Dasgupta Chandrika, Rafi Md Abdur, Salam Md Abdus
Chandrika Dasgupta, MBBS. Intern Doctor, Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh. Shaheed Ziaur Rahman Medical College, Bogura, Bangladesh.
Md. Abdur Rafi, MBBS. Intern Doctor, Rajshahi Medical College Hospital, Rajshahi, Bangladesh.
Pak J Med Sci. 2020 Sep-Oct;36(6):1297-1302. doi: 10.12669/pjms.36.6.2943.
Urinary tract infections due to multi drug resistant bacteria have been on the rise globally with serious implications for public health. The objective of this study was to explore the prevalence of multi drug resistant uropathogens and to correlate the urinary tract infections with some demographic and clinical characteristics of patients admitted in a tertiary care hospital in Bangladesh.
A cross sectional prospective study was conducted at Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh among clinically suspected urinary tract infection patients from January to December, 2018. Clean-catch midstream or catheter-catch urine samples were subjected to bacteriological culture using chromogenic agar media. Antimicrobial susceptibility testing of the isolates was done by Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. Descriptive statistical methods were used for data analysis.
Culture yielded a total of 537 (42.8%) significant bacterial growths including 420 (78.2%) multi drug resistant uropathogens from 1255 urine samples. was the most common isolate (61.6%) followed by . (22.5%), . (7.8%), (5.4%) and . (2.6%) with multi drug resistance frequency of 77.6%, 71.9%, 90.5%, 86.2% and 92.9% respectively. There was female preponderance (M:F; 1:1.97; P=0.007) but insignificant differences between paediatric and adult population (43.65% vs. 42.57%) and also among different age groups. Diabetes, chronic renal failure, fever and supra-pubic pain had significant association as co-morbidities and presentations of urinary tract infections (P<0.05). Multi drug resistance ranged from 3.7 to 88.1% including moderate to high resistance found against commonly used antibiotics like ciprofloxacin, cephalosporin, azithromycin, aztreonam, cotrimoxazole and nalidixic acid (28.6 to 92.9%). Isolates showed 2.4 to 32.2% resistance to nitrofurantoin, amikacin, netilmicin and carbapenems except . (66.7% resistance to nitrofurantoin) and . (28.6 to 42.9% resistance to carbapenems).
There is very high prevalence of multi drug resistant uropathogens among hospitalized patients and emergence of carbapenem resistance is an alarming situation. Antibiotic stewardship program is highly recommended for hospitals to combat antimicrobial resistance.
全球范围内，多重耐药菌引起的尿路感染呈上升趋势，对公众健康造成严重影响。本研究的目的是探讨多重耐药尿路病原体的流行情况，并将尿路感染与孟加拉国一家三级护理医院收治患者的一些人口统计学和临床特征相关联。
2018年1月至12月，在孟加拉国博古拉的谢赫·齐亚乌尔·拉赫曼医学院医院，对临床疑似尿路感染患者进行了一项横断面前瞻性研究。采用显色琼脂培养基对清洁中段尿或导尿采集的尿液样本进行细菌培养。按照临床和实验室标准协会的指南，采用 Kirby-Bauer 纸片扩散法对分离株进行药敏试验。采用描述性统计方法进行数据分析。
从1255份尿液样本中培养出537株（42.8%）有意义的细菌生长，其中包括420株（78.2%）多重耐药尿路病原体。 是最常见的分离株（61.6%），其次是 。（22.5%）， 。（7.8%）， （5.4%）和 。（2.6%），多重耐药频率分别为77.6%、71.9%、90.5%、86.2%和92.9%。女性占优势（男：女；1：1.97；P = 0.007），但儿童和成人人群之间（43.65%对42.57%）以及不同年龄组之间差异不显著。糖尿病、慢性肾衰竭、发热和耻骨上疼痛作为尿路感染的合并症和表现有显著关联（P<0.05）。多重耐药率在3.7%至88.1%之间，包括对常用抗生素如环丙沙星、头孢菌素、阿奇霉素、氨曲南、复方新诺明和萘啶酸的中度至高度耐药（28.6%至92.9%）。分离株对呋喃妥因、阿米卡星、奈替米星和碳青霉烯类药物的耐药率为2.4%至32.2%，但 。（对呋喃妥因耐药率为66.7%）和 。（对碳青霉烯类药物耐药率为28.6%至42.9%）除外。
住院患者中多重耐药尿路病原体的患病率非常高，碳青霉烯类耐药的出现是一个令人担忧的情况。强烈建议医院开展抗生素管理计划以对抗抗菌药物耐药性。
