Title: Culture and Sensitivity Pattern of Urinary Tract Infection among Women of

Reproductive Age Group

INTRODUCTION

Urinary Tract Infection (UTI) refers to a diverse spectrum of conditions affecting the urinary tract presenting
with variable clinical complaints1. UTIs are usually classified as upper and lower urinary tract infections either
involving the lower tract or simultaneously both and are termed in accordance with the anatomical part
involved.2-6 Acute Pyelonephritis (APN) mainly affecting the kidneys are described as upper UTIs with
complaints of high grade fever temperature, pain in the flank, nausea, vomiting, and rigors.1,6,8 Lower UTIs
presenting with symptoms of dysuria, urgency, frequency, nocturia and incontinence covers infection of
bladder(cystitis) and inflammation of urethra.1,6,8 The etiology of UTI is microbial in most cases however
involvement of bacterial pathogen is not always suggestive of disease.1

UTIs are either acquired from community or within the hospital setting and victimizes approximately 150
million population of the world annually.2-4 In accordance with National Ambulatory Medical Care Survey and
National Hospital Ambulatory Medical Care Survey, that occurred in 1997, UTIs results in approximately 7
million outpatient visits and therefore rank as the second most frequent problem confronted by a clinician
practicing community medicine.3,4

UTIs are most commonly caused by Escherichia coli.7 Other gram negative bacteria are Klebsiella spp,
Enterobacter spp., and Pseudomonas aeruginosa, Proteus spp. Gram positive organisms include Enterococcus
spp, Staphylococci and Streptococci and account for 5 to 15 % of the cases.9 Despite of the fact that wide range
of antibiotics is available against UTI, it remains one of the most common infections and is responsible for
significant morbidity in females. The quality of life is affected in women with UTI and may have serious
consequences of developing renal damage. This warrants greater attention for reproductive health needs of the
women, and health education for hygienic/ safe use of family planning methods. Resistance of antibiotics is yet
another serious problem. This is due to overuse as well as misuse of antibiotics that resistance of antibiotics is
increasing day by day.10 A study from Pakistan with limited sample size reported that of 70 isolated pathogens
the most common isolate was Escherichia coli (70%), followed by Klebsiella pneumonia (14%), Streptococcus
faecalis (5.7%), Acinetobacter (4.2%), Staphylococcus aureus (2.8%), Candida (1.4%), Pseudomonas (1.4%)
and Proteus (1.4%).11 In the similar study, fourteen antibiotics commonly used were tested against the isolated
E. coli. Amikacin was found to be the most effective drug (97.61%) followed by nitrofurantoin (90%). 11 The
study conducted by study conducted by Dilnawaz S et al 2005, which
reflected that first two common organisms were E coli and Klebsiella pneumonia, followed by Pseudomonas.12

As the above statistics showed that culture and drug sensitivity pattern of UTI vary with patient from different
geographical areas thus to better understand the culture and antibiotic sensitivity pattern of UTI, the study is
planned. The findings of culture and sensitivity pattern from this study will help us to identify the frequency of
pathogen causing Urinary Tract Infection among women and antimicrobial sensitivity pattern. Thus the study
will provide evidence for the more common causative organisms for the Urinary Tract Infection and assist the
clinicians in better patient management by giving appropriate antibiotics which will ultimately reduce the
morbidity and mortality due to Urinary Tract Infection.

1
OBJECTIVES:

To determine the culture and sensitivity pattern of microorganisms in Urinary Tract Infection among women of
reproductive age group

OPERATIONAL DEFINITIONS

Antimicrobial Susceptibility

It includes whether a micro organism is sensitive or resistant to an antibiotic. The antimicrobial agents are
analyzed for the susceptibility and resistance sequence of uropathogen to different antibiotics. The group of
antibiotics tested on organisms will be B-Lactam drugs such as penicillin; cephalosporin; monobactum and
carbapenem. Other antibiotics tested will be aminoglycoside; quinolone; nitrofurantoin; fosfomycin and co-
trimaxole.

Positive Culture

Gram-staining and standard biological mediums will be used to identify the infective agent. 5 Only those
specimens will be included that fulfilled the criteria of positive bacteriuria i.e. 10 4-5 CFU/ml or greater than 105
CFU/ml growth of bacteria on culture medium.

MATERIALS AND METHODS

Study setting

Microbiology department, SIMS, Lahore.

Duration of Study

Six months after the approval of synopsis.

Sampling Technique

Non-probability consecutive sampling

Inclusion Criteria

 Patients with confirmed diagnosis of Urinary Tract Infection.

 Women with age 18 to 44 years.
 Culture positive i.e. 104-5 CFU/ml or greater than 105 CFU/ml growth of bacteria on culture medium.

2
Exclusion Criteria

 Prior antibiotic therapy

 Incomplete records on reports.
 Recent Surgery
 Steroid therapy

Study Design

Retrospective analysis

Data Collection Procedure

This study will be initiated after approval from Ethical Review Committee. The study is a retrospective
secondary data analysis of freshly voided midstream samples obtained from a local laboratory from over a
period of one years between June, 2017 to May 2018. The samples collected were analyzed for Urine culture
and antibiotic sensitivity test (ABS) and the reports for the tests were retrieved separately from the Database.
Only those specimens were included that fulfilled the criteria of positive bacteriuria during the study period.
Identification of the isolated bacterial pathogens will be done on the basis of gram staining, morphology and
biochemical characters. For the positive cultures, antibiotic sensitivity discs will be put on the Muller Hinton
agar plates. The plates will be incubated at 37 0C for 18-24 hours. The results of sensitivity plates will be read
after 24 hours. Negative cultures will be reincubated for another 24 hours and report will be given as no growth
at the end of 48 hours of incubation. All data will be retrieved from the single laboratory ensure calibration.

Ethical Considerations

The study will be conducted according to the ethical guidelines of Helenski declaration and Pakistan Medical
research Council (PMRC). Anonymity and confidentiality of participant’s data will be maintained throughout
the research. The research will only be initiated after the ethical approval is obtained.

Data Analysis

Data will be analyzed by using SPSS version 21 (IOBM) Descriptive statistics will be performed. Categorical
variables (i.e. age categories, organism isolate) will be presented as frequency and percentage. Continuous
variable (i.e. age) will be presented as mean ± Standard deviation.

3
REFERENCES

1. National Collaborating Centre for Women’s and Children’s Health, Commissioned by the National
Institute for Health and Clinical Excellence. Urinary tract infection in children: diagnosis, treatment and
long-term management. London: RCOG Press; 2007.Available from:
http://www.guiasalud.es/egpc/traduccion/ingles/ITU/completa/apartado04/clasificacion.html

2. Akram M, Shahid M, Khan AU. Etiology and antibiotic resistance patterns of community-acquired
urinary tract infections in J N M C Hospital Aligarh, India. Ann Clin Microbiol Antimicrob. 2007 Mar
23; 6(4):1-7.

3. Betsy Foxman Epidemiology of urinary tract infections: Incidence, morbidity, and economic costs.
Disease-a-Month. 2003 Feb;49(2): 53-70.
4. Farooqi BJ, Shareeq F, Rizvi QK, Qureshi HS, Ashfaq MK. Changing pattern of antimicrobial
susceptibility of organisms causing community acquired urinary tract infections. J Pak Med
Assoc. 2000 Nov; 50(11):369-73.
5. De Vecchi E, Sitia S, Romano CL, Ricci C, Mattina R, Drago L. Aetiology and antibiotic resistance
patterns of urinary tract infections in the elderly: a 6-month study. J Med Microbiol. 2013; 62(Pt
6):859–63.
6. Edirinsinghe LU, Vidanagama D. A retrospective analysis of urine culture results issued by the
microbiology department, Teaching Hospital, Karapitiya. J Med Galle.2008; 13(1):40-44.
7. Ahmed MA. Antibiotic Resistance Pattern of Uropathogens in Community and Hospital Acquired
Urinary Tract Infections. J Life Sci. 2014; 11(1):332-336.
8. Car J, Sheikh A. Recurrent urinary tract infection in women. BMJ 2003 Nov; 327.
9. Farhatullah, Akbar Malik S, Jawad A. Antibiotic susceptibility pattern and ESBL prevalence in
nosocomial Escherichia coli from urinary tract infections in Pakistan. Afr J Biotechnol. 2009; 8: 3921-
3926.
10. Vasquez Y. Antibiotic susceptibility patterns of community- acquired urinary tract infection isolates
from female patients on the US (Texas) - Mexico Border. The J Appl Research. 2004; 2: 321-326.
11. Humayun T, Iqbal A. The culture and sensitivity pattern of urinary tract infections in females of
reproductive age group. Ann Pak Inst Med Sci. 2012; 8(1):19-22.
12. Sheikh D, Ashfaq S, Sheikh K, Sheikh M. Studies on resistance/ sensitivity pattern of bacterial related
with urinary tract infections. Med J Isl World Acad Sci. 2005; 15; 129-133.