MOJ Biology and Medicine

Research Article Open Access

Prevalence of symptomatic urinary tract infections

and antimicrobial susceptibility patterns of isolated
uropathogens in kohat region of Pakistan
Abstract Volume 3 Issue 3 - 2018

Urinary tract infections are commonly distributed infectious diseases. This study
Anwar Ullah,1 Syed Rafiq Hussain Shah,1
is designed to determine the prevalence of symptomatic UTIs and antimicrobial
susceptibility patterns of uropathogens to commonly use antibiotics. A total of 500
Babiker Saad Almugadam,2 Shahida Sadiqui1
1
Department of Microbiology, Faculty of Health Sciences, Hazara
patients, age ranges 20-90years were included in this study that conducted in Kohat
University, Mansehra, Pakistan
Teaching Hospital of Kohat District, Khyber Pakhtunkhwa, Pakistan. Midstream 2
Department of Microbiology, Faculty of Medical Laboratory
urine samples were collected from patients of both genders. All samples were Sciences, University of El Imam El Mahdi, Kosti city, Sudan
cultured aerobically in Blood agar, MaCconkey agar and CLED medium (Oxoid). The
identification of isolated bacteria were performed using manual biochemical tests. Correspondence: Anwar Ullah, Department of Microbiology,
All uropathogenic isolates were subjected to antimicrobial susceptibility testing. The Faculty of Health Sciences, Hazara university, Mansehra, Pakistan,
prevalence of UTIs were 11.6%. The frequency of UTIs was 8.9% in males and 13.8% Tel +923015709168, Email [email protected]
in females. Out of total positive cultures, 20.7% (12/58) were Gram positive bacteria
and 79.3(46/58) were Gram negative bacteria. The commonly isolated pathogens are Received: June 17, 2018 | Published: July 27, 2018
Escherichia coli 24 (41.4%), Klebsiella pneumoniae 9 (15.5%) and Proteus mirabilis 8
(13.8%). Most lactose fermenter Gram-ve bacteria were sensitive to Cefepime and all
Gram positive isolates were sensitive to Meropenem. In this study, it was concluded
that there is marked variation in the prevalence of UTIs (between males and females)
and antibiotics susceptibility patterns of uropathogens. Meropenem is appropriate
antibiotics to treated UTIs causes by Gram positive bacteria. These data demonstrate
that future studies should be focused on the causes of antibiotics resistance to solve
this problem.

Keywords: antimicrobial, Pakistan, prevalence, urinary tract infection, uropathogen

Introduction (MDR) bacteria is has been exaggerated over the time due to increase
use of antibiotics in many sectors such as agricultural, medical and
Urinary tract infection (UTI) is a one of the most frequent and veterinary.19,20 The main factors which leads to antibiotics resistance
contagious infection. Due to its complexity, it damages various types include the incorrect investigation and drugs abuse.21 In some time the
of delicate organs in the human body such as urethra, ureters and treatments of simple infection can become complicated or impossible
bladder.1 UTIs is more common in females especially in pregnant due to bacterial resistant strains. This study is designed to determine
women as a result of anatomical difference and the decrease level of the prevalence of symptomatic UTIs and antimicrobial sensitivity
urination during pregnancy.2,3 Pregnancy increases bactriuria which patterns of uropathogens in District Kohat of Pakistan.
leads to pyelonephritis and obstetric such as higher fetal mortality
rates, low-birth weight and prematurity.4 It has been estimated that Materials and methods
about 150 million peoples were diagnosed worldwide for the presence
of Gram negative bacteremia which is the significant cause of UTI in Study design, area and duration
all ages specifically in the old age peoples.5 Fifteen to twenty percent This is cross sectional hospital base study carried out from June to
of the urinary tract infection is caused by Gram positive bacteria December 2015 in Kohat Teaching Hospital of Kohat District, Khyber
and about eighty to eighty five percent is caused by Gram negative Pakhtunkhwa, Pakistan.
bacteria. The mechanisms of pathogenesis depend on the causative
agent and its virulence factors.6–9 Study population
Due to multi-drug Resistant microorganisms there have been All patients with symptomatic UTIs, ages ranging 20-90years
great changes occurred in the antimicrobial susceptibility patterns and belonged to District Kohat of Pakistan were fulfill the inclusion
of urinary pathogens.10,11 And due to antibiotic-resistant bacteria, the criteria.
treatment of UTIs become empirical hard so raising the prevalence of
infection.12 In the world, the unusual development and increasing of Sampling
multidrug-resistant in bacterial pathogens is a great health problem A total of 500 midstream urine samples were collected from
which is rising day by day in a growing community.13,14 In worldwide, patients of both genders, those attended Kohat Teaching Hospital with
for the last two or three decades, hospital acquired UTIs are increased the symptoms of UTIs.
due to the emergence of multidrug resistant uropathogens.15–17
According to the geographical location, different antibiotics have
Methodology
different resistance rate and they are directly proportional to the abuse All urine samples were cultured on Blood agar, MaCconkey agar
of antibiotics.18 The increasing appearance of multidrug resistant and CLED medium (Oxoid).22 The significant growth bacteria was

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© 2018 Ullah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which
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Prevalence of symptomatic urinary tract infections and antimicrobial susceptibility patterns of isolated Copyright:
©2018 Ullah et al. 86
uropathogens in kohat region of Pakistan

processed for identification and antibiotics susceptibility testing. The frequency of commonly isolated bacteria
Isolation and identification: Out of total positive cultures, 20.7% (12/58) were Gram positive
bacteria and 79.3(46/58) were Gram negative bacteria. The most
Each specimen was thoroughly mixed by inverting the container prevalent uropathogenic bacteria were Escherichia coli 24 (41.4%),
2-3times and inoculated into culture mediums. The culture plates were Klebsiella pneumoniae 9 (15.5%) and Proteus mirabilis 8 (13.8%),
incubated at 37ºC for 24hours. In case of no growth, further incubation Table 1.
was carried out for additional 24hour. More than 105 colony forming Table 1 Frequency of isolated uropathogens
unit per ml was considering as the significant level of bacteriuria. The
identification of isolates were performed on the base of gram reaction, Number of
Name of bacteria Percentage P value
colonial morphology and biochemical characterization.22 isolates

Antibiotic susceptibility testing: Escherichia coli 24 41.4%(24/58)

The antibiotic susceptibility testing was performed by Kirby Staph. aureus 6 10.34%(6/58)
Bauer’s disc diffusion technique (Bauer et al., 1966) as suggested by
clinical and laboratory standard institute.23 The zone of inhibition was Klebsiella pneumoniae 9 15.5%(9/58)
0.000
calculated and interpreted using the standard chart and the organisms
Proteus mirabilis 8 13.8%(8/58)
were reported as susceptible, intermediate or resistant accordingly.
Different antibiotic discs (Oxoid) were used in this study and these P.aeruginosa 5 8.62%(5/58)
were Ceftriaxone (CRO), Ceftazidime (CAZ), Cefepime (FEP),
Meropenem (MRP), and Ciprofloxacin (CIP). Plus Augmentin (AUG) S. Saprophyticus 6 10.34%(6/58)
and Levofloxacin (LEV), only for Gram-ve bacteria. E. coli ATCC
252395 was used as control strain. Total 58

Ethical statement Antibiotics susceptibility of urinary isolates

This study was undertaken with the approval of Hazara University The emergence of drugs resistance among urinary isolates
and conducted according to the declaration of Helsinki and with to commonly use antibiotics has been observed (Figure 2), and
particular ethical standards of Hazara University. Verbal consent was only cefepime and Meropenem are showed a great value against
taken from each participant. uropathogens. As displayed in Table 2, in our current study the highly
prevalent uropathogenic bacteria E. coli was showed the highest
Data analysis sensitivity (91.7%) to cefepime and lowest sensitivity (12.5%) to
All data were analyzed with SPSS software version 17. Chi ciprofloxacin, similarly the K. pneumoniae showed the highest
squire test was performed and P value less than 0.05 was considered sensitivity (88.9%) to Augmentin and the lowest sensitivity (22.2%)
statistically significant. to ceftazidime. The P. mirabilis was 87.5% sensitive to Meropenem,
while it was showed low sensitivity (12.5%) to cefepime. The
Result highest sensitivity rate which was showed by P. aeruginosa was 80%
against cefepime and the lowest sensitivity rate was 20% (against
Prevalence of UTIs ceftazidime). All S. aureus and S. saprophyticus isolates were
The current study was conducted on 500 patients of different sensitive to Meropenem. Hindered percent of resistant to ceftazidime
gender (Males and females) and their corresponding ratio was 225:275 was observed in S. saprophyticus isolates and same percentage of
(M:F, 45%: 55%), in district Kohat of Pakistan. A total of 58 (11.6%) resistant to ciprofloxacin was detected in S. aureus isolates, Table 3.
urine samples were showed the significance growth of uropathogenic
bacteria. The prevalence of UTIs in males was 8.9%(20/58) and in
females was 13.8% (38/58), See Figure 1.

Figure 1 The prevalence of UTIs in gender.

Figure 2 The susceptibility of urinary pathogens to commonly use antibiotics.

Citation: Ullah A, Shah SRH, Almugadam BS, et al. Prevalence of symptomatic urinary tract infections and antimicrobial susceptibility patterns of isolated
uropathogens in kohat region of Pakistan. MOJ Biol Med. 2018;3(3):85‒89. DOI: 10.15406/mojbm.2018.03.00082
Prevalence of symptomatic urinary tract infections and antimicrobial susceptibility patterns of isolated Copyright:
©2018 Ullah et al. 87
uropathogens in kohat region of Pakistan

Table 2 Antibiotics susceptibility profile of gram negative isolates

Antibiotics Isolate
E. coli K. pneumoniae P. aeruginosa P. mirabilis Total
Sensitive 25% (6/24) 44.4% (4/9) 60% (3/5) 50% (4/8) 37% (17/46)
CRO
Resistant 75% (18/24) 55.6% (5/9) 40% (2/5) 50% (4/8) 63% (29/46)
Sensitive 50% (12/24) 88.9% (8/9) 40% (2/5) 62.5% (5/8) 58.7% (27/46)
AUG
Resistant 50% (12/24) 11.1% (1/9) 60% (3/5) 37.5% (3/8) 41.3% (19/46)
Sensitive 33.3% (8/24) 22.2% (2/9) 20% (1/5) 37.5% (3/8) 30.4% (14/46)
CAZ
Resistant 66.7% (16/24) 77.8% (7/9) 80% (4/5) 62.5% (5/8) 69.6% (32/46)
Sensitive 50% (12/24) 66.7% (6/9) 60% (3/5) 87.5% (7/8) 60.9% (28/46)
MRP
Resistant 50% (12/24) 33.3% (3/9) 40% (2/5) 12.5% (1/8) 39.1% (18/46)
Sensitive 62.5% (15/24) 44.4% (4/9) 60% (3/5) 62.5% (5/8) 58.7% (27/46)
LEV
Resistant 37.5% (9/24) 55.6% (5/9) 40% (2/5) 37.5% (3/8) 41.3% (19/46)
Sensitive 91.7% (22/24) 77.8% (7/9) 80% (4/5) 12.5% (1/8) 73.9% (34/46)
FEP
Resistant 8.3% (2/24) 22.2% (2/9) 20% (1/5) 87.5% (7/8) 26.1% (12/46)
Sensitive 12.5% (3/24) 44.4% (4/9) 40% (2/5) 50% (4/8) 28.3% (13/46)
CIP
Resistant 87.5% (21/24) 55.6% (5/9) 60% (3/5) 50% (4/8) 71.7% (33/46)
Table 3 Antibiotics susceptibility profile of gram positive isolates

Isolate
Antibiotic Susceptibility result
S. saprophyticus S. aureus Total
Sensitive 50% (3/6) 83.3% (5/6) 66.7% (8/12)
CRO
Resistant 50% (3/6) 16.7% (1/6) 33.3% (4/12)
Sensitive 0% (0/6) 50% (3/6) 25% (3/12)
CAZ
Resistant 100% (6/6) 50% (3/6) 75% (9/12)
Sensitive 83.3% (5/6) 50% (3/6) 66.7% (8/12)
FEP
Resistant 16.7% (1/6) 50% (3/6) 33.3% (4/12)
Sensitive 100% (6/6) 100% (6/6) 100% (12/12)
MRP
Resistant 0% (0/6) 0% (0/6) 0% (0/12)
Sensitive 33.3% (2/6) 0% (0/6) 16.7% (2/12)
CIP
Resistant 66.7% (4/6) 100% (6/6) 83.3% (10/12)

Discussion However, all these prevalence are highest than our study result, but
they agreed in the increase of UTIs in females than males that is
Urinary tract infection (UTI) is a one of the most common previously confirmed in many others studies.
infections worldwide and it account for 1–2% of all consultation.24
It has been estimated that more than 6million outpatient visits and Among the total of isolated bacteria, we found the prevalence
300,000 hospital stays every year are due to UTIs. Approximately of Gram positive bacteria and Gram negative bacteria were 20.7%
10% of humans will have a UTI at some time during their lives.25 and 79.3%, respectively. And the most prevalent uropathogenic
bacteria were Escherichia coli (41.4%), Klebsiella pneumoniae
Our study was found the prevalence of UTI is 11.6% among (15.5%), Proteus mirabilis (13.8%), S. saprophyticus (10.34%),
symptomatic patients; and 8.9% in males and 13.8% in females. Staphylococcus aureus (10.34%), and P. aeruginosa (8.62%). These
Similar studies has been conducted in different countries includes results, indicate Gram negative are more commonly implicated in
Mandokhail et al.,26 Prakash D et al.,27 and Patil et al.,28 studies which UTIs in this area of Pakistan. Previously, Prakash D et al., (2013)
reported the prevalence of UTIs were 60.63% , 53.82%, and 49%, study was found the prevalence of Gram negative bacteria (90.32%)
respectively.26–28 Several reports have indicated that the prevalence were higher than Gram positive (9.68%); and the most frequently
of UTIs is more in females than males. John MS et al.,29 reported isolated urinary pathogen is Escherichia coli (42.58%), followed
the rate of culture positivity in females was 91.6% and in males was by Klebsiella pneumoniae (18.71%) and Pseudomonas aeruginosa
40.3%.29 Also Prakash et al.,27 are found the prevalence of UTIs was (12.90%) [27]. Similar results, Also were reported by Patil S et al.,
significantly higher in females (73.57%) than in males (35.14%).27 (2013) study, who found out of the 48 positive culture , 83.3% (40/48)

Citation: Ullah A, Shah SRH, Almugadam BS, et al. Prevalence of symptomatic urinary tract infections and antimicrobial susceptibility patterns of isolated
uropathogens in kohat region of Pakistan. MOJ Biol Med. 2018;3(3):85‒89. DOI: 10.15406/mojbm.2018.03.00082
Prevalence of symptomatic urinary tract infections and antimicrobial susceptibility patterns of isolated Copyright:
©2018 Ullah et al. 88
uropathogens in kohat region of Pakistan

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Citation: Ullah A, Shah SRH, Almugadam BS, et al. Prevalence of symptomatic urinary tract infections and antimicrobial susceptibility patterns of isolated
uropathogens in kohat region of Pakistan. MOJ Biol Med. 2018;3(3):85‒89. DOI: 10.15406/mojbm.2018.03.00082
Prevalence of symptomatic urinary tract infections and antimicrobial susceptibility patterns of isolated Copyright:
©2018 Ullah et al. 89
uropathogens in kohat region of Pakistan

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Citation: Ullah A, Shah SRH, Almugadam BS, et al. Prevalence of symptomatic urinary tract infections and antimicrobial susceptibility patterns of isolated
uropathogens in kohat region of Pakistan. MOJ Biol Med. 2018;3(3):85‒89. DOI: 10.15406/mojbm.2018.03.00082