 2 Piperacillin tazobactum Cefipime 2 3 Cefotaxim Nitrofurantoin 1 3 Cefotaxim Levofloxacin 1 5 Nitrofurantoin Meropenem 1 1 Meropenem Ampicillin 1 1 Imipenem Ampicillin 1 3 Cefotaxim Ciprofloxacin 1 3 Cefoperazone sulbactum Ciprofloxacin 1 2 Piperacillin tazobactum Cefotaxim 1 1 Meropenem Linezolid 1 1 Imipenem Faropenem 1 3 Cefuroxime Ciprofloxacin 1 2 Piperacillin tazobactum Ofloxacin 1 4 Ciprofloxacin Ciprofloxacin 1 1 Faropenem Nitrofurantoin 1 World Journal of Biology Pharmacy and Health Sciences, 2025, 21(01), 589-597 593 3 Ceftriaxone Amoxiclav 1 6 Linezolid Faropenem 1 1 Imipenem Cefuroxime 1 3 Ceftriaxone Ampicillin 1 5 Nitrofurantoin Faropenem 1 3 Cefpodoxime Piperacillin tazobactum 1 2 Piperacillin tazobactum Ampicillin 1 4 Ciprofloxacin Meropenem 1 7 Amikacin Ceftriaxone 1 Table 7 Coding of Antibiotic class Code Antibiotic 1 Carbapenem 2 Penicillin 3 Cephalosporin 4 Quinolones 5 Nitrofuran 6 Oxazolidinedione 7 Aminoglycoside Here, each class of antibiotic is assigned a code for identification purpose. Table 8 Frequency and percentage distribution of class of antibiotics changed after C/S done. N= 50 Antibiotics Frequency (n) Percentage (%) Carbapenem 10 20 Penicillin 18 36 Cephalosporin 14 28 Quinolones 4 8 Nitrofurantoin 2 4 Oxazolidinedione 1 2 Aminoglycoside 1 2 The table indicates that Penicillin is the most frequently changed antibiotic after culture sensitivity. This suggests that initial treatments involving these antibiotics are frequently adjusted after culture sensitivity results. This could imply a higher rate of resistance. World Journal of Biology Pharmacy and Health Sciences, 2025, 21(01), 589-597 594 Table 9 Frequency and percentage distribution of class of antibiotic which replaced Penicillin after C/S done. N=18 Antibiotics Frequency (n) Percentage (%) Nitrofuran 3 18 Carbapenem 8 44 Cephalosporin 5 28 Fluoroquinolones 1 5 Other type of penicillin 1 5 This data suggests that, most of the time carbapenem (44%) replaces penicillin after viewing C/S report followed by cephalosporin (28%), nitrofuran (18%), fluoroquinolones (5%) and other type of penicillin (5%). Table 10 Statistical Analysis of antibiotics before and after culture and sensitivity done. Change in drug No change in drug Chi-square test Before C/S 0 100 Chi-square=12.5 After C/S 50 50 P value = < 0.01 Statistical analysis was done using chi-squared test. The table shows a chi-square value of 12.25 with a p-value less than 0.001, signifying a statistically insignificant association. This shows that the drugs given before c/s and drugs given after c/s having a huge significant difference. Table 11 Antibiotic Sensitivity Pattern Of Uropathogens Antibiotics Sensitive Moderate sensitive Resistant Frequency(n) Percentage (%) Frequency (n) Percentage (%) Frequency (n) Percentage (%) Cefuroxime 61 26 27 12 145 62 Ampicillin/sulbactam 186 80 1 0 46 20 Cefoperazone/sulbactam 131 56 44 19 58 25 Levofloxacin 109 47 19 8 105 45 Cefixime 76 33 23 10 134 57 Ceftriaxone 98 42 29 12 106 46 Sparfloxacin 104 45 20 8 109 47 Nalidixic acid 49 21 12 5 172 74 Ciprofloxacin 108 46 21 9 104 45 Furantoin 145 62 25 11 63 27 Cefotaxime 75 32 44 18 114 50 Meropenem 197 85 7 3 29 12 Cefipime 150 65 24 10 59 25 Tobramycin 151 65 24 10 58 25 Colistin 200 86 0 0 33 14 Gentamycin 157 67 23 10 53 23 World Journal of Biology Pharmacy and Health Sciences, 2025, 21(01), 589-597 595 Amikacin 169 72 25 11 39 17 Imipenem 202 87 10 4 21 9 Ofloxacin 106 45 20 9 107 46 Tetracycline 80 34 35 15 118 51 Cotrimoxazole 124 53 3 1 106 46 Norfloxacin 105 45 22 9 106 46 Ceftizoxime 95 41 21 9 117 50 Chloramphenicol 182 78 4 2 47 20 Piperacillin/tazobactam 89 38 85 37 59 25 Nithillin 195 84 6 2 32 14 Methicillin 9 4 1 0 223 96 Cephalexin 61 26 13 6 159 68 Lincomycin 20 9 0 0 213 91 Amoxicillin/clavulonic acid 69 30 20 8 144 62 Faropenem 74 32 2 1 157 67 Cefpodoxime 26 11 30 13 177 76 Ceftazidime 87 37 32 14 114 49 Tigecycline 168 72 43 18 22 10 This table shows antibiotics, such as Meropenem, Imipenem, and Colistin show high sensitivity rates indicating their effectiveness against most of the bacterial isolates. 4. Limitations • Errors in laboratory practices, such as improper handling or incubation, can affect the results of susceptibility testing. • Infections caused by multidrug-resistant pathogens complicate treatment choices and complicate the analysis of antibiotic effectiveness. • Contamination of urine samples with commensal flora or external bacteria during collection or processing can result in false positive or misleading results. • Factors like immune status, comorbid conditions, and prior antibiotic use can influence both the pathogen's resistance and the outcome of the infection, complicating the interpretation of susceptibility. • Not all available antibiotics are tested, especially newer or less commonly used ones. This can lead to underestimation of the full range of effective treatment options. 5. Conclusion The research evaluated the antibiotic sensitivity pattern of uropathogens that cause UTIs in 100 patients. Over 70-yearold make up 50% of UTI patients. Urinary tract infections (UTIs) are more common in this age group for a variety of reasons, including changes in hormones, bladder problems, catheter use, problems with mobility, and chronic illnesses like kidney disease, diabetes mellitus, and urine incontinence. The research population consists of 47% men and 53% women for a variety of reasons, including the shorter length of the female urethra and its close proximity to the anus, as well as hormonal changes that occur during menstruation, pregnancy, and menopause. Gram-negative bacteria cause 83% of UTI cases and Gram-positive bacteria cause 17% of cases. Gram-negative bacteria are the primary cause of UTIs. This implies that the majority of pathogens in UTI infections are Gram-negative bacteria. E. coli was the mostfrequently isolated microorganism, followed by Acinetobacter, Pseudomonas aurogenosa, Beta haemolytic streptococci, and Klebsiella pneumoniae. After conducting C/S, the antibiotics were changed in 50% of the cases. This implies that the C/S results World Journal of Biology Pharmacy and Health Sciences, 2025, 21(01), 589-597 596 required a modification in the antibiotic treatment. After performing C/S, the antibiotics were left unchanged in the remaining 50% of cases. This suggests that based on the C/S results, the initial antibiotic treatment was appropriate. Inappropriate use of antibiotics is the primary cause of AMR and should be monitored. The proposed regulations from the Infectious Diseases Society of America state that patient history, drug accessibility, and geographic susceptibility data should all be taken into consideration when empirically treating UTIs with antibiotic. In India, bacterial uropathogen resistance is turning into a public health concern. Lack of suitable microbiological labs in many Indian cities and towns results in a higher empirical usage of antibiotics and less microbiological evaluations. Urine samples are usually sent for microbiological testing only in cases of recurrent or relapsing infections or treatment failure. Our results highlight the importance of local patterns of antibiotic resistance, which can then be utilized to inform regional and hospital antibiotic policy. Compliance with ethical standards Acknowledgments We take this opportunity to express our deep sense of gratitude and respectful regards to Dr. Binsy Jacob (General medicine) Physician and Diabetologist MBBS, MD & PGDDM Tertiary Care Hospital Kottayam for their immense support, encouragement and credible ideas which have been great contributors in completion of this thesis. We are also thankful to the Management, Nursing Staff and all other Staffs of Tertiary Care Hospital, Kottayam, for their immense support. We sincerely express our gratitude and respect to Dr. Cijo George who worked hard to understand our requirements and made the results available on time. 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