Mohapatra Sarita, Panigrahy Rajashree, Tak Vibhor, J V Shwetha, K C Sneha, Chaudhuri Susmita, Pundir Swati, Kocher Deepak, Gautam Hitender, Sood Seema, Das Bimal Kumar, Kapil Arti, Hari Pankaj, Kumar Arvind, Kumari Rajesh, Kalaivani Mani, R Ambica, Salve Harshal Ramesh, Malhotra Sumit, Kant Shashi
Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Department of Microbiology, SUM Hospital, Bhubaneswar, India.
Access Microbiol. 2022 Feb 9;4(2):000321. doi: 10.1099/acmi.0.000321. eCollection 2022.
Urinary tract infection (UTI) is one of the most common infections in clinical practice worldwide in both healthcare and community settings causing significant morbidity and mortality. It is one of the major conditions at the community level treated empirically and regarded as a potential cause of emergence of antimicrobial resistance (AMR). Limited information is available regarding community-acquired UTI (CA-UTI) from India.
This is a first of its kind, multicentric-cross-sectional study at the community level targeting patients attending the out-patient department (OPD) of the community health centre (CHC) from four geographical regions (North, South, West and East) of India. The study had been designed to determine the epidemiology, antibiogram profile and identification of extended-spectrum beta-lactamase (ESBL) producer and carbapenem resistant (CR) uropathogens. Samples were collected prospectively from UTI suspected patients coming at CHC and processed at the tertiary healthcare centres using a common standard operating procedure. Clinical history of all the patients exhibiting significant bacteriuria was collected and data was analysed.
Overall, 250 out of a total of 2459 (10.1 %) urine samples were positive for bacteria with significant bacteriuria (adult: paediatrics, 6.7 : 1). Females were predominantly affected (male: female, 1 : 2.9). History of recent episode of UTI was observed as the commonest risk factor followed by diabetes mellitus. Altogether, 86 % of total cases were caused by (68 %) and (17.6 %) together. Among the commonly used oral antibiotics for the Gram-negative bacilli (GNB), the highest resistance was observed against beta-lactams, first- and second-generation cephalosporins, fluoroquinolones and co-trimoxazole. Overall, the prevalence of ESBL producer and CR isolates were 44.8, and 4.3 %, respectively. However, the ESBL production, CR and nitrofurantoin resistance among the uropathogenic (UPEC) isolates was 52.8, 5.1 and 14 %, respectively. No resistance was found against fosfomycin among the UPEC isolates.
The current study highlights the increasing incidence of AMR among uropathogens at the community-settings of India. A significant percentage of ESBL producers among the isolated UPEC and were observed. The currently available evidence supports the clinical recommendation of fosfomycin and nitrofurantoin for empiric therapy in CA-UTI in India.
尿路感染（UTI）是全球临床实践中最常见的感染之一，在医疗保健和社区环境中均会导致显著的发病率和死亡率。它是社区层面主要的凭经验治疗的疾病之一，被视为抗菌药物耐药性（AMR）出现的潜在原因。关于印度社区获得性尿路感染（CA-UTI）的信息有限。
这是一项在社区层面开展的同类研究中的首例多中心横断面研究，针对来自印度四个地理区域（北部、南部、西部和东部）社区卫生中心（CHC）门诊（OPD）的患者。该研究旨在确定流行病学、抗菌谱以及超广谱β-内酰胺酶（ESBL）产生菌和耐碳青霉烯类（CR）尿路病原体的鉴定。前瞻性地从到CHC就诊的疑似UTI患者中采集样本，并在三级医疗中心按照通用标准操作程序进行处理。收集所有出现显著菌尿的患者的临床病史并进行数据分析。
总体而言，在总共2459份尿液样本中，有250份（10.1%）细菌培养结果为显著菌尿阳性（成人：儿童，6.7∶1）。女性受影响更为显著（男性：女性，1∶2.9）。近期UTI发作史是最常见的危险因素，其次是糖尿病。总共86%的病例由大肠埃希菌（68%）和肺炎克雷伯菌（17.6%）共同引起。在针对革兰氏阴性杆菌（GNB）常用的口服抗生素中，对β-内酰胺类、第一代和第二代头孢菌素、氟喹诺酮类和复方新诺明的耐药性最高。总体而言，ESBL产生菌和CR分离株的患病率分别为44.8%和4.3%。然而，尿路致病性大肠埃希菌（UPEC）分离株中的ESBL产生率、CR和呋喃妥因耐药率分别为52.8%、5.1%和14%。在UPEC分离株中未发现对磷霉素的耐药性。
当前研究突出了印度社区环境中尿路病原体AMR发生率的上升。在分离出的UPEC和肺炎克雷伯菌中观察到相当比例的ESBL产生菌。目前可得的证据支持在印度将磷霉素和呋喃妥因作为CA-UTI经验性治疗的临床推荐用药。
