Antibiotic susceptibility of bacterial strains isolated from urinary tract infections

Abstract

Introduction: Urinary tract infections (UTIs) are one of the most common bacterial infections in humans both in the community and hospital setting. In almost all cases there is a need to start treatment before the final microbiological results are available. Area-specific monitoring studies aimed to gain knowledge about the type of pathogens responsible for UTIs and their resistance patterns may help the clinician to choose the right empirical treatment. Many different antimicrobial agents are available in Republic of Moldov, always on physician prescription, for the treatment of UTI. Furadonin, ciprofloxacin, norfloxacin, nitrofurantoin, first and second-generation cephalosporins and semi- synthetic penicillins with or without inhibitors and fosfomycin trometamol are the most commonly used antibacterial drugs in the treatment of UTI outside of the hospital. Aim : The aim of this study was to obtain data on susceptibility patterns of major pathogens from both community and hospital UTIs in Republic of Moldova to antimicrobial agents currently used in the treatment of UTI. Materials and methods: The bacterial strains (n-1329) were isolated from urine specimens from 1101 patients who were hospitalized in Republican Clinical Hospital. Only patients who had pyuria and significant bacteriuria obtained from a clean-catch midstream urine sample were included in the microbiological analysis. Local laboratories performed identification to species level and antibiotic susceptibility testing by disc diffusion. The antibiotics tested were ampicillin, amoxiclav, ceftazidime, ceftriaxone, meropenem, cefepime, doxycycline, netilmicin, norfloxacin, ciprofloxacin, nitrofurantoin, fosfomycin and others. Results: Results of antibiotic susceptibility testing of the isolated bacterial strains 1) Escherichia coli. The antibiotic susceptibility rates for Escherichia coli were: ampicillin (47,3%), amoxiclav (54,7%), cefixime (71,5%), cefazolin (12,5%), ceftazidime (38,3%), ceftriaxon (73,6%),nalidixic acid (63,7%), norfloxacin (82,9%), ciprofloxacin (74,8%), fosfomycin (99,2%), gentamicin (56,1%) and others. 2) Enterococcus faecalis. The antibiotic susceptibility rates for Enterococcus faecalis were: ampicillin (92% ), amoxiclav (94%), cefixime (3,7%), cefazolin (13,4%), ceftazidime (0%), ceftriaxon (30,9% ), nalidixic acid (2%), norfloxacin (41,9%), ciprofloxacin (20%), fosfomycin (93%), gentamicin (3,2% ) and others. 3) Klebsiella pneumonia. The antibiotic susceptibility rates for Klebsiella pneumonia were: ampicillin (5,1%), amoxiclav (23,6%), cefixime (35,6%), cefazolin (13,9%), ceftazidim e (13,5%), amicain (86,8%), imipenem (97,2%), ceftriaxon (45,9%), nalidixic acid (43,6% ), norfloxacin (51,3%), ciprofloxacin (56,7%), fosfomycin (68,1%), gentamicin (42,9%) and others. 4) streptococcus phaemolyticus The antibiotic susceptibility rates for streptococcus phaemolyticus were: ampicillin (88,7%), amoxiclav (100%), cefixime (66,7%), ceftriaxon (96% ),nalidixic acid (1,6%), norfloxacin (50%), ciprofloxacin (54,8%), fosfomycin (88,6%) and others. Concluzions: This study conducted to determine the prevalence of UTI, the effect of gender and age on its prevalence, and their susceptibility profile in the community. This study provides valuable laboratory data to monitor the status of antimicrobial resistance among uropathogens and to improve treatment recommendations in a specific geographical region. The study also allows comparison of the situation in Republic of Moldova and outside the state.