Antimicrobial Susceptibility Patterns of Leading Uropathogens and an Empirical Therapy at a Tertiary Care Hospital, Muzaffarabad

Background: Urinary tract infections (UTI) with non-specific treatment are leading to drug resistance. Cost-effective empirical therapy demands a brief survey of causative agents with their antibiograms. This study will show the bacterial spectrum and their susceptibility toward drugs which will enable us to make an accurate choice of drugs for empirical therapy. Aim: The aim of this study is to determine the bacterial profile in UTI and demonstrate its pattern of antimicrobial susceptibility. Method: This cross-sectional study was conducted in the microbiological lab of Sheikh Khalifa Bin Zayed Al-Nahyan Hospital, Muzaffarabad, Azad Jammu and Kashmir (AJK) from Oct 2017 to Oct 2018. Mid-stream urine received in the Department of Microbiology with symptomatic UTI was considered and inoculated onto Cysteine Lactose Electrolyte Deficient (CLED) agar. Bacterial identification with a series of biochemical tests and diffusion disc-based antimicrobial susceptibility test were done according to standard operating procedures. Results: Out of 552 samples, 113(20.4%) of the specimens were cultured positive with the majority of females with 80(70.7%) of prevalence while the male were 33(29.3%). E. coli was most frequent bacteria isolated about 49(43.4%) followed by S. aureus 23(20.4%), Klebsiellapneumonia 15(13.3%), Pseudomonas aeruginosa 9(8%), Proteus mirabilis 6(5.3%), Enterobacter spp. 5(4.4%), Citrobacter spp. 3(2.6%), Salmonella 2(1.7%) and Klebsiellaoxytoca 1(0.9%). Gram-negative bacteria showed great susceptibility for Tazobactam-piperacillin, Meropenem, Levofloxacin and Nitrofurantoin. Gram-positive were highly sensitive to Nitrofurantoin, Amikacinand Cefixime. Ampicillin showed the highest resistance rate of 87.4%. Conclusion: As an empirical treatment, Tazobactam-piperacillin and Meropenem are good choices for gram-negative bacteria while Nitrofurantoin showed high efficacy toward gram-positive bacteria