Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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

Important Notice

Original article / research
Year : 2012 | Month : September | Volume : 6 | Issue : 7 | Page : 1192 - 1195

Urinary Tract Infections – An overview on the Prevalence and the Anti-biogram of Gram Negative Uropathogens in A Tertiary Care Centre in North Kerala,India

Syed Mustaq Ahmed, Ramakrishna Pai Jakribettu, Shaniya koyakutty, Arya B, Shakir VPA

1. Associate Professor, Department of Microbiology, 2. Assistant Professor, Department of Microbiology, 3. Tutor, Department of Microbiology, 4. Assistant Professor, Department of Microbiology, 5. Tutor, Department of Microbiology, MES Medical College, Perinthalmanna, Malappuram dist, Kerala, 679338, India.

Correspondence Address :
Dr. Syed Mustaq Ahmed
Associate Professor, Department of Microbiology
MES Medical College,Perinthalmanna, dist
Malappuram, Kerala 679338, India.
Phone: 09846609106
E-mail: mustaq105@rediffmail.com

Abstract

Despite the advances in the antimicrobial therapy, Urinary Tract Infections (UTIs) tends to remain a major health hazard, which are responsible for significant morbidity, often resulting in alarming complications. A variety of organisms have been implicated in its aetiology. The indiscriminate and the inappropriate usage of anti-microbial agents has led to the emergence of resistant strains.
Aim:
To determine the prevalence and the antimicrobial sensitivity pattern of uropathogens.
Methods and Materials:

The urine samples from the patients at a medical college hospital , were processed according to the standard protocol over a period of one year from April 2011 to March 2012. The antimicrobial susceptibility was tested by the modified Kirby-Bauer’s disc diffusion method as per the CLSI guidelines. The data was interpreted by using the WHO Net Antibiotic Susceptibility Surveillance Software.
Results:

Out of 2540 urine samples, 511(20.12%) were found to be positive for microbial isolates, of which 343 samples (67.12%) were from females and 168 samples (32.36%) were from males. The highest rate of the isolation was detected in the geriatric age group i.e., 61-80 years (39.53 %). The most isolated organism was Escherichia coli (81.80%). The isolation rates were highest in the surgical departments (38.34%). Piperacillin/tazobactam, cefoperazone/sulbactam, imipenem and amikacin were found to be the most effective drugs among a majority of the isolates.
Conclusion:
Before prescribing the antimicrobial therapy, a thorough knowledge of the susceptibility patterns of the uropathogens is essential to avoid incongruous and irrational antibacterial usage and to restrain the further development of drug resistance.

Keywords

Uropathogens, Multidrug Resistance

How to cite this article :

Syed Mustaq Ahmed, Ramakrishna Pai Jakribettu, Shaniya koyakutty, Arya B, Shakir VPA. URINARY TRACT INFECTIONS – AN OVERVIEW ON THE PREVALENCE AND THE ANTI-BIOGRAM OF GRAM NEGATIVE UROPATHOGENS IN A TERTIARY CARE CENTRE IN NORTH KERALA,INDIA. Journal of Clinical and Diagnostic Research [serial online] 2012 September [cited: 2019 Jan 23 ]; 6:1192-1195. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=September&volume=6&issue=7&page=1192-1195&id=2437

Introduction
Urinary tract infections are defined as diseases which are caused by the invasion of the genitourinary tract by microorganisms. Despite the advances in and the wide spread availability of antimicrobials, UTIs continue to be the most common causes of infections in hospitalized patients, accounting for approximately 40% of the hospital acquired infections (1),(2). Acute UTI is one of the most important causes of morbidity, occasionally becoming life threatening, forcing the general population to seek medical attention, and accounting for considerable health care costs. Wide spectrums of organisms are implicated in its aetiology, the most common being Escherichia coli (1),(2),(3) and other gram negative bacteria, followed by gram positive organisms. The culture of the urine samples is essential for identifying the organisms and their antimicrobial susceptibilities. The antibiotic therapy aims at relieving the existing symptoms and in preventing the development of complications like renal scarring. The increased emergence of antimicrobial resistance in the uropathogens, probably due to the empirical administration of anti bacterial therapy, even before the availability of the urine culture results, is a matter of growing concern worldwide (4). This study aimed at determining the changing trends of the occurrence and the antimicrobial sensitivity patterns of the uropathogens which were isolated at a medical college hospital, which will enable the clinicians to devise and endorse a O riginal Article Microbiology Sectionpotent, competent and a rational anti bacterial policy to reduce the incidence of UTIs.

Material and Methods

A prospective study was carried out at a tertiary care centre in north Kerala, from April 2011 to March 2012, after getting a clearance from the institutional ethical committee. The clinical samples which were received from patients who were suspected of having UTIs were processed according to the standard laboratory methods. The sample plates which yielded a colony count of >1,00,000 Colony Forming Units (CFUs) /ml were considered as suggestive of significant bacteriuria. The uropathogens were further identified by their morphologies and biochemical characteristics. The positive isolates were tested for their antimicrobial susceptibility patterns by the modified Kirby-Bauer disk diffusion method on Mueller Hinton agar. Their sensitivities to amoxyclav (20/10 μg ), ciprofloxacin (5 μg), norfloxacin (10μg), ofloxacin (5μg), amikacin (30μg), gentamicin (10μg), cefuroxime (30μg), cefepime (30μg), ceftazidime (30 μg), ceftriaxone (30 μg), cefotaxime (30 μg), cotrimoxazole(1.25/23.75μg), imipenem (10 μg), aztreonam (30μg), piperacillin/tazobactam (100/10μg), cefoperazone/sulbactam (75/10μg) and nitrofurantoin (300μg), were tested according to the Clinical Laboratory Standard Institute guidelines (5). Escherichia coli ATCC 25922 and Pseudomonas aeruginosa ATCC 27853 were used as the control strains for the identification and the anti microbial susceptibility tests. The data were analyzed and interpreted by using the WHO Net Antibiotic Susceptibility Surveillance Software.

Results

Out of 2540 urine samples, 511(20.12%) were found to be positive for gram negative bacterial isolates. 343 samples (67.12%) from females were culture positive, thus showing a female predominance. The highest isolation rate was found in the 61-80 years age group, thus revealing the increased vulnerability of the geriatric population to UTIs, presumably due to the various age related physiological changes (Table/Fig 1)(a) and (Table/Fig 1)(b). Irrespective of the age group, Escherichia coli (81.80%) was found to be the predominant organism which was isolated, followed by 2Klebsiella pneumoniae (14.87%). A majority of the culture positive isolates were obtained from the surgical departments (38.34%), followed by those from the medical departments (33.33%) and the intensive care units (25.82%).The resistance among the uropathogens to the agents that had traditionally been recommended as the first line therapy is on the rise. The gram negative bacteria which were isolated, showed a higher resistance rate towards some of the widely used antimicrobials like cefuroxime, ceftriaxone, ciprofloxacin, norfloxacin and cotrimoxazole, as has been shown in (Table/Fig 5) and (Table/Fig 6). Pseudomonas aeruginosa showed a relatively lesser resistance towards the flouroquinolones than E.coli and Klebsiella. The antibiotic sensitivity pattern of Escherichia coli showed a higher sensitivity towards imipenem (98.5%) followed by nitrofurantoin (98.1%) and piperacillin/tazobactam (91.5%), cefoperazone/sulbactam (86.8%) and amikacin (98.1%). Pseudomonas species and Citrobacter species showed 100% sensitivity to amikacin, imipenem, and piperacillin/ tazobactam. Monotherapy with amikacin and imipenem demonstrated statistically significant susceptibility patterns and these were found to be effective against a majority of the isolates. Recently, an escalation in the drug resistance among the gram negative bacteria was observed against the 3rd generation cephalosporins and quinolones, as has been shown in (Table/Fig 5) and (Table/Fig 6).The organisms which belonged to the Enterobacteriaceae family showed a predominant resistance against the penicillins (amoxyclav), flouroquinolones (ciprofloxacin, norfloxacin), cephalosporins (cefuroxime, ceftriaxone), and the aminoglycosides (gentamicin). The analysis of the age-wise data, as has been shown in (Table/Fig 2)(a) and (Table/Fig 2)(b), portrayed an increased prevalence in the 61-80 years age group (39.53%), which was at par with the findings of similar studies which were done by Manjunath G N et al., (6), Akram et al., (7) and Barate D L et al., (8). The increased vulnerability in the geriatric population maybe due to their age related physiological and immunological changes and other co morbidities (1).

Discussion

changing trends in the aetiopathogenesis of UTIs and the emerging resistance to the antimicrobial agents are a matter of worldwide concern. Even with the adequate precautions, preventive measures and the advances in therapy, UTIs still remain the commonest infections, both in the hospitalized patients and in the out patients. This may plausibly be due to the advancing age, increase in the immunocompromised hosts, prolonged hospitalization, inadequate personal and environmental hygiene, instrumentation (catheters), co morbidities and functional or anatomical abnormalities (9). The indiscriminate, inadequate and the irrational usage of antimicrobials has further contributed to the emergence of resistant strains, which may turn out to be a leading cause for the morbidity and mortality in the developing countries. The present study provided an outlook on the prevalence and the antibiogram of the uropathogens which were isolated in this part of north Kerala. E.coli (81.80%) was the predominant organism which was isolated, followed by Klebsiella pneumoniae (14.87%), which was in comprehension with the findings of similar studies which were by Supriya et al., (10), Pallavi Khanna et al., (3), S Baby Padmini et al., (2), Manjunath et al., (6) and Oladeinde B.H et al., (4), as has been shown in (Table/Fig 1)(a). The rate of the isolation was higher in females (66.86%), thus revealing the increased susceptibility of females to UTIs than males (33.14%), as has been shown in (Table/Fig 1)(b)., which was in concordance with the findings of similar studies which were done by Khadri et al.,(11), Oladeinde B.H et al., (4), Manjunath et al.,(6) 3and Barate D L et al., (8). Females are more prone to develop UTIs, probably due to their characteristic anatomical and physiological changes - short urethra, its proximity to the anus, urethral trauma during intercourse, dilatation of the urethra and the stasis of urine during pregnancy (1),(4). The department wise isolation rate was the highest on the surgical side (general surgery, OBG, ENT etc) (38.34%), as has been shown in (Table/Fig 4), as has also been reported in similar studies. This may be due to the instrumentation, surgical procedures, obstruction to the urinary outflow and immunosuppressive drugs (3),(12). The antimicrobial resistance among uropathogens is one of the barricades that might interfere with an effective treatment. This study depicted the anti microbial susceptibility patterns among the gram negative bacteria which were isolated, as has been shown in (Table/Fig 4) and (Table/Fig 5). These are of the organisms which belonged to the Enterobacteriaceae family, which showed heavy resistance towards amoxyclav (79.6%), a majority of the flouroquinolones [ciprofloxacin (62.5%) and norfloxacin (71.6%) and the cephalosporins [cefuroxime (75.9%) and ceftriaxone (71.6%)], which was in accordance with the findings of the studies which were done by Manjunath G N et al6, Khadri et al., (11), Akram et al., (7) and Barate D L et al., (8). The reason for this might be the irrational and the prophylactic usage and the easy availability and the over the counter sale of the antimicrobials without a proper prescription and an appropriate dosing schedule. A notable observation was that a majority of the isolates showed a higher sensitivity pattern towards imipenem, piperacillin/tazobactam, and amikacin . Nitrofurantoin, with a resistance of 1.9%, was found to be an effective cure against the E.coli which induced UTIs. Klebsiella pneumonia showed an increased resistance to amoxyclav and cefuroxime and a decreased resistance to ciprofloxacin and norfloxacin as compared to E.coli. However, it showed an increased resistance towards nitrofurantoin. Pseudomonas aeruginosa showed an increased resistance towards the 3rd generation cephalosporins and a decreased resistance towards the flouroquinolones. Imipenem, piperacillin/tazobactam and cefoperazone/sulbactam with 100% sensitivity and amikacin with 87.5% sensitivity, were found to be the most effective drugs for the therapy of UTIs, as has been shown in (Table/Fig 6).

Conclusion

The escalation of drug resistance among the uropathogens poses a global threat. The wide spread availability and the usage of penicillins and cotrimoxazole has led to the development of resistant strains. A disturbing fact is that even the flouroquinolones and the cephalosporins are getting exceedingly affected day by day. Before prescribing an empirical anti microbial therapy, an in-depth knowledge of the aetiology, the predisposing factors, the cultural positivity and the continued evaluation of the susceptibility patterns of the uropathogens to the traditional as well as the new antimicrobials , is essential to avoid irrational drug usage and to ascertain the optimal prophylactic therapy.

References

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Kamat US, Fereirra A, Amonkar D, Motghare DD, Kulkarni MS.Epidemiology of the hospital acquired urinary tract infections in a medical college hospital in Goa. IJU. 2009; 25(1):76.
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Babypadmini S, Appalaraju B. Extended spectrum-lactamases in the urinary isolates of Escherichia coli and Klebsiella pneumoniae- the prevalence and the susceptibility patterns in a tertiary care hospital. Indian Journal of Medical Microbiology. 2004; 22(3):172.
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DOI and Others

ID: JCDR/2012/4602:2437

Financial OR OTHER COMPETING INTERESTS:
None.
Date of Submission: May 28, 2012
Date of Peer Review: Jul 03, 2012
Date of Acceptance: Jul 12, 2012
Date of Publishing: Sep 30, 2012

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