Antibiotic susceptibility profile of bacterial uropathogens in Al-Shomali General Hospital, Babylon, Iraq

Ali Abedulameer Alhusayni; Falah Hasan Obayes Al-Khikani; Hassanin Khalil Aljaburi; Bassim Abed Ali Alkareawiu; Raheem Malallah Abadi

doi:10.4103/jpdtsm.jpdtsm_45_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 1 | Issue : 4 | Page : 240-245

Antibiotic susceptibility profile of bacterial uropathogens in Al-Shomali General Hospital, Babylon, Iraq

Ali Abedulameer Alhusayni¹, Falah Hasan Obayes Al-Khikani¹, Hassanin Khalil Aljaburi², Bassim Abed Ali Alkareawiu¹, Raheem Malallah Abadi¹
¹ Department of Microbiology, Al-Shomali General Hospital, Babylon Health Directorate, Babylon, Iraq
² Department of Microbiology, College of Science, Babylon University, Babylon, Iraq

Date of Submission	09-Jun-2022
Date of Decision	11-Jul-2022
Date of Acceptance	25-Sep-2022
Date of Web Publication	5-Dec-2022

Correspondence Address:
Falah Hasan Obayes Al-Khikani
Department of Microbiology, Al-Shomali General Hospital, Babylon
Iraq

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpdtsm.jpdtsm_45_22

Abstract

BACKGROUND: Urinary tract infection (UTI) is a group of common diseases that are among the most common bacterial infections in humans. Antibiotics are often effective therapy, although antibiotic resistance is increasing. The study aimed to isolated pathogenic bacteria from UTI patients attended to Al-Shomali General Hospital and to detect the antibiotic susceptibility rate to isolated bacteria.
MATERIALS AND METHODS: The bacterial identification and antibacterial susceptibility of this work were done in the Clinical Microbiology Laboratory of Al-Shomali General Hospital for the period between March 1, 2022, and June 1, 2022. Bacteria have been diagnosed by morphology and biochemical tests as well as using some selective and differential media. The results were analyzed using Microsoft Excel and SPSS version 26 (SPSS Inc., Chicago, IL, USA).
RESULTS: A total of 124 positive urine cultures were studied that showed 101 (81.4%) females and 23 (18.5%) males. The data revealed the most predominant of uropathogen isolates were Escherichia coli (34%), Staphylococcus aureus (31%), Staphylococcus saprophyticus (13%), Enterococcus spp. (11%), Pseudomonas aeruginosa (4%), Klebsiella spp. (3%), Micrococcus spp. (2%), and Proteus mirabilis (2%). Antibiotic resistance in this study shows the most bacteria resistance for an antibiotic is P. mirabilis (81%), P. aeruginosa (76%), Enterococcus spp. (66%), S. aureus (65%), E. coli (54%), S. saprophyticus (52%), Micrococcus spp. (48%), and Klebsiella spp. (44%).
CONCLUSIONS: In UTI infections, resistant bacteria are becoming increasingly prevalent, with a high proportion of multidrug-resistant isolates. Furthermore, the meropenem, imipenem, and amikacin seemed to be more effective against bacterial UTI infection in this setting.

Keywords: Escherichia coli, Iraq, susceptibility test, urinary tract infection, uropathogens

How to cite this article:
Alhusayni AA, Obayes Al-Khikani FH, Aljaburi HK, Ali Alkareawiu BA, Abadi RM. Antibiotic susceptibility profile of bacterial uropathogens in Al-Shomali General Hospital, Babylon, Iraq. J Prev Diagn Treat Strategies Med 2022;1:240-5

How to cite this URL:
Alhusayni AA, Obayes Al-Khikani FH, Aljaburi HK, Ali Alkareawiu BA, Abadi RM. Antibiotic susceptibility profile of bacterial uropathogens in Al-Shomali General Hospital, Babylon, Iraq. J Prev Diagn Treat Strategies Med [serial online] 2022 [cited 2023 Jan 29];1:240-5. Available from: http://www.jpdtsm.com/text.asp?2022/1/4/240/362822

Introduction

One of the most prevalent infectious disorders identified among outpatients is urinary tract infection (UTI).^[1] Bacterial infections are the most common cause; however, fungal and viral infections can also occur. Gram-negative bacteria are responsible for the majority of UTI infections, whereas Gram-positive bacteria are responsible for just a small percentage of cases. Escherichia ^{More Details} coli is the most often isolated uropathogen, accounting for 65%–90% of UTIs.^[2],[3]

The most frequent bacterial infections in humans are UTIs.^[4] In their lifetimes, 40% of women and 12% of men are projected to have at least one symptomatic UTI episode, with 27%–48% of afflicted women suffering from recurrent UTIs.^[5],[6] UTIs account for over 40% of all hospital-acquired infections and 50% of bacterial infections that cause higher morbidity and longer hospitalization.^[7],[8]

The bulk of clinical samples is connected to UTI, which is regarded as the most common illness producing considerable morbidity across the world. Many bacteria, notably antibiotic-resistant pathogens and biofilm makers, have the capacity to penetrate urinary tract tissues, colonize, and establish infections that can be severe.^[9]

Asymptomatic bacteriuria, recurrent UTI, severe UTI, UTI associated with bladder catheterization, acute cystitis, and acute pyelonephritis are some of the clinical symptoms associated with UTIs, depending on their temporal history or location of infection.^[10]

E. coli, Proteus spp., Pseudomonas aeruginosa, Acinetobacter spp., Klebsiella spp., Enterobacter spp., Citrobacter spp., Staphylococcus saprophyticus, Enterococcus spp., and Coagulase-negative Staphylococcus are the most common uropathogenic bacteria infecting the urinary tract and kidney.^[11] Age, sex, catheterization, hospitalization, and previous antibiotic exposure all influence the relative frequency of uropathogens.^[12]

Antibiotic resistance in the treatment of UTI s is a critical public health concern. There is a large incidence of fake and spurious pharmaceuticals of uncertain quality in circulation, particularly in developing countries, where there is a high degree of poverty, illiteracy, and poor hygiene standards.^[13] The medications are prone to misuse because of their wide availability in the community without a prescription and inexpensive cost.^[14],[15]

Antimicrobial resistance (AMR) is a rapidly increasing problem that jeopardizes patient treatment and the smooth running of health-care facilities across the world.^[16] Through a variety of (chromosomally encoded or plasmid-mediated) resistance mechanisms, pathogenic bacteria can develop resistant to a wide spectrum of chemically unrelated drugs.^[17]

Materials and Methods

Data collection

This study was done in the Clinical Microbiology Laboratory of Al-Shomali General Hospital. One hundred twenty-four positive urine culture specimens were obtained for the period between March 1, 2022, and June 1, 2022. The questionnaire was obtained from all participants in this study such as age, sex, and general symptoms.

Sampling and identification of pathogens

Al-Shomali General Hospital received a total of 124 urine samples from UTI patients. Urine samples were collected from a midstream location and placed in a standardized, sterile container before being transferred to the laboratory in under 2 h. Culture characteristics, Gram stain, and regular standard biochemical testing were used to identify the bacteria. Using the calibrated loops technique, urine samples were grown on 5% blood agar, mannitol salt agar, MacConkey, and eosin methylene blue agar and incubated in both aerobic and anaerobic conditions for 24 h at 37°C in both aerobic and anaerobic settings. After a 24-h incubation period, cultures that had not formed a colony were incubated for another 48 h. Samples having a colony count of 105 colony-forming units/ml or above are deemed positive. Gram staining, colony morphology on media, growth on selective medium, lactose and mannitol fermentation, H2S generation, catalase, oxidase, coagulase, indole, and citrate utilization, and urease test were used to identify and confirm the isolates.

Antimicrobial susceptibility testing

The susceptibility test was performed using commercial disks and the conventional disk diffusion technique on Mueller–Hinton agar. According to Clinical and Laboratory Standards Institute recommendations, a turbidity standard methodology was performed to get a homogenized bacterial inoculum solution. The following antibiotic disks were used for the disk diffusion tests: cefotaxime 30 μg, vancomycin (VA, 30 μg), gentamicin (GM, 10 μg), amoxicillin (AML, 25 μg), nitrofurantoin (F, 50 μg), ciprofloxacin (CIP, 5 μg), co-trimoxazole 25 μg, nalidixic acid (NA, 30 μg), erythromycin (E, 15 μg), GM, 10 μg, azithromycin (AZM, 15 μg), amikacin (AK, 30 μg), piperacillin (PRL, 100 μg), cloxacillin (CX, 5 μg), tobramycin (TOB, 30 μg), ceftazidime (CAZ, 30 μg), cefoxitin (FOX, 30 μg), cephalothin 30 μg, rifampicin (RD, 5 μg), meropenem (MRP, 10 μg), imipenem (IMI, 10 μg), aztreonam (ATM, 30 μg), ceftriaxone (CRO, 30 μg), and tetracycline (TE, 30 μg).

Ethics

On March 1, 2022, the research protocol was accepted by the Ethical Committee of the Babylon Health Directorate. Furthermore, the patients' verbal consent was obtained before taking the sample. During the sampling, precautions were taken to ensure the safety of the participants. This work was also carried out by the Iraqi Ministry of Health's Ethics Committee and followed all national rules. The number and date of projects approval were 74,584 in March 01, 2022.

Results

There were a total of 124 positive urine culture findings obtained, with 101 (81.5%) females and 23 (18.5%) men. The prevalence of uropathogens was E. coli 42 (33.8%), Staphylococcus aureus 38 (30.6%), S. saprophyticus 16 (12.9%), Enterococcus spp. 14 (11.2%), P. aeruginosa (4%), Klebsiella spp. 4 (3.2%), Micrococcus spp. 3 (2.4%), and Proteus mirabilis 2 (2.4%) were (1.6%) [Table 1].

Table 1: Prevalence of uropathogens among positive patients according to gender

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The urine-positive samples yielded a total of 124 bacterial isolates from eight distinct types of uropathogens. In terms of age, 18 samples (14.5%) belonged to persons aged 0–18, 62 (50%) to people aged 19–30, 26 (20.9%) to people aged 31–45, and 18 samples (14.5%) to those aged 46–86 [Table 2].

Table 2: Prevalence of uropathogens among positive patients by age group

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A total of 24 disks were utilized to detect the resistance profiles in each isolate; antibiotics with detected percentages of resistance were CX (95%), followed by PRL (91%), AML (89%), NA (88%), CAZ (86%), CRO (86%), ATM (81%), E (79%), cefotaxime (76%), clindamycin (75%), GM (65%), CIP (63%), AZM (57%), TE (57%), RD (55%), TOB (49%), F (43%), VA (40%), FOX (29%), IMI (20%), AK (12%), and MRP (9%), as in [Figure 1].

Figure 1: Frequency of antibiotic resistance and sensitivity among isolated bacteria

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The P. mirabilis isolated from UTI reveals highly resistance to antibiotics used in the current study and Klebsiella spp. reveal less resistance to antibiotics among bacterial isolates. Bacterial sensitivity to various antimicrobial agents is illustrated in both [Figure 2] and [Table 3].

Figure 2: The resistance percent of bacteria isolate against antibiotics

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Table 3: General resistance percentage of isolated bacteria to antibiotics in the study

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Discussion

One of the most prevalent reasons for seeking medical help in the community is a bacterial infection of the urinary tract.^[18] The identification of the organisms that caused the disease and the selection of an effective antibiotic drug for the organism in question are frequent components of the efficient management of individuals with bacterial UTIs.

The prevalence of UTI in the current study is higher in females (81.4%) than in males (18.5%). This might be due to the anatomical differences of urogenital organs between the two sexes.^[19]

Men are less susceptible to UTIs than women, but their risk of infection increases with age. Furthermore, infected men are more likely to experience more severe forms of infection, such as pyelonephritis and urosepsis.^[20]

A study by Wubalem D. and Alemayehu D. in 2018 showed the total positive patients for uropathogens, while 71.7% were female and 28.3% were male. Statistical analysis revealed that there was a significant relationship between sex and the prevalence of uropathogens.^[21]

Sex was one of the considered factors, and the result indicated that UTI prevalence was higher in females than males for each isolate. Previously, another studies have shown that the incidence of UTI was found to be higher in females than in males. This is probably due to multiple factors contributing to the problems among females. The first possible reason would be the anatomical feature of the female urethra, which is much shorter than the males' urethra. The shortness of the urethra allows the pathogens easy access to the bladder during sexual intercourse. This in turn results in increased bacterial counts in the bladder after intercourse.^[22]

Prevalence difference has been also observed among various age groups. This difference suggests that age is one risk factor associated with UTIs. A high incidence of UTI among the^{[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30]} age group has been observed. The high prevalence recorded among the young age group could be due to increased sexual activity in this group.^[23]

Statistical analysis revealed that there was a significant difference between the prevalence of UTI in patients who were practicing frequent sexual activity and those who were not. This indicates that those patients who were practicing frequent sexual activity would have more probability of having UTI than those who were not.^[24] This is consistent with the findings reported by many authors. They showed the incidence of UTI is higher in sexually active females causing 75%–90% of bladder infections,^[25] The current result is similar to another study result by Angoti et al. found the most common isolated uropathogens in Gram-negative bacilli and Gram-positive cocci were E. coli (55.3%) and S. aureus (3.21%), respectively.^[26] This finding agrees with another study.^[27]

Uropathogenic E. coli (UPEC) is the most common cause of UTI, accounting for approximately 80% of infections. In 2019, a study showed more specifically, the principal cause of UTIs (>90%) are UPEC and uropathogenic Klebsiella pneumoniae, while other members of the order are represented to a lesser extent.^[28]

This study revealed a higher prevalence rate of resistance to the commonly prescribed antibiotic agent. The result shown there were multiple antibiotic resistances on many of the identified species. Thus, E. coli, Enterococcus spp., P. mirabilis, Micrococcus spp., and P. aeruginosa isolated bacteria were members resistant by a 100% ration to more than four antibiotics. This also agrees with^[29] that the development of higher resistance against the above-mentioned antimicrobials could be due to repeated use or prolonged exposure of uropathogens to the antibiotics.^[30]

Antibiotic use over time can harm the periurethral flora, allowing uropathogens to proliferate and infect the urinary system. As a result, clinicians have a limited number of medications to choose from when treating UTIs.^[31]

AMR in UPEC and the spreading of multidrug-resistant (MDR) UPEC in recent decades is a clinical problem, particularly in women with recurrent UTIs. The increasing frequency of MDR UPEC, especially in developing countries, results in excessive use of broad-spectrum antibiotics such as fluoroquinolones, cephalosporins, and aminoglycosides that raise the cost of treatment and hospitalization.^[32],[33]

Conclusions

Females are more infected with UTIs than males 81.5% and 18.5%, respectively. This study revealed that the common uropathogen were E. coli 33.8%, S. aureus 38 (30.6%), S. saprophyticus 12.9%, Enterococcus spp 11.2%, P. aeruginosa 4%, Klebsiella spp 3.2%, Micrococcus spp 2.4%, and P. mirabilis 1.6%. MRP, IMI, and AK seemed to be more effective against bacterial UTI infection.

Limitation of the study

The main limitation in this study is the absence of genotyping study of the bacteria for participants; the current study took in consideration only phenotypic properties. Small numbers of specimens may not reflect all population in the Babylon city.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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