Antibiotic resistance in pathogens causing community-acquired urinary tract infections in India: a multicenter study

BACKGROUND: Empiric treatment of community-acquired urinary tract infections (CA-UTI) is determined by the antibiotic sensitivity patterns of uropathogens in a population. This study was conducted to determine patterns of resistance amongst CA-uropathogens in India, to help establish local guidelines on treatment of CA-UTI. METHODOLOGY: 531 consecutive positive urine cultures taken from adult non-pregnant females attending outpatient clinics of five hospitals in Delhi, India, were analysed. Sensitivity testing was done for ciprofloxacin, trimethoprim-sulphamethoxazole (SXT), amoxicillin, amoxicillin-clavulanate, amikacin, nitrofurantoin, piperacillin-tazobactam and meropenem in each isolate. RESULTS: E. coli comprised 68%; Klebsiella 16.9%; Proteus 5.5%; Enterobacter 5.3%; Staphylococcus saprophyticus 2.8%; and others 1.5% of the isolates. Furthermore, 26.9% of the gram negative isolates were ESBL producers. Antibiotic sensitivity of all the gram negative organisms showed that 35.8% were sensitive to ciprofloxacin; 30% to SXT; 17.7% to amoxicillin; 41.6% to amoxicillin/clavulanate; 75.6% to amikacin; 65.7% to nitrofurantoin; 90.2% to piperacillin-tazobactam; and 100% to meropenem. CONCLUSION: High levels of ESBL producers among gram negative CA-uropathogens was seen in our country. This, along with the alarming rate of resistance to ciprofloxacin, SXT and amoxicillin, precludes the use of these commonly used antibiotics for empiric treatment of CA-UTI in India.