title: Anti-microbial resistance stratified by risk factor among Escherichia coli strains isolated from the urinary tract at a rural clinic in Central India.
abstract: BACKGROUND
  The failure of empirical therapy is frequently observed, even in community-acquired urinary tract infections. We, therefore, conducted a prospective, clinic-based study in 2004-2005 to document anti-microbial resistance rates and correlate them with possible risk factors to assist empirical decision-making.
  
  
  METHODS
  Symptomatic patients with pyuria underwent urine culture. Isolates were identified using standard methods and anti-microbial resistance was determined by disk-diffusion. Ultrasonography was used to detect complicating factors. Patients were stratified by the presence of complicating factors and history of invasive procedures for comparison of resistance rates. STATISTICAL METHOD USED: Chi-square or Fisher exact tests, as appropriate.
  
  
  RESULTS
  There were 156 E. coli isolates, of which 105 were community-acquired. Twenty-three community-acquired isolates were from patients with complicating factors while 82 were from patients without any. Fifty-one isolates were from patients who had recently undergone invasive procedures on the urinary tract. Thirty-two community-acquired isolates from reproductive-age women without apparent complicating factors had resistance rates of 50% or above against tetracyclines, Co-trimoxazole, aminopenicillins, Nalidixic acid, Ciprofloxacin and 1 st generation cephalosporins. Resistance rates were significantly higher among isolates from patients subjected to invasive procedures, except against Co-trimoxazole, tetracyclines and Amikacin.
  
  
  CONCLUSIONS
  High rates of anti-microbial resistance in community-acquired uropathogens have made antimicrobial sensitivity testing necessary even in a rural, primary-care setting.
authors.affiliation: Jan Swasthya Sahyog, Village and P. O. Ganiyari - 495 112, District Bilaspur, Chhattisgarh, India. doctorbiswaroopchatterjee@gmail.com
authors.forename: B
authors.initials: B
authors.lastname: Chatterjee
authors.forename: S
authors.initials: S
authors.lastname: Kulathinal
authors.forename: A
authors.initials: A
authors.lastname: Bhargava
authors.forename: Y
authors.initials: Y
authors.lastname: Jain
authors.forename: R
authors.initials: R
authors.lastname: Kataria
mesh_terms: D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D017714:Community-Acquired Infections / Q000382:microbiology; D003428:Cross Infection / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000382:microbiology*; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D012424:Rural Population; D014552:Urinary Tract Infections / Q000382:microbiology*; D014556:Urine / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents