title: A retrospective analysis of the etiologic agents and antibiotic susceptibility pattern of uropathogens isolated in the Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
abstract: BACKGROUND
  Urinary tract infection is one of the major public health problems. Specific population studies to understand the common etiologic agents and antibiotic susceptibility patterns are important to determine the empirical treatment of urinary tract infections. This is the first study in Bhutan to analyze the etiologic agents and antibiotic susceptibility pattern of uropathogens isolated from patients visiting Jigme Dorji Wangchuck National Referral Hospital with the ultimate goal of guiding empirical treatment.
  
  
  METHODS
  Hospital based (inpatients/outpatients) retrospective cross sectional study of 6030 clinically suspected patients with urinary tract infections who have submitted urine samples for culture in a 6 months period was done. Urine samples were collected and processed as per standard microbiological procedures and antibiotic susceptibility testing performed by CLSI guidelines.
  
  
  RESULTS
  Significant bacteriuria were detected in 14.9 % of the total patients. The most common uropathogens isolated were Escherichia coli (79.3 %) followed by Klebsiella pneumoniae. Females around the age group of 18-26 have the highest prevalence of urinary tract infection. The highest rate of antibiotic resistance was seen in amoxicillin (71.4 %) and nalidixic acid (80.3 %), and resistance were lower in nitrofuration (3.4 %) and gentamycin (17.5 %). The third generation cephalosporin resistance (which is a surrogate marker of ESBL) was 16.1 % in outpatient and 16.7 % approximately in inpatient setting.
  
  
  CONCLUSIONS
  Escherichia coli was the predominant uropathogen making up 79.3 % (outpatient 81.1 % and inpatient 69.5 %) of the total and its antibiotic susceptibility pattern needs to be considered for treating community-acquired UTIs empirically. The third generation cephalosporin resistance (which is a surrogate marker of ESBL) is alarmingly high among the isolates and there is need for further studies.
authors.affiliation: Microbiology unit, Department of Laboratory Services, JDWNRH, Thimphu, Bhutan. adeepmonger11@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Adeep
authors.affiliation: Microbiology unit, Department of Laboratory Services, JDWNRH, Thimphu, Bhutan. tsheringnims@gmail.com.
authors.forename: T
authors.initials: T
authors.lastname: Nima
authors.affiliation: Microbiology unit, Department of Laboratory Services, JDWNRH, Thimphu, Bhutan. kesangwangchuk87@yahoo.com.
authors.forename: W
authors.initials: W
authors.lastname: Kezang
authors.affiliation: Microbiology unit, Department of Laboratory Services, JDWNRH, Thimphu, Bhutan. doc_tshokey@yahoo.com.
authors.forename: T
authors.initials: T
authors.lastname: Tshokey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification*; D001631:Bhutan; D004352:Drug Resistance, Microbial / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010045:Outpatients; D012017:Referral and Consultation; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
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