title: Antimicrobial resistance pattern in Escherichia coli causing urinary tract infection among inpatients.
abstract: OBJECTIVE
  Recent studies suggest an increasing antimicrobial resistance among Escherichia coli causing urinary tract infection (UTI). We undertook this study to know the resistance pattern of E. coli causing UTI in patients admitted to a tertiary care hospital in north India, and to know the treatment given and response of the patients.
  
  
  METHODS
  The details of E. coli grown from urine samples and their antibiotic sensitivity pattern were collected from the laboratory registers and the patient details were collected from the case records. The urine samples received were processed using standard methods and antibiotic susceptibility was done by Kirby-Bauer disk diffusion test.
  
  
  RESULTS
  Of the total 311 E. coli isolates, 119 (38.2%) were isolated from in-patients, which were considered for the study. Of these 119 E. coli isolates, 91 (76.51%) were multi drug resistant (MDR). The isolates showed high levels of resistance to ampicillin (88.4%), amoxicillin-clavulanic acid (74.4%), norfloxacin (74.2%), cefuroxime (72.2%), ceftriaxone (71.4%) and co-trimoxazole (64.2%). The isolates were sensitive to amikacin (82.6%), piperacillin-tazobactum (78.2%), nitrofurantoin (82.1%) and imipenem (98.9%). Ceftriaxone was most commonly used for empirical therapy for UTI among inpatients in our hospital. Of the 93 cases of UTI due to MDR E. coli, 73 improved on treatment and 12 worsened, which were referred to higher centres.
  
  
  CONCLUSIONS
  Our study showed that 76.5 per cent of E. coli isolates from urine samples of inpatients were MDR. Diabetes, chronic renal disease and catherization were some of the risk factors associated. The high rate of resistance could be because only inpatients were included and the increased usage of cephalosporins in our hospital for empirical therapy.
authors.forename: V
authors.initials: V
authors.lastname: Niranjan
authors.affiliation: Department of Microbiology, Indira Gandhi Medical College & Research Institute, Puducherry, India.
authors.forename: A
authors.initials: A
authors.lastname: Malini
mesh_terms: D002443:Ceftriaxone / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D052978:Disk Diffusion Antimicrobial Tests; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D004926:Escherichia coli / Q000235:genetics*; D006801:Humans; D007194:India / Q000453:epidemiology; D007297:Inpatients / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*
chemical_list: D002443:Ceftriaxone
references.citation: Trop Med Int Health. 2008 Jan;13(1):41-5
references.pmid: 18291000
references.citation: J Infect. 2003 Feb;46(2):94-100
references.pmid: 12634070
references.citation: J Infect Dev Ctries. 2008 Oct 01;2(5):354-8
references.pmid: 19745502
references.citation: Antimicrob Agents Chemother. 2001 May;45(5):1402-6
references.pmid: 11302802
references.citation: Ann Clin Microbiol Antimicrob. 2007 Mar 23;6:4
references.pmid: 17378940
references.citation: J Ayub Med Coll Abbottabad. 2007 Jan-Mar;19(1):39-41
references.pmid: 17867478
references.citation: Indian J Med Sci. 2006 Feb;60(2):53-8
references.pmid: 16505574
references.citation: Mem Inst Oswaldo Cruz. 2006 Nov;101(7):741-8
references.pmid: 17160281
references.citation: J Chemother. 2007 Jun;19(3):263-70
references.pmid: 17594920
references.citation: Int J Antimicrob Agents. 2001 Aug;18(2):189-92
references.pmid: 11516944
references.citation: Indian J Med Microbiol. 2002 Apr-Jun;20(2):96-8
references.pmid: 17657041