Antimicrobial Resistance in Hospitalized Patients with Community Acquired Urinary Tract Infection in Isfahan, Iran

Abstract

Background: Antibiotic resistance against uro-pathogens is a worldwide health concern. The aim of this study was to determine the causative bacteria and antibiotic susceptibility patterns among hospitalized patients with community acquired urinary tract infection (UTI). Methods: This cross-sectional study was performed in 2016-2018 in Isfahan, Iran. Urine samples were examined for strain identification and antimicrobial resistance pattern using standard tests. Stratification was done based on gender and age (<20 and >20 years) groups. Chi-square and Fisher exact tests were applied to assess differences in etiology and susceptibility rates between groups. Results: Among 1180 patients, Escherichia coli was the commonest pathogen (68.1) followed by Enterococcus spp. (8.8) and Klebsiella pneumonia (8.0 ). Non -E. coli pathogens were more frequent among males (41.8 versus 24.8 in females, P < 0.01) and in those aged under 20 years (61.0 versus 22.2 in older than 20 years, P < 0.01). Isolated bacteria revealed high susceptibility to imipenem (94.9), meropenem (92.2), and amikacin (91.9); moderate sensitivity to gentamicin (64.4), cefepime (52.6) and ceftazidime (47.2); and low susceptibility to ceftriaxone (41.8), cefotaxime (40.0), ciprofloxacin (38.6) and trimethoprim-sulfamethoxazol (31.3). The sensitivity of isolates to ceftriaxone, ceftazidime, cefepime, imipenem, meropenem, amikacin and ciprofloxacin was significantly higher in females. Compared to the older age group, uro-pathogens were more susceptible to ciprofloxacin, ceftazidime and gentamicin in patients aged under 20 years. Conclusion: We found that imipenem, meropenem and amikacin were good choices for empiric therapy of complicated or severe hospitalized patients with community acquired UTI; and gentamicin, cefepime and ceftazidime were acceptable as initial choices in non-severe infections in the area.