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Urinary tract infection (UTI) is second most common infection in human, a serious health problem affecting millions of people each year. Complicated UTI (cUTI) frequently associated with either structural or functional abnormality in urinary tract or any medical conditions compromising host defence. Patients with cUTI are more susceptible to treatment failure, sepsis and development of antimicrobial resistance. The Pattern of antimicrobial resistance of the organism causing UTI vary from place to place and time to time. An appropriate and comprehensive knowledge about culture sensitivity pattern of uro-pathogens causing UTI in specific geographical area is important for choosing suitable antibiotic.
This cross sectional study was done from February 2022 to September 2023 at department of Nephrology, Bangladesh Medical College Hospital, Dhaka, Bangladesh.Total 151 patients with signs and symptoms of UTI and with positive culture sensitivity reports who had CKD ,presence of any underlying conditions which can impair urinary tract defence were included in this study.
Among 151 patients of cUTI 70% (n=105) were female with Female:Male ratio 2.3:1. Majority 44.67% of patients were in 50-60 years (n=48). Mean Age was 53.49± 14.05. Total 89.2% patients were married, 55.4% patients were from rural area.Among all 73% were diabetic,71% had CKD ,34% obstructive uropathy,32% patients on immunosuppressive drug. Total 22 patients were Renal allograft recipient taking triple anti- rejection drug ( steroid , MMF, tacrolimus) other 4 patients had history of taking chemotherapy. Seventy (46%) patients had recurrent UTI. Among Clinical features majority 49.2% patients presented with burning micturition, increased frequency of micturition 38.5%.fever was presenting feature of 13.8%(n=9) patients and total 12.3% patient presented with acute confusional state. Out of 151 patients total 129 (85%) patients were isolated with gram negative organism and majority 51% (n=78) was Escherichia coli, Among gram positive organisms Enterococcus sp, was most common organism 9%(n=13) Among culture sensitivity reports E.coli was found to be most sensitive to Imipenem94%,Ertapenem94%, Meropenem90%,Tigacyclin89%,pipercillintazobactam81%,colistin86%,amikacin85%.Regarding other Gram negative organisms Ertapenem90%,Imipenem86% Meropenem80% colistin80%.Most common antibiotics were found sensitive to gram positive organisms were Linezolid 94%, vancomycin 89%,Imipenem and Meropenem 80%. As a whole all, mostly resistant to commonly used drugs like cefixime(E.coli 64%, Gram negative ,54%,Gram positive 83%), cefuroxime (E.coli 62%, Gram negative 64%,Gram positive 60%) , ceftriaxone (E.coli 52% Gram negative 56%,Gram positive 67%), ciprofloxacin (E.coli 58%, Gram negative 51%,Gram positive 69%),cotrimoxazole(E.coli 45%, Gram negative 61%,Gram positive 88%).
In our study female are mostly affected to complicated UTI , majority between age 50-60 years .Moreover most predominant uropathogen was E.coli which more sensitive to Imipenem,Ertapenem,Meropenem,Tigacyclin,pipercillintazobactam,colistin,amikacin,nitrofurantoin. . Linezolid, vancomycin,imipenem and meropenem were mostly found sensitive to gram positive organisms. And most resistant antibiotic to majority of organisms are cefixime , cefuroxime, ceftriaxone, ciprofloxacin .Therefore a comprehensive idea about of predominant organism and their antibiotic sensitivity pattern is very helpfull during empirical therapy and to identify changing pattern over time.