Fluoroquinolone Resistance Pattern among the Bacterial Pathogens Causing Urinary Tract Infection in a Tertiary Care Hospital, Kottayam, Kerala

Abstract

BACKGROUND Urinary tract infection (UTI) is a very important reason for increased hospital stay, increased morbidity and mortality in the hospital setting. Annually, about 150 million people are diagnosed with UTI worldwide.1The fluoroquinolones have assumed an important role in the therapy of UTI. But the prevalence of urinary tract infections caused by fluoroquinolone-resistant bacteria has been increasing over the years. The purpose of this study was to evaluate fluoroquinolone resistance pattern among the bacterial pathogens causing urinary tract infections. METHODS This is a cross-sectional descriptive study. A total of 200 urine samples were collected from clinically suspected UTI patients, attending out-patient department (OPDs) and were admitted to various wards of our hospital. The samples were inoculated using the standard loop, incubated aerobically, isolates were identified by standard biochemical reactions and antibiotic susceptibility testing was performed. RESULTS Out of 200 samples, the most common organism isolated was Escherichia coli (57 %), followed by Klebsiella pneumoniae subsp pneumonia (27 %). 93.9 % of Escherichia coli and 100 % of Klebsiella pneumoniae subsp pneumoniae isolates were resistant to ampicillin. The present study also documented high level of fluoroquinolone resistance among almost all common uropathogens. Among Escherichia coli and Klebsiella pneumoniae subsp pneumoniae; ciprofloxacin resistance was 77.2 % and 85.2 % respectively. Quinolone resistance was found to be more common in hospitalised patients and catheterized patients. According to our study, although levofloxacin is far effective than ciprofloxacin for uropathogens, the resistance to both are increasing. CONCLUSIONS The results presented in this study indicate that it is time to reconsider the frequent use of fluoroquinolones. Use of fluoroquinolones to treat patients before getting the sensitivity pattern of the isolate should be stopped. It is mandatory to formulate antimicrobial policy according to the local resistance pattern. Resistance pattern must be assessed in hospital and laboratory-based surveillance studies. KEY WORDS Urinary Tract Infections, Escherichia coli, Antibiotic Sensitivity, Fluoroquinolones