Isolation, identification, and determination of antimicrobial resistance pattern of isolates collected from UTI patients of Dhaka, Bangladesh

Abstract

Nearly 150 million individuals all over the world suffer from urinary tract infections, which are among the most prevalent bacterial infections. The uropathogens responsible for such infections are predominantly Escherichia coli (UPEC), with Klebsiella spp., Acinetobacter spp, and other bacteria following closely behind. The discovery of antibiotics, namely penicillin, paved the way for modern treatment of UTIs. Antibiotic resistance, however, has risen substantially as the consequence of antibiotic abuse and overuse and now presents a global threat. By isolating, identifying, and analyzing the antimicrobial resistance patterns of uropathogens from UTI patients in Dhaka, Bangladesh, this study aims to provide data that can shape the future clinical practices and contribute to effective treatments. By comparing the results with previously conducted studies, our study also intends to identify trends or changes in resistance patterns as the data acquired may ultimately offer new insights that will be beneficial for clinical practices in the future. From March 2023 to October 2023, 152 urine samples were collected from UTI patients at Labaid Specialized Hospital and Bangladesh Shishu Hospital and Institute and carried to Brac University microbiology laboratory. Initial isolation was conducted using HiCrome differential medium and NA media was used to derive pure cultures. Identification of the isolates included Gram staining and biochemical tests (Catalase, Oxidase, Indole, Methyl Red, Voges-Proskauer, Citrate Utilization, and TSI test). The tests identified uropathogenic Escherichia coli (UPEC) as the most frequent pathogen (51%), followed by Klebsiella spp. (16.3%), Acinetobacter spp. (12.2%), Pseudomonas spp. (8.2%), Flavobacterium and Citrobacter spp. (4.1% each), and GBS and Proteus spp. (2% each). 94.4% of the detected isolates were gram-negative. Of all the patients, 61.2% were women and 51.7% were pediatric cases. Antimicrobial susceptibility testing was performed using the Kirby Bauer disc diffusion method using 13 antibiotics from 10 different groups while maintaining the global CSI guidelines. The test revealed high resistance rates to Ampicillin (AMP25) and Cefixime (CFM5) at nearly 100%. The two most effective antibiotics were Colistin (CL10) and Imipenem (IPM10), with resistance rates of 15% and 25%, respectively. The study corroborates regional research, suggesting UPEC as the predominant pathogen and significant resistance to commonly used antibiotics such as ampicillin. The study results raised concerns as it showed a high resistance to the last resort antibiotic– Imipenem. Comparative analysis with studies conducted in South Asia emphasizes regional differences in antibiotic resistant patterns. The study also provides a comprehensive analysis of uropathogen prevalence and resistance patterns in Dhaka. The findings in the study underline the urgent necessity for surveillance and regulation of antibiotic drug usage in order to counter the threat that antibiotic resistance poses. The data can guide effective treatment strategies, especially for high-risk individuals such as women and pediatric patients.