Bacterial Uropathogens Causing Urinary Tract Infection with Antibiotic Susceptibility Pattern of E. Coli: A Cross Sectional Study

Background: Urinary tract infection (UTI) is a major public health burden and affect the quality of life with significant morbidity of affected individuals. The aim of this study was to determine bacterial uropathogens along with antimicrobial susceptibility pattern of E. coli among patients with symptoms of UTIs in a tertiary care hospital in Dhaka, Bangladesh. Methods: This cross-sectional observational study was conducted from May, 2023 to April, 2024 at Bangladesh Medical College Hospital (BMCH), Dhaka, Bangladesh and laboratory work was carried out in Microbiology department of Bangladesh Medical College (BMC), Dhaka, Bangladesh. A total of 170 urine samples were collected from both outpatient and inpatient department patients with clinical evidence of one or more symptoms of UTI, such as dysuria, increased frequency, hesitation, urgency and abdominal pain. Each patient’s clean-catch midstream urine was collected in a sterile screw-capped universal container. Patients’ written consents were also collected before specimen collection. Urine samples were sent to microbiology laboratory for further study. A specimen was considered positive for UTI if an organism was cultured at a concentration of ≥105CFU/ ml or when an organism was cultured at a concentration of 104CFU/ml and >5 pus cells per high power field were observed on microscopic examination of urine. Identification of bacterial pathogens was made on the basis of Gram reactions, morphology, motility test, biochemical and cultural characteristics. Antimicrobial susceptibility testing of E. coli was performed by disc diffusion method following the National Committee for Clinical laboratory Standards (NCCLS) guidelines. Results: A total 170 urine samples were collected from symptomatic UTI patients, among which 120 (70.59%) patients were female and 50 (29.41%) patients were male. In OPD, male and female patients were 37 (74%) and 86 (71.67%) and in IPD, male and female patients were 13 (26%) and 34 (28.33%) respectively. Out of 50 male patients, common age group of symptomatic UTI was 70-79 years whereas in 120 female patients, the majority of the UTIs were reported within the age group of 19-29 years, 50-59 years and 60-69 years (p <0.001). Among five risk factors observed for UTI, the most common risk factor in female was DM 37 patients, followed by HTN 28 patients, H/O UTI in last one year 21 patients, previous H/O taking antibiotics in last six months 15 patients & CKD 3 patients. In male, commonest risk factor was HTN 20 patients, followed by DM 14 patients, previous H/O taking antibiotics in last six months 7 patients, CKD 5 patients & H/O UTI in last one year 4 patients. Culture positive samples were detected 62(36.47%) from 170 urine samples. Out of 62 culture positive isolates, E. coli 34(20%) was found to be the most common pathogen followed by Klebsiella spp. 13(7.65%), Pseudomonas spp. 7(4.12%), Enterobacter spp. 4(2.35%) and Enterococci spp. 4(2.35%). E. coli was highly susceptible to mecillinam 28(82.35%), nitrofurantoin 30(88.23%) and meropenem 28(82.35%). Susceptibility to netilmicin 26(76.47%), ceftazidime 24(70.58%), amikacin 24 (70.58%) were also detected. Conclusion: We observed that E. coli was highly susceptible to mecillinam, nitrofurantoin and meropenem. As mecillinam and nitrofurantoin are oral antimicrobial agents, clinician can choose these drugs for the treatment of UTI. We attempted to investigate the susceptibility patterns of E. coli; however, the results were not representative of the entire Bangladeshi situation. Therefore, a mass study is required to find out the real scenarios of antibiotic susceptibility pattern of uropathogens.