Microbiological Profile in Urinary Tract Infections among Children in a Tertiary Care Center in Kumaun region, India

Abstract Background Trimethoprim/Sulfamethoxazole (TMP/SMX) is not routinely employed for urinary tract infections (UTI) with multi-drug-resistant organisms (MDRO) due to paucity of effectiveness data, concerns regarding inadequate urinary penetration, and risk of adverse effects. We describe our experience with TMP/SMX as definitive therapy for MDRO Enterobacteriaceae (MDRO-E). Methods We carried out a retrospective review of patients hospitalized at a tertiary care center and treated with TMP/SMX as definitive therapy for UTI with MDRO-E (as defined by resistance to third-generation cephalosporins in culture). We evaluated rates of overall cure rate (CR), adverse events (AE), recurrence (RC) and reinfection (RI). Repeat growth of same or different pathogen in urine culture (UC) within 30 days of completion of treatment was defined as RC or RI, respectively. Results 92 patients had 101 episodes of MDRO-E UTIs treated with TMP/SMX as initial (n = 26, 25.7%) or as step-down therapy (n = 23, 77%) after broad-spectrum empiric antimicrobials (ceftriaxone n = 22, cefepime n = 21, piperacillin/tazobactam n = 12, carbapenems n = 6, ciprofloxacin n = 3). 63 (68.5%) patients were 65 years or older. MDRO-E in 10 (9.9%) episodes were also resistant to carbapenems. Empiric therapy was appropriate in 56 (55.5%) episodes. Median duration of treatment was 8.5 (range 3–24) days for all antimicrobials and 7 (range 2–15) days for TMP-/SMX. Overall CR was 100%. RC/RI was seen in 23/101 (22.8%) episodes (RC n = 9; RI n = 14); UC data were available for 20 of which 8/20 (40%) had a TMP/SMX-resistant organism. 4 (3.9%) patients required readmission for a RC/RI UTI. In terms of AEs: 10 (9.9%) episodes of hyperkalemia (median maximum potassium level 4.5 mmol/L, range 2.7–6.4), 3 (2.9%) episodes of acute kidney injury, 5 episodes of Clostridium difficile infection, and 4 (3.9%) readmissions for a RC/RI UTI within 90 days. Conclusion Our findings suggest that TMP/SMX can be safe and effective as definitive therapy for ESBL-E UTI. The major AE are hyperkalemia and AKI, the incidence of which is high when TMP/SMX is used in combination with ACEI/ARBs. No clinical factors were found to be predictive of recurrence of reinfection. Disclosures All authors: No reported disclosures.

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In Vitro Susceptibility of Escherichia coli and Enterococcus faecalis Isolates from Patients with Urinary Tract Infections to Fosfomycin in North India: A Retrospective Study in a Tertiary Care Center

MGM Journal of Medical Sciences ◽

10.5005/jp-journals-10036-1197 ◽

2018 ◽

Vol 5 (3) ◽

pp. 112-116

Author(s):

Anupam Das ◽

Gaurav Kumar ◽

Manodeep Sen ◽

Sana Islahi ◽

Rachana Kanaujia ◽

...

Keyword(s):

Escherichia Coli ◽

Retrospective Study ◽

Urinary Tract ◽

Care Center ◽

Tertiary Care ◽

North India ◽

Tertiary Care Center ◽

In Vitro Susceptibility ◽

Tract Infections

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Study of Culture and Sensitivity Pattern In Urinary Tract Infections in A Tertiary Care Center in Nepal

Medical Laboratory Technology Journal ◽

10.31964/mltj.v4i2.191 ◽

2018 ◽

Vol 4 (2) ◽

pp. 63

Author(s):

Binod Chapagain ◽

Parshal Bhandari ◽

Binod Aryal

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Care Center ◽

Tertiary Care ◽

Antibiotic Sensitivity ◽

Multidrug Resistant ◽

Sensitivity Pattern ◽

Causative Agents ◽

Gram Negative Organisms ◽

Tract Infections

The main purpose of this study was to find out the causative agents of urinary tract infections (UTI) and their culture and antibiotic sensitivity in patients visiting Tribhuvan University and Teaching Hospital (TUTH). A retrospective study conducted among 155 patients, aged from 25-50 years with culture-positive UTI, who visited TUTH from 1st April 2017 to 30th September 2017. A culture of midstream urine was done to find out causative agents and their antibiotic sensitivity performed. Data were evaluated using Microsoft Excel 2016. Female were more affected than males. Escherichia coli (E. coli) was the most common microbes causing UTI in 53% patients. Most of the isolates on culture were Multi-Drug Resistant (MDR) strains to comprise 52%. Of the total gram-negative organisms, 33.9% were Extended Spectrum β-lactamase (ESBL) producers, and 3.57% were Metallo β-lactamase (MBL) producers. 29.41% of Staphylococcus were resistant to methicillin. E.coli is the most common organism causing UTI among adults. Multidrug-resistant has appeared alarming with resistant to most of the first line antibiotics.

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