title: Antimicrobial resistance in pathogens causing urinary tract infections in a rural community of Odisha, India.
abstract: BACKGROUND
  Antimicrobial resistance of urinary tract pathogens has increased worldwide. Empiric treatment of community-acquired urinary tract infection (CA-UTI) is determined by antimicrobial resistance patterns of uropathogens in a population of specific geographical location.
  
  
  OBJECTIVE
  This study was conducted to determine the prevalence of CA-UTI in rural Odisha, India, and the effect of gender and age on its prevalence as well as etiologic agents and the resistance profile of the bacterial isolates.
  
  
  METHODS
  Consecutive clean-catch mid-stream urine samples were collected from 1670 adult patients. The urine samples were processed and microbial isolates were identified by conventional methods. Antimicrobial susceptibility testing was performed on all bacterial isolates by Kirby Bauer's disc diffusion method.
  
  
  RESULTS
  The prevalence of UTI was significantly higher in females compared with males (females 45.2%, males 18.4%, OR = 2.041, 95% CI = 1.64-2.52, P ≤ 0.0001). Young females within the age group of 18-37 years and elderly males (≥68 years) showed high prevalence of UTI. Escherichia coli (68.8%) was the most prevalent isolate followed by Enterococcus spp. (9.7%). Amikacin and nitrofurantoin were the most active antimicrobial agents which showed low resistance rate of 5.8% and 9.8%, respectively.
  
  
  CONCLUSIONS
  Our study revealed E. coli as the pre-dominant bacterial pathogen. Nitrofurantoin should be used as empirical therapy for uncomplicated CA-UTIs. In the Indian setting, routine urine cultures may be advisable, since treatment failure is likely to occur with commonly used antimicrobials. Therefore, development of regional surveillance programs is necessary for implementation of national CA-UTI guidelines.
authors.affiliation: Department of Microbiology, Maharaja Krushna Chandra Gajapati Medical College and Hospital, Berhampur University, Odisha, India.
authors.forename: Muktikesh
authors.initials: M
authors.lastname: Dash
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Padhi
authors.forename: Indrani
authors.initials: I
authors.lastname: Mohanty
authors.forename: Pritilata
authors.initials: P
authors.lastname: Panda
authors.forename: Banojini
authors.initials: B
authors.lastname: Parida
keywords: Antimicrobial; Escherichia coli; community-acquired urinary tract infection; prevalence; resistance