Download A study on Bacterial contamination of Cell phones of Health Care

DETECTION & PREVALENCE OF EXTENDED SPECTRUM βETA - LACTAMASES AMONG
ENTEROBACTERIACEAE SPECIES FROM VARIOUS CLINICAL SAMPLES AT KIMS, AMALAPURAM.
*N.Padmaja,Anand Acharya, P.N.Rao.
Abstract: The present study was conducted in the Department of Microbiology, KIMS,
Amalapuram, East Godavari from January 2012 to July 2012. Out of 100 different clinical
samples, 50 were culture positive. Of the 100 samples collected, more were from post operative
wound sepsis - 44 (44%), followed by cellulites - 20 (20%), Ulcers - 17 (17%), Injuries 15 (15%).
Least number of cases are from burns - 4 (4%). Among 50 culture positive cases, 38 (76%)
isolates belonged to Enterobacteriaceae family, followed by Pseudomonas aeruginosa - 8 (16%),
followed by Staphylococcus aureus - 4 (8%). Among 38 Enterobactriaceae family isolates. 15
were ESBL producers. Among ESBL positive strains, more drug resistance was seen to
ceftazidime and Ampicillin (93.33%), followed by Ceftrioxone (86.66%), Aztreonam &
Cefotaxime (80%). All ESBL producers showed full sensitivity to Imipenem.
Introduction:
Hospital outbreaks of multi-drug resistant Enterobacteriaceae are now frequently
caused by extended spectrum beta-lactamase (ESBL) producers. The incidence of ESBL
producing strains among clinical isolates has been steadily increasing over past years resulting in
limitation of therapeutic options.
β - lactamase antibiotics are the most varied and widely used agents accounting for over
50% of all systemic antibiotics in use. The most common mode of acquisition of bacterial
resistance to
β - lactam antibiotics is the production of β – lactamase. However, new β - lactamases emerged
against each of the new classes of β – lactamase that were introduced & caused resistance. The
latest in the arsenal of these enzymes has been evolution of extended spectrum β - lactamases
(ESBLs). These enzymes are commonly produced by many members of Enterobacteriaceae and
efficiently hydrolyze oxyimino cephalosporins conferring resistance to 3rd generation
cephalosporins like Cefotaxime, Ceftazidime & Ceftriaxone.
ESBLs pose a major problem for clinicians. Hence, this study is taken to identify the
prevalence of these strains in hospital & to determine suitable preventive measures &
treatment policies.
Materials & Methods:
Different clinical samples collected from both inpatients & outpatients of KIMS Hospital,
Amalapuram, during January 2012 - July 2012, constitute the material for this study.
A total of 38 Enterobacteriaceae species were isolated from 100 pus samples of
different diseases including both sexes and all age groups.
Materials Required:
Specimens were inoculated on to the media – Mac Conkey, Blood agar and incubated at
37 C for 18 - 24 hr and identified by Gram’s stain, culture, biochemical tests and Antibiotic
sensitivity test. For detection of ESBL, ESBL E Strip test is used. Method : E-TEST ESBL SCREEN :
(CORMICAN etal 1996)
0
The strip carries two antibiotic gradients Ceftazidime (0.5-35 µg/ml) and Ceftazidime
with Clavulanic acid (0.064 - 4 µg/ml). The E test method was carried out according to
manufactures instructions.
Colonies from 18-24 hrs. culture were emulsified in sterile normal saline, incubated for 4
to 6 hrs. to an inoculum turbidity equivalent to 0.5 Mc Farland standard. This suspension was
swabbed over on to Muller hinton agar plate and it is allowed to dry for 10 – 15 mins at room
temperature. An ESBL E strip was then applied to plate with sterile forceps and the plate was
incubated at 370 C for 18 hrs. After incubation, the MICs were read according to the
manufacturers guidelines and the ratio determined. (The MIC ratio ≥ 8 indicates ESBL
production. It is considered Gold standard.)
INTERPRETATION OF TEST RESULT:
The MIC value was read where the elliptical zone of growth inhibition intersected the E
test strip. The MIC of Ceftazidime alone on one end of strip was compared with the MIC of
Cetazidime + Clavulanic acid combination at other end. A greater than four fold reduction in the
Cetazidime MIC in the presence of Clavulanic acid was taken as positive for ESBL production.
For ESBL screening, the antibiotic discs used are Ceftazidime, Cefotaxime, Ceftrioxone,
Aztreonam, Amoxycillin+Clavulanic acid, Ceftazidime+Clavulanic acid, Cefotaxime+Clavulanic
acid and Imipenem. The incubated plates were read for zone of inhibition and results are
interpreted comparing with the standard zone size given by Kirby-Bauer chart
Quality control:
Escherichia coli ATCC 25922 - Used as negative control.
In house ESBL producers are used as positive control.
Results:
Out of 100 samples collected, high number of cases are from males 70 (70%) and low
number of cases are from males 30 (30%).
S.No
Sex
No. Of Cases
%
1
Males
70
70 %
2
Females
30
30 %
Among 100 sample collected, more were from post-operative wound sepsis - 44(44%),
followed by Cellulitis - 20 (20%), Ulcer - 17 (17%), Injuries 15 (15%), Burns 4 (4%).
S.No
Disease
No. of Samples
1
Post operative wounds
44
2
Cellulitis
20
3
Ulcer
17
4
Injuries
15
5
Burns
4
Of the 100 samples processed, 50 were culture positive. Of these, 38 (76%), isolates
belonged to Enterobacteriaceae family, followed by Pseudomonas aeruginosa 8 (16%), followed
by Staphylococcus aureus - 4 (8%).
Table: 3 Different types of Bacterial species isolated
S.No.
Bacterial Species
Culture Positive
cases
Percentage
1
Escherichia coli
21
42 %
2
Klebsiella pneumonia
9
18 %
3
Proteus mirabilis
4
8%
4
Citrobacter
2
4%
5
Proteus vulgaris
2
4%
6
Pseudomonas aeruginosa
8
16 %
7
Stahylococcus aureus
4
8%
Of the 38 Enterobacteriaceae isolates, 15 are ESBL producers.
Table 4: Distribution of Bacteria producing ESBLs
S.No
Bacterial Species
Total isolates
ESBL Producers
No.
%
1
Escherichia coli
21
8
38 %
2
Klebsiella pneumoniae
9
5
55.5 %
3
Proteus mirabilis
4
1
25 %
4
Citrobacter
2
1
5%
5
Proteus vulgaris
2
0
-
(Note: Percentage of ESBL producers calculated as per the respective total isolates)
Among ESBL positive strains, more drug resistance was seen to Ceftazidime and Ampicillin
(93.33%), followed Ceftriaxone (86.66%) Aztreonam & Cefotaxime (80 %). All ESBL producers
showed full sensitivity to Imipenem.
Table 5: Comparison of Antimicrobial Resistance pattern of ESBL producers & Non ESBL
producers.
S.No
Drugs
ESBL Positive (15)
No.
%
ESBL Negative (23)
No.
%
1
Ampicillin
14
93.33 %
10
43.47 %
2
Gentamicin
3
20 %
9
39.13 %
3
Amikacin
4
26.66 %
4
17.39 %
4
Ciprofloxacin
4
26.66 %
3
13.04 %
5
Chloramphenicol
5
33.33 %
4
17.39 %
6
Co - trimoxazole
7
46.66 %
12
52.17 %
7
Aztreonam
12
80 %
8
34.78 %
8
Cefotaxime
12
80 %
2
8.69 %
9
Ceftazidime
14
93.33 %
3
13.04 %
10
Ceftriaxone
13
86.66 %
3
13.04 %
11
Imipenem
0
0
0
0
(Note: Percentage of positive and negative ESBL drug resistance pattern calculated as per
respective antibiotics tested).
Discussion:
The present study was undertaken to evaluate the pattern of drug resistance produced
by isolates of Enterobacteriaceae family causing various diseases especially in hospitalized
patients and to known the prevalence of ESBL production.
In the present study, out of 100 pus samples, rate of recovery of isolates belonging to
Enterobacteriaceae family is 38. i.e. 76 %. In this study, males (70%) are more commonly
affected than females (30%) due to the fact that males are more involved in out door activities
& hence chances of infection or injury are more likely.
An outbreak of nosocomial infection due to ESBL isolates of Enterobacteriaceae family
occur world wide in intensive care units as shown by different workers, Yagi et al 2000, Silver et
al 2001. Risk factors associated with ESBL production include – prolonged hospital or intensive
care stay, use of multiple courses of antimicrobial therapy, particularly extended spectrum
cephalosporins. In the present study, ESBL production is more in Cellulitis cases due to
prolonged hospital stay & indiscriminate use of multiple courses of antibiotics. Hence
indiscriminate use of cephalosporins and broad spectrum antibiotics should be avoided.
References:
1. A. Varaiya, J. Dogra, M. Kulkarni, P. Bhalekar - " Extended spectrum Beta lactamase
(ESBL) producing Escherichia coli and Klebsiella pneumoniae in Diabetic foot infection Department of Microbiology ”, S.L. Raheja Hospital, Mahim West, Mumbai - 400016,
IJMM, India - 7th August 2008.
2. Subha, S. Ananthan – “ Extended spectrum Betalactamase (ESBL) Mediated Resistance
to Third Generation Cephalosporins among Klebsiella pneumoniae in Chennai “ - Indian
Journal of Medical Microbiology, (2002) 20 (2) ; 92-95.
3. A.A. Dashit, P. West, R. Paton and S.G.B. Amyes – Characterization of extendedspectrum Beta-Lactamase (ESBL) - Producing Kuwait and UK strains identified by the
Vitek system, and sub sequent comparison of the Vitek system, with other commercial
ESBL - Testing systems using these strains” – Molecular Chemotherapy, Centre for
Infectious Disease – January 2006.
4. Amit Jain & Rajesh Mondal – "Prevalence and antimicrobial resistance of extended
spectrum Beta-Lactamase producing Klebsiella spp. isolated from cases of neonatal
septicemia" – Indian J Med. Res, January 2007, PP 89-94.
5. Ankur Goyal, Amit Prasd, Ujjala Ghosal & K.N. Prasad - "Comparison of disk diffusion,
disk potentation & double disk synergy methods for detection of extended spectrum
beta lactamase in Enterobacteriaceae" – Indian Journal Med Res. 128, August 2008, PP
209-211.
6. Ashwin N Ananthakrishnan, Reba Kanungo, A. Kumar and S. Badrinath - "Detection of
extended spectrum Beta-lactamase producers among surgical, wound infections and
Burns patients in jipmer" - Indian Journal of Medical Microbiology (2000) 18 (4) : 160165.
7. Bisson, G.Fishman, N.O. Patel, J.B.; Edel Stein, P.H ; Lautenbanch,E. '' Extendedspectrum beta-lactamase-producing Escherichia coli and Klebseilla species; risk factors
for colonization and impact of antimicrobial formulary interventions on colonization",
Prevalence, Infection and control, Thorofare, v.23, p.254-260,2002.
8. C. Rodrigues, P Joshi, SH Jain, M Alphonse, R. Radhakrishnan, ''A Metal-detection of
Beta-lactamases in Nosocomial Gram Negative Clinical Isolates''- Indian Journal of
Medical Microbiology, (2004) 22 (4) : 247-250.
9. Colonder, R.; Raz, R.; Chazan, B.; akran, W. ''Susceptibility pattern of extended-spectrum
Beta-lactamase producing bacteria isolated from inpatients to five antimicrobial drugs in
community hospital in Northern Israel'', International Journal of Antimicrobial Agents,
Shannon, v. 24, p. 409-410,2004.
10. Cormican MG, Marshall SA, Jones RN. ''Detection of spectrum β-lactamases (ESBL)
producing strains by E-test ESBL screen'' J. Clin Microbiol 1996: 1880-84.
11. MS Kumar, V. Lakshmi, R. Rajagopalam ''Occurance of extended spectrum BetaLactamases among Enterobacteriaceae SPP isolated at a Tertiary care institute'' - Indian
Journal of Medical Microbiology (2006) 24 (3) : 208-11.
12. Yagi, T.; Kurokawa, H.; Shibata, N.; Shibayama, K.; Arakawa, Y. ''A Preliminary survey of
extended-spectrum Beta-lactamases (ESBLs) in clinical isolates of Klebsiella pneumoniae
and Escherichia coli''. FEMS Microbiology Letters, Amsterdan, v.184, p.53,2000.
13. Silva, J.; Gatica, R.; Aguilar, C.; Becerra, Z.; Ramos, U.G.; Velazquez, M.; Miranda, G.;
Leanos, B.; Solorzano, F.. Echaniz, G. ''Outbreak of infection with extended-spectrum
Beta-lactamase producing Klebsiella pneumoniae in a Mexican hospital''. Journal of
Clinical Microbiology, Washington, V.39, p. 3193-3193, 2001.
A study on Bacterial contamination of Cell phones of
Health Care Workers (HCW) at KIMS Hospital, Amalapuram.
*N.Padmaja, P N. Rao.
Abstract: A random 100 samples of cell phones of HCWs workers and Doctors working in various
wards, Opds and laboratories, Blood Bank, Causality, ICU of KIMS Hospital were subjected to
bacterial analysis by conventional methods to know about the Bacterial contamination of the
cell phones from July 2011 to December 2011. The commonest organism isolated from the
contaminated cell phone is MRSA - 20%, followed by MSSA - 5%, CONS - 10 %, Micrococcus - 15
% . The obvious observation is none of the doctors’ cell phones are contaminated. In the present
study, the contamination rate is compared to the controlled group consisting patients, relatives
attending in OPD’s and not working in health care setting.
Introduction:
Hospital infections pose problem of increased mortality and morbidity in patients. The hands of
the health care workers act as an important role in transmission of hospital infections. For more
than one decade cell phones have become an accessory in day to day life and they have become
a part of life. The cell phones of health care workers act as a source of hospital infections. In this
connection, it is imperative to study about the contamination of the cell phones which act as a
vehicle of transmission of hospital infections.
The causative agents of hospital infections have found a significant way to spread
infection in the hospital environment. The present study is aimed at investigating the rate of
bacterial contamination of the cell phones of the health care workers in KIMS, Amalapuram. In
the present study the contamination rate is compared to the controlled group consisting
patients, relatives attending in OPD’s and not working in health care setting.
Materials and Methods:
Random sampling of 100 cell phones from HCWs working in KIMS hospital from July
2011 to December 2011 was carried out. Samples were collected from OPD’s, in patients wards,
ICU, Burns ward and Laboratories. A sterile wet swab moistened with sterile demineralised
water is used for collecting the sample from the sides of the cell phone and key pad of the cell
phone. The swabs were inoculated and streaked on 5 % Sheep blood agar and MacConkey agar
(Hi Media, India). The culture plates were aerobically incubated at 370 C for 24 hrs. Isolated
organisms were processed according to the colony morphology and Grams stain. The isolates
were identified according to the Standard protocol. Tests for identification of Gram positive
cocci included catalase, Oxidative/ Fermentative test, aerobic mannitol fermentation and
coagulase production, Oxacillin sensitivity of Staphylococcus aureus was carried out by using
Oxacillin disk diffusion test.
Out of 100 HCWs, Doctors - 25, Nurses - 25, Laboratory Technicians - 25, House Keeping - 25.
Area wise distribution of sample is as follows
OPD’s : Pediatrics-2, Obg & Gyn-3, Medicine-2, Dermatology-2, Pulmonary medicine-2, Surgery3, ENT-2, Dental-2, Orthopedics-3, Ophthalmology-1, Causality-2, ICU-1.
Wards : Pediatrics-2, Labor room-2, Medicine-3, Gynaecology-4, Blood bank-2, Surgery-2, ENT-2,
Dental-2, Orthopedics-2, Ophthalmology-1, Burns ward-2, ICU-1.
Laboratories: 25 from laboratories (Microbiology, Pathology, Biochemistry, Radiology, Blood
Bank) Biochemistry-5, Microbiology-6, Pathology-9, Radiology-2, Blood Bank-3.
House Keeping - 25
In the present study, the contamination rate is compared to the controlled group consisting
patients, relatives attending in OPD’s and not working in health care setting.
Results:
Bacteriological analysis: Out of 100 samples 50 (50%) were contaminated with bacteria. Out of
50 isolates from cell phones the following bacteria were isolated
Methicillin resistant Staphylococci (MRSA) - 20%.
Methicillin Sensitive Staphylococci (MSSA) - 5%.
Coagulase Negative staphylococci (CONS) 10%
Micrococcus - 15 %.
From the above observations, it is clear that 25 % of the cell phones are contaminated
with hospital associated infections that is Staphylococcus aureus. .
The pathogen staphylococcus aureus isolated from cell phones of Doctors is nil. Nurses18, Laboratory workers-7, House keeping-10.
Area wise distribution of MRSA shows: 8 from HCW working in OPDs, 6 from Laboratories, 5
from wards, 1 from causality.
Controls of 50 samples were taken. Out of 50 control samples, 1 swab from control
group showed isolation of Coagulase negative staphylococci. Remaining were sterile. From the
above observations it is obvious that Gram negative bacteria and Enterococcus bacteria were
not isolated in any of the cell phones and it is found that the hands of HCWs at KIMS hospital
setting and the cell phones used by HCWs are colonized with Staphylococci.
Khivsara et al. reported 40% contamination of mobile phones by Staphylococcus and MRSA from
HCWs working in a Mangalore Hospital. In a similar study from Turkey hospital, only 9% of
mobile phones sampled showed contamination by bacteria associated with nosocomial
infections. Similarly, Brady et al. said 14 % of mobile phones showed growth of bacteria known
to cause nosocomial infection. Comparing these studies with our study, a higher percentage
(50%) of Cell phones sampled was contaminated and 20% HCWs had MRSA growing on their Cell
phones.
DISCUSSION
The above study reveals cell phones as potential threat in infection control practices and
causes health care associated infections. Cell phones carried these bacteria because count of
these bacteria increase in high temperatures and our cell phones are ideal breeding sites for
these microbes as they are kept in warm in our pockets and hand bags. There are no guidelines
for the care, cleaning and restriction of cell phones in our health care system.
So in a country like India, cell phones of HCWs play an important role in transmission of
infections to patients which can increase the burden of health care.
CONCLUSION
In conclusion, it can be said that hand hygiene is overlooked and is under emphasized in
health care settings. Simple measures like increasing hand hygiene and regular decontamination
of cell phones with alcohols, disinfectant wipes may reduce the risk of cross contamination by
these devices.
References
1. Brady RR, Fraser SF, Dunlop MG, Paterson - Brown S, Gibb AP. Bacterial contamination
of mobile communication devices in the operative environment. J Hosp Infect 2007;
66:397-8.
2. Clinical Laboratory Standards Institute, Performance standard for antimicrobial disk
susceptibility tests; Approved standards, 2005, vol.25, 8th edn, M02-A8.
3. Brady RR, Wasson A, Stirling I, McAllister C, Damani NN. Is your phone bugged? The
incidence of bacteria known to cause nosocomial infection on healthcare worker’s
mobile phones. J Hosp Infect 2006;62:123-5
4. Karabay O, Kocoglu E, Tahtaci M. The role of mobile phones in the spread of bacteria
associated with nosocomial infections. J infect Developing countries 2007; 1:72-3.
5. Khivsara A, Sushma T, Dhanashree B. Typing of Staphylococcus aureus from mobile
phones and clinical samples. Curr Sci 2006;90:910-2.
6. Gupta V, Datta P, Singla N. Skin and soft tissue infection : Frequency of aerobic bacterial
isolates and their antimicrobial susceptibility pattern. J Assoc Physicians Indians India
2008;56:389-90.
7. Jeske HC, Tiefenthaler W, Hohlrieder M, Hinterberger G, Benzwer A. Bacterial
contamination of anesthetist’s hands by personal mobile phone use in the operation
theater. Anesthesia 2007;62:904-6.
IDENTIFICATION OF UROVIRULENT MARKERS IN UROPATHOGENIC E.COLI
* N. Padmaja, Anandacharya, P.N.Rao.
Abstract: The present study was conducted in the Department of Microbiology, KIMS,
Amalapuram, East Godavari District from August 2011 to January 2012. 50 E.coli strains isolated
from urine samples of different clinical entities and 25 feacal isolates were studied for the
detection of virulence markers of E.coli. There are 27 UPEC isolates from 50 E.coli & 5 UPEC
from 25 controls. Among isolates tested the most common virulent marker is haemolysin 21
(42%), followed by Mannose resistant haemagglutination 16 (32%), cell surface hydrophobicity
13 (26%). In this, there are 14 cases with only one virulence marker, 8 with 2 marker
combinations and 15 cases with combination of 3 markers.
Introduction:
UTI is one of the most important causes of morbidity and mortality. E.coli is the most frequent
urinary pathogen isolated from 50 % - 90 % of all uncomplicated urinary tract infections. It is
now recognized that there are subsets of faecal E.coli, which can colonize periurethral area,
enter urinary tract and cause symptomatic diseases. These are currently defined as
Uropathogenic E.coli. It has been traditionally described that certain serotypes of E.coli were
consistently associated with uropathogenicity and were designated as uropathogenic E.coli.
These isolates express chromosomally encoded virulence markers. The virulence factors include
different adhesins, haemolysin production, haemagglutination, cell surface hydrophobicity. The
present study was designated to determine the urovirulence factors of E.coli isolated from the
patients of UTI and to study their antimicrobial susceptibility pattern.
Materials and Methods:
The study was conducted in the Department of Microbiology, KIMS, Amalapuram, East
Godawari from August 2011 to January 2012. 50 E.coli strains isolated from urine samples & 25
faecal isolates were studied for 1. α Haemolysin on 5% sheep blood agar. 2. Mannose Resistant
Haemagglutination. 3. Cell surface hydrophobicity. 4. Antibiotic susceptibility testing by Kirby Bauyer disc diffusion method.
Inclusion criteria: Adult patients with UTI attending various clinical departments of KIMS and
adult healthy individuals for stool samples are taken.
Samples: 1. Clean catch midstream urine samples from the patients (50). 2. Stool samples of
adult healthy individuals (25)
Collection and Culture of sample: Sample is transported to Microbiology lab with in half an hour
and processed by 1. Wet film preparation. 2.Culturing on Mac Conkey, Blood agar & CLED agar
medium & incubated aerobically at 370 C for 24 hrs. 3. Growth on plates and significant bacterial
count. i.e. 105 col / ml and tested for further identification of E.coli by various biochemical
reactions. Such E.coli were screened for virulence markers.
Haemolysin: For detecting haemolysin, 5% sheep B.A is used and a zone of lysis around each
colony is observed after overnight incubation at 370C, if haemolysin is produced.
Haemagglutination: HA is detected by clumping of erythrocytes by bacterial fimbriae in the
presence of D-Mannose. The test was carried out as per the direct bacterial HA test slide
method and mannose sensitive and resistant HA tests. HA was considered when it occurred in
the presence of 2 % D- Mannose and Mannose sensitive, when it was inhibited by D-Mannose.
Cell surface hydrophobicity: This was done by Salt Aggregation test. Strains are considered
hydrophobic, if they are aggregated in concentration of < 1.4 M. Ammonium sulphate.
Antibiotic susceptibility testing: This was performed on all isolates of E.coli by Kirby-bauyer`s
disc diffusion method on Muller hinton agar.
Results:
Of the 50 patients, 0 - 15 age group comprised of 11 persons, 16 - 40 age group comprised
of 18 persons and > 40 years group comprised of 21 persons. Females (30) are more than
male (20) patients. Among various clinical entities, 30 cases presented with lower UTI (60%),
14 cases with asymptomatic bacteriuria (28%) and 6 with pyelonephrities (12%).
Among 50 cases tested 27 (54%) were positive for virulence markers and out of 25 controls,
5 (20%) were positive for virulence markers. Among the isolates tested, the most common
virulent marker is haemolysin 21 (42%) followed by Mannose resistant Haemagglutination
16 (32%) and Cell surface hydrophobicity 13 (26%). In control group, the occurrence of
haemolysin was 1 (20%), MRHA 3 (60%), CSH 1 (20%). (Note: Percentage calculated as per
total 50 isolates). There are 14 cases positive for 1 marker, 8 cases positive for 2 markers
and 5 cases positive for 3 markers.
Table showing No. of positive virulence markers - Table I
Composition
No. of Tested
Positive virulence markers
%
Cases
50
27
54%
Control
25
5
20%
Antibiotic Sensitivity Test: Table II
S.No.
1
Drug
Amikacin
Sensitivity
%
Resistant
%
41
82%
6
12%
2
Nitrofurantoin
39
78%
11
22%
3
Cefotaxime
36
72%
14
28%
4
Cephalexin
26
52%
21
48%
5
Co-trimoxazole
23
46%
17
54%
6
Cefuroxime
16
16%
34
68%
7
Ampicillin
13
26%
37
74%
8
Norfloxacin
10
20%
40
80%
41% isolates were sensitive to Amikacin, 78% to Nitrofurantion, 72% sensitive to Cefotaxime,
52% sensitive to Cephalexin, 46% sensitive to Co-trimoxazole. High resistance is seen for
Norfloxacin 80% followed by Ampicillin 73%, Cefuroxime 68%. (Note : Percentage drug
sensitivity and resistance pattern calculated for total number of 50 strains isolated).
Discussion:
The present study was undertaken to study the virulence factors namely haemolysin production,
MRHA and CSH. 50 E.coli isolates from urine of cases with clinically diagnosed UTI are taken as
study group and 25 E.coli from faeces of healthy persons as control group. Most of the cases of
UTI are from above 40 years age group (21), followed by 16-40 years(18) and 0-15 years (11).
The high incidence of UTI was observed above 40 years age group followed by 16-40 years age
group. This is because, the elderly patients are likely to be predisposed to conditions like 1.
Urinary tract obstruction. 2.Poor bladder emptying 3. Diabetes 4. Prostate enlargement. These
factors favour colonization of bacteria and play an important role in UTI.
High incidence of UTI is observed in females (30) than males (20), which is due to 1.
short urethra. 2. close proximity of urethra to perianal region.
Regarding AST, most of the isolates are sensitive to Amikacin (82%) and Nitrofurantoin
(78%). Where as most of the isolates are resistant to Norflox, Ampicillin, Cefuroxime and
Cephalexin. This shows that Aminoglycosides and Nitrofurantoin are useful for most of UTI and
high level of resistance indicates the lack of rational drug use.
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