title: Pattern of Antibiotic Resistance Among Community Derived Isolates of Enterobacteriaceae Using Urine Sample: A Study From Northern India.
abstract: BACKGROUND
  Despite world-wide evidence of increased antibiotic resistance, there is scarce data on antibiotic resistance in community settings. One of the reason being difficulty in collection of biological specimen (traditionally stool) in community from apparently healthy individuals. Hence, finding an alternative specimen that is easier to obtain in a community setting or in large scale surveys for the purpose, is crucial. We conducted this study to explore the feasibility of using urine samples for deriving community based estimates of antibiotic resistance and to estimate the magnitude of resistance among urinary isolates of Escherichia coli and Klebsiella pneumonia against multiple antibiotics in apparently healthy individuals residing in a rural community of Haryana, North India.
  
  
  METHODS
  Eligible individuals were apparently healthy, aged 18 years or older. Using the health management information system (HMIS) of Ballabgarh Health Demographic Surveillance System (HDSS), sampling frame was prepared. Potential individuals were identified using simple random sampling. Random urine sample was collected in a sterile container and transported to laboratory under ambient condition. Species identification and antibiotic susceptibility testing for Enterobacteriaceae was done using Clinical Laboratory and Standards Institute (CLSI) 2012 guidelines. Multi-drug resistant (MDR) Enterobacteriaceae, Extended Spectrum Beta Lactamase (ESBL) producing Enterobacteriaceae, and Carbapenem producing Enterobacteriaceae (CRE) were identified from the urine samples.
  
  
  RESULTS
  A total of 433 individuals participated in the study (non-response rate - 13.4%), out of which 58 (13.4%) were positive for Enterobacteriaceae, 8.1% for E. coli and 5.3% for K. pneumoniae. Resistance against penicillin (amoxicillin/ampicillin) for E. coli and K. pneumoniae was 62.8% and 100.0% respectively. Isolates resistant to co-trimoxazole were 5.7% and 0.0% respectively. None of the isolates were resistant to imipenem, and meropenem.
  
  
  CONCLUSIONS
  It is feasible to use urine sample to study magnitude of antibiotic resistance in population based surveys. At community level, resistance to amoxicillin was considerable, negligible for co-trimoxazole, and to higher antibiotics including carbapenems.
authors.affiliation: Junior Resident, Centre for Community Medicine, All India Institute of Medical Sciences , New Delhi, India .
authors.forename: Ayush
authors.initials: A
authors.lastname: Lohiya
authors.affiliation: Professor, Centre for Community Medicine, All India Institute of Medical Sciences , New Delhi, India .
authors.forename: Shashi
authors.initials: S
authors.lastname: Kant
authors.affiliation: Professor, Department of Microbiology, All India Institute of Medical Sciences , New Delhi, India .
authors.forename: Arti
authors.initials: A
authors.lastname: Kapil
authors.affiliation: Professor, Centre for Community Medicine, All India Institute of Medical Sciences , New Delhi, India .
authors.forename: Sanjeev Kumar
authors.initials: SK
authors.lastname: Gupta
authors.affiliation: Professor, Centre for Community Medicine, All India Institute of Medical Sciences , New Delhi, India .
authors.forename: Puneet
authors.initials: P
authors.lastname: Misra
authors.affiliation: Professor, Centre for Community Medicine, All India Institute of Medical Sciences , New Delhi, India .
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Rai
keywords: Bacteria; Drug resistance; Epidemiology