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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Bacteriological Profile and Antibiogram of Urinary Tract Infections at a Tertiary Care Hospital in Kerala, India: A Retrospective Study
Correspondence Address :
Dr. VS Roshni,
KNRA 22, Kairali Nagar, Kuravankonam, Kowdiar P.O., Thiruvananthapuram-695003, Kerala, India.
E-mail: roshnisajil1@gmail.com
Introduction: Urinary Tract Infections (UTIs) are caused by microbial invasion of the urinary tract, extending from the renal cortex of the kidney to the urethral meatus. Over the past years, resistance levels to the traditional drugs used for the treatment of UTIs have been gradually increasing. Therefore, a therapy based on the individual culture report and antibiotic sensitivity test is highly encouraged.
Aim: To determine the age-wise and sex-wise prevalence of UTI, as well as to determine the bacteriological profile and antimicrobial sensitivity pattern of isolated uropathogens.
Materials and Methods: This retrospective record-based study was conducted in the Department of Microbiology at Travancore Medical College in Kollam, Kerala, India. Samples were collected from patients with clinically suspected UTI attending the Outpatient Department (OPD) and Inpatient Department (IPD) of Travancore Medical College, Kollam, Kerela, India over a period of six months from July 2022 to December 2022. Both male and female patients with clinically suspected UTI were included in the study. The clinical diagnostic criteria included dysuria, frequency, urgency, and fever. Data were retrieved from the culture register maintained in the Microbiology laboratory, LIS (ELLIDER), and the WHONET software system. Urine culture was performed using a semiquantative technique. A growth of >105 Colony Forming Units (CFU)/mL was considered indicative of an active UTI with significant bacteriuria. Organisms were identified using Gram stain, motility testing, and biochemical reactions following standard microbiological techniques. Antimicrobial sensitivity testing was conducted using the Kirby-Bauer Disc diffusion method. The data were entered into a Microsoft Excel worksheet, and the results were analysed using simple descriptive statistics involving percentages and proportions using Statistical Package for Social Sciences (SPSS) software version 16.0.
Results: Of the total 2,794 samples, 319 (11.4%) samples yielded significant bacteriuria. Among the positive samples, 204 (64%) were from females and 115 (36%) were from males. UTIs were most commonly seen in the age group of 61-80 years. Escherichia coli (E.coli), with 148 isolates (46.4%), was the predominant organism, followed by Klebsiella pneumoniae with 72 isolates (22.6%). E. coli showed the highest susceptibility to meropenem, with 137 isolates (92.6%), and imipenem, with 136 isolates (91.9%), followed by cefoperazone/sulbactam with 129 isolates (87.2%), and piperacillin/tazobactam with 128 isolates (86.5%). Klebsiella pneumoniae was most susceptible to imipenem, with 42 isolates (60%), followed by meropenem, with 29 isolates (41.4%). Most non fermenters were highly susceptible to carbapenems, cefoperazone/sulbactam, and piperacillin/tazobactam. Among the gram-positive organisms, Enterococcus spp. was the most frequently isolated, showing 100% sensitivity to vancomycin and linezolid.
Conclusion: In this study, UTI was found to be more prevalent among elderly females. Gram-negative organisms were the most commonly isolated pathogens in UTI, with E. coli being the most frequent agent. Urinary pathogens exhibited resistance to commonly used antibiotics such as ampicillin, cephalosporins, quinolones, and cotrimoxazole. Based on this study, it can be concluded that the resistance to commonly used antibiotics is very high. Due to the changing trends in the sensitivity patterns of various antibiotics, it is important to understand the antibiogram of common isolates in a specific area or hospital to ensure better empirical treatment.
Antibiotic sensitivity test, Pyelonephritis, Urethritis, Uropathogens
The urinary tract consists of the kidneys, ureters, bladder, and urethra. Based on the anatomical location of the infection: UTIs are either Upper (U-UTI) or Lower (L-UTI). Upper UTIs may manifest as ureters (ureteritis) or the renal parenchyma (pyelonephritis). Lower UTIs can present as asymptomatic bacteriuria, the urethra (urethritis), the bladder (cystitis), acute urethral syndrome, or the prostate in males (prostatitis) (1). Pyelonephritis refers to inflammation of the kidney parenchyma, calyces, and the renal pelvis and is associated with systemic manifestations such as fever, flank pain, and vomiting. Asymptomatic bacteriuria means the patient is symptomless but is excreting bacteria in quantities equal to or greater than 105 CFU/mL. Clinical symptoms of urethritis include dysuria and frequency. The most common type of infection is cystitis, manifested as dysuria, frequency, urgency, tenderness over the bladder area, and sometimes bloody urine. Acute urethral syndrome is manifested as dysuria, frequency, and urgency in young sexually active women who excrete bacteria fewer than 105 CFU/mL in urine (2). UTIs are the most common bacterial infections in humans, with an estimated 150 million UTIs occurring annually worldwide (3). Recent use of a diaphragm with spermicide, frequent sexual intercourse, and a history of UTI are independent risk factors for acute cystitis. In healthy postmenopausal women, sexual activity, diabetes mellitus, and incontinence are risk factors for UTI (4). UTIs are important complications of diabetes, renal disease, renal transplantation, and structural and neurologic abnormalities that interfere with urine flow. UTIs are a leading cause of gram-negative sepsis in hospitalised patients. Escherichia coli is the most frequent cause of community-acquired UTIs. Other bacteria frequently isolated from patients with UTIs are Klebsiella spp., other Enterobacteriaceae, Acinetobacter spp., Coagulase-negative Staphylococcus, Staphylococcus aureus, and Enterococci. Proteus, Pseudomonas, and Klebsiella spp. are responsible for complicated UTIs (1). Bacteria invade the urinary tract mainly by two routes-ascending and descending routes.
Enteric endogenous bacteria enter the urinary tract via the ascending route, which is the most common route (1),(2). The descending route refers to the invasion of renal parenchyma through haematogenous seeding of the pathogen. If diagnosed early and treated adequately with antibiotic coverage, UTI is not alarming. However, if inadequately treated, it can cause significant morbidity and mortality. The aim of the study was to determine the age-wise and sex-wise prevalence of UTI and to determine the bacteriological profile and antimicrobial sensitivity pattern of isolated uropathogens, which may help in the management of UTI and guide medical practitioners to carry out empirical treatment.
The present study was a retrospective study conducted in the Department of Microbiology at Travancore Medical College, Kollam, Kerala, India, over a period of six months from July 2022 to December 2022. Samples were collected from patients with clinically suspected UTI attending the OPD and IPD of Travancore Medical College, Kollam, Kerala, India. Ethics approval was obtained from the Travancore Medical College Ethics Committee, IEC No-149/23.
Inclusion criteria: Both male and female patients with clinically suspected UTI were included in the study. The clinical diagnostic criteria include dysuria, frequency, urgency, and fever.
Exclusion criteria: Patients with polymicrobial infections involving more than two bacterial species, patients with Candida spp. as the sole pathogen, and repeat samples received from the same patients on follow-up were excluded from the study.
Study Procedure
Patients with clinically suspected UTI were asked to collect fresh urine samples. A total of 2,794 clean-catch midstream urine samples were collected in a wide-mouthed sterile container from both outpatients and inpatients and immediately transported to the Microbiology laboratory for processing within two hours of collection. Specimens were collected using the standard “clean catch” mid-stream method for patients without a catheter in place. For catheterised patients, the sample was collected in a sterile, screw-capped, wide-mouth container after clamping the catheter. Before collecting the sample, male subjects were instructed to clean the genital parts with soap and water, while female patients were asked to wash the vulva and carefully separate the labia before voiding the urine into the sterile bottle.
The urine samples were inoculated on both blood and MacConkey agar using calibrated loops for a semiquantative method. An inoculating loop of standard dimensions was used to take up a small, approximately fixed, and known volume of mixed uncentrifuged urine, which was spread over a plate of agar culture medium. The plates were incubated aerobically at 37°C for 24 hours, and the number of colonies was counted to calculate the number of viable bacteria per mL of urine. Urine culture was performed using a semiquantative technique, where 0.01 mL of urine was cultured. A growth of >105 CFU/mL was considered as an active UTI with significant bacteriuria (5). Gram stain of the colony was then performed, and all biochemical tests were conducted after overnight incubation at 37°C for 24 hours.
Antimicrobial susceptibility testing: The antibiotic sensitivity test was performed using the Kirby Bauer disc diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines (6). All the media and antibiotics were purchased from HiMedia in Mumbai. The antibiotic discs used were as follows: ampicillin (10 μg), amoxicillin-clavulanic acid (20/10 μg), cefoperazone-sulbactam (75/30 μg), piperacillin-tazobactam (100/10 μg), cefuroxime (30 μg), ceftazidime (30 μg), cefotaxime (30 μg), cefepime (30 μg), cefixime (5 μg), cefpodoxime (10 μg), cephalexin (30 μg), imipenem (10 μg), meropenem (10 μg), amikacin (30 μg), gentamicin (10 μg), ciprofloxacin (5 μg), norfloxacin (10 μg), cotrimoxazole (1.25/23.75 μg), fosfomycin (200 μg), nitrofurantoin (300 μg), cefoxitin (30 μg), linezolid (30 μg), vancomycin (30 μg), and high-level gentamicin (120 μg).
Statistical Analysis
The data was entered into a Microsoft Excel worksheet, and the results were analysed using simple descriptive statistics, involving percentages and proportions, using SPSS software version 16.0.
The overall prevalence of UTI in both male and female patients was found to be 11.4%. Among the 2794 samples, 319 (11.4%) urine samples showed significant bacterial growth, comprising 115 (36%) samples from males and 204 (64%) from females. It was observed that in both sexes, the maximum number of uropathogens were isolated from patients in the age group 61-80 years, followed by the age group 21-40 years (Table/Fig 1).
Out of the 319 culture isolates as shown in (Table/Fig 2), Escherichia coli was the most common with 148 (46.4%), followed by Klebsiella spp. with 72 (22.6%), Enterococcus spp. with 44 (13.8%), Pseudomonas spp. with 25 (7.8%), and Acinetobacter baumannii with 13 (4.1%).
Based on the antibiotic sensitivity pattern analysis, E. coli showed higher sensitivity to fosfomycin with 148 (100%), imipenem with 136 (91.9.%), meropenem with 137 (92.6%), cefoperazone/sulbactam with 130 (87.8%), piperacillin/tazobactam with 129 (87.2%), amikacin with 116 (78.4%), and nitrofurantoin with 105 (70.9%), while it was resistant to ampicillin, cephalexin, cefuroxime, and cefpodoxime. Klebsiella pneumoniae showed higher sensitivity to imipenem with 42 (60%) and meropenem with 29 (41.4%), but was resistant to cephalexin and cefuroxime. Proteus spp. showed 6 (100%) sensitivity to imipenem and meropenem but was highly resistant to ampicillin, cephalexin, and cefuroxime (Table/Fig 3)a,b.
Enterococcus spp. was highly sensitive to vancomycin with 44 (100%) and linezolid with 44 (100%), but resistant to ciprofloxacin with 17 (39.3%) and norfloxacin with 17 (38.6%). Nitrofurantoin and high-level gentamicin showed a sensitivity of 32 (72.7%) and 32 (72.7%), respectively (Table/Fig 4).
Staphylococcus spp. showed a higher level of sensitivity to vancomycin with 4 (100%), linezolid with 4 (100%) followed by nitrofurantoin with 3 (75%), but the highest resistance to ampicillin with 3 (75%) followed by cephalexin with 2 (50%) (Table/Fig 5).
P. aeruginosa isolates showed higher sensitivity to amikacin with 19 (76%) and cefoperazone/sulbactam with 20 (80%), while being resistant to ceftazidime with 12 (48 %) and cefepime with 11 (44%) (Table/Fig 6).
Acinetobacter spp. demonstrated the highest sensitivity to Cotrimoxazole (100%) and the highest resistance to ceftazidime and cefepime (Table/Fig 7).
Streptococcus spp. was highly sensitive to ampicillin with 4 (100%), ceftriaxone with 4 (100%), but resistant to ciprofloxacin with 2 (50%) and norfloxacin with 2 (50%) (Table/Fig 8).
UTI is a major health problem worldwide, and the pattern of antibiotic resistance varies in different regions. The judicious usage of higher antibiotics at the community level is making the situation more alarming. The present study provides an outlook on the prevalence and antibiogram of the uropathogens isolated in this part of South Kerala. In the present study, the prevalence of UTI was 11.4%, which was in concordance with the findings of similar studies conducted by Mehrishi P et al., (9.7%), Baveja CP et al., (10.2%), and Kumar A et al., (12.18%) (7),(8),(9). A higher prevalence of 29% was found in a study by Agarwal A et al., (10). The difference in prevalence might be due to geographical variation, sociocultural habits of the community, health awareness, and personal hygiene practices.
The rate of isolation was higher in females, with 204 (64%) cases, revealing the increased susceptibility of females to UTIs compared to males, with 115 (36%) cases, similar to various cited studies (11),(12),(13). Females are more prone to UTIs due to a short urethra, proximity to the anus, absence of prostatic secretion, pregnancy, and easy contamination of the tract with faecal flora and urethral trauma during sexual intercourse. A study by Patil S showed that males were the most common gender compared to females. This finding does not match with present study (14).
The analysis of the age-wise data portrayed an increased prevalence in the 61-80 years age group with 103 (32.3%), which was in line with the findings of similar studies conducted by Manjunath GN et al., (43%) in the age group 50-79 years (15) and Barate DL and Ukesh C (42.85%) in the above 40 years age group (16). In contrast, Akram M et al., reported a prevalence of 16.66% in the 50-80 years age group (17). The increased vulnerability in the geriatric population may be attributed to age-related physiological and immunological changes and other infirmities like diabetes and enlarged prostate, as depicted in other studies (15),(16),(18).
In the present study, nine different types of organisms were isolated, with E. coli being the predominant one at 148 (46.4%), followed by Klebsiella spp. at 72 (22.6%). Enterococcus spp. and Pseudomonas spp. constituted 44 (13.7%) and 25 (7.8%) of the total urinary isolates, respectively. A study by Akter L et al., stated that E. coli (59.30%) was the leading bacteria, followed by Enterococcus spp. (11.56%), Klebsiella spp. (5.53%), Pseudomonas spp. (2.01%), and Proteus spp. (1.51%) (19). A higher isolation rate of E. coli was noted in the study by Parveen R et al., at 64.49%, followed by 11.21% for Klebsiella spp. (20).
The data from the present study demonstrated that E. coli isolates were highly resistant to ampicillin (92.6). These findings support previous research by Achaarya D et al., who found that 87.5% of bacterial E. coli were sensitive to ampicillin (21). In this study, E. coli isolates were most commonly resistant to cephalosporins, co-trimoxazole, ciprofloxacin, and norfloxacin. On the other hand meropenem (92.6%), imipenem (91.9%), and amikacin (78.4%) showed high potency against E. coli isolates as well as other gram-negative uropathogens tested in this study.
Organisms belonging to the Enterobacteriaceae family in this study showed resistance to ampicillin and cephalosporins such as cephalexin, cefuroxime, and cefotaxime, which aligns with the findings of studies conducted by Ahmed SM et al., who reported resistance towards amoxyclav (79.6%), fluoroquinolones ciprofloxacin (62.5%) and norfloxacin (71.6%), and cephalosporins cefuroxime (75.9%) and ceftriaxone (71.6%) (22). In a study by Manjunath G et al., E. coli showed high resistance to ampicillin (80.4%), cephalexin (49.4%), cefuroxime (47.4%), and ceftriaxone (43.2%) (15). Similarly, in a study by Barate DL and Ukesh C E. coli exhibited high resistance to amoxiclav (85%) and cephalexin (83%) (16), and in another study by Akram M et al., E. coli showed high resistance to cefuroxime (69%) and cefotaxime (56%) (17).
In this study, the majority of isolates showed a higher sensitivity pattern towards meropenem, imipenem, piperacillin/tazobactam, and amikacin. Most non fermenters were highly susceptible to carbapenems, cefoperazone/sulbactam, and piperacillin/tazobactam.
Due to irrational and prophylactic usage, as well as over-the-counter sale of easily available antibiotics, Pseudomonas aeruginosa, which is the most common cause of hospital-acquired UTI, showed higher resistance to ciprofloxacin (36%), norfloxacin (32%), and cephalosporins (ceftazidime 48%) compared to aminoglycoside (amikacin 24%). This aligns with the findings of a similar study by Bose S et al., in which Pseudomonas exhibited heavy resistance to ciprofloxacin (67.28%), ceftazidime (54.55%), and amikacin (23.64%) (3).
In the case of gram-positive bacteria, especially Staphylococcus aureus, sensitivity was observed towards vancomycin and linezolid, while resistance was seen towards ampicillin, cephalexin, and to some extent norfloxacin. Similar trends in antibiotic sensitivity patterns were reported in a study by More SK et al., where Staphylococcus strains were more resistant to amoxicillin (48.58%) and norfloxacin (31.43%) (23).
Nitrofurantoin is an effective drug against Enterococcal UTI and other microorganisms causing lower UTI. It is effective against both E. faecalis and E. faecium, including most Vancomycin-Resistant Enterococci (VRE) strains (24). Nitrofurantoin can also be used in early pregnancy [4,25].
Due to the high incidence of multidrug-resistant uropathogens, the use of older antibiotics like nitrofurantoin and fosfomycin has increased in clinical practice. The reversion of susceptibility to nitrofurantoin and fosfomycin is likely due to the non usage of these drugs for an extended period. In this study, nitrofurantoin and fosfomycin were found to be very effective for treating MDR uropathogens. This finding was supported by another study by Kaase M et al., which found that 21 out of 107 strains of E. coli (19.6%; 95% CI, 12.6% to 28.4%) were classified as resistant to fosfomycin using CLSI criteria (26). Gupta V et al., documented that the resistance rate of fosfomycin for both ESBL-positive and -negative isolates was nil using both disk diffusion and E-test methods (27).
Considering the above findings, there is a dire need to introduce new antimicrobial drugs for UTIs. Extended Spectrum Beta Lactamases (ESBL) have evolved significantly over the last 20 years, and antimicrobial resistance is likely to pose significant therapeutic challenges in the future. It is unlikely that many new antibiotic options will be available in the next 5 to 10 years to address such multiresistant infections.
Limitation(s)
In the present study, molecular studies were not conducted due to limited resources. Another limitation of the study is the small sample size. As it is a retrospective record-based study and data were not collected in a predesigned proforma according to the specific requirements of the study, some data may be missing.
In the present study, most of the isolates showed resistance to commonly used antibiotics such as ampicillin, cephalosporins, quinolones, and cotrimoxazole, but were susceptible to beta-lactam/ beta-lactamase inhibitor combinations and carbapenems. The study revealed an increasing trend of antibiotic resistance among patients with UTI. Drug resistance among pathogens is a dynamic process, so routine surveillance and monitoring are essential. This study has provided valuable insights into the common isolates and their antibiotic sensitivity and resistance patterns, aiding in the selection of appropriate drugs and ultimately reducing the burden of emerging antibiotic resistance in this hospital. Strict adherence to infection control policies and regulations on the over-the-counter sale of antibiotics without a physician’s prescription is crucial in our country. Empirical treatment guidelines for UTI should be adjusted based on regional or institutional in-vitro susceptibility data.
Authors are thankful to Microbiology department of Travancore Medical College for allowing to conduct the study.
DOI: 10.7860/JCDR/2024/68553.19413
Date of Submission: Nov 08, 2023
Date of Peer Review: Dec 29, 2023
Date of Acceptance: Feb 16, 2024
Date of Publishing: May 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 13, 2023
• Manual Googling: Feb 10, 2024
• iThenticate Software: Feb 13, 2024 (15%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
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