Because of the high prevalence of infection in the community and hospital setting, urinary tract infections have imposed a significant financial burden on the health system . Effective treatment of patients with bacterial urinary tract infections is often dependent on pathogen identification and antibiotic selection based on ongoing surveillance of the antimicrobial susceptibility pattern of urinary tract pathogens in specific regions . The current study’s findings provide light on antimicrobial resistance patterns in Bangladesh, a country with sparse antimicrobial resistance surveillance data.
In this study, most of the uropathogens were isolated from female patients. Several predisposing factors might contribute to the higher prevalence of UTIs among women . It is well recognized that UTI is more prevalent in female than in male, and our data corroborate this generalization and correspond with a previous study conducted by Deshpande et al. . Similarly, our observation on the prevalence of uropathogens is consistent with other prior reports . We found that women of reproductive age are most susceptible group for UTI. Vaginal colonization with pathogens, and sexual activity are identified as risk factors of UTI in women of this age group in previous studies[7, 8] Besides, prevalence of UTI was also high in post-menopausal women. This phenomenon might be a result of genito-urinary atrophy and vaginal prolapse after menopause that alters the vaginal pH, decreasing the normal vaginal flora. This condition allows for Gram-negative bacteria to grow as uropathogens .
Antibiotic resistance is a major concern when it comes to common bacterial infections, including UTI. Antimicrobial drugs such as amoxicillin, cotrimoxazole, cephradin, nalidixic acid, ciprofloxacin, and azithromycin are still used in many underdeveloped and developing countries, including Bangladesh, to treat a variety of gram-positive and gram-negative bacterial infections, including UTI. Unfortunately, all of these drugs were shown to have an unacceptable spectrum of antibacterial activity against uropathogens identified in our research. This outcome is concerning in terms of the availability of effective therapeutic options in the treatment of UTI and should be of major concern to treating physicians. Ciprofloxacin was originally thought to be the treatment of choice for both uncomplicated and complicated UTI, however owing to a lack of sensible usage, this broad-spectrum drug has completely lost its efficacy not just in UTI but also in other frequent infections. A similar image may be seen with first, second, and third generation cephalosporins. It is possible to hypothesize that a few cases of extended spectrum beta-lactamase (ESBL)-producing uropathogens, particularly Gram-negative isolates, that could not be isolated in the current analysis due to limitations are considered to be responsible for resistance to a variety generation of cephalosporin.
E. coli demonstrated the greatest multidrug resistance among the identified uropathogens, with more than 70% of the isolates resistant to more than five antibiotic classes tested. This is comparable to a research done in a tertiary hospital in Pakistan .
Nitrofurantoin was shown to be a relatively effective agent among all antimicrobials used to treat practically all uropathogens in the current setting, and similar findings have been reported in other investigations [21, 23].
This is really reason for optimism, especially for uncomplicated UTI and prophylaxis, given the continuously declining susceptibility of most of the considerably less expensive oral anti-UTI medications. As a result, nitrofurantoin can be considered as a first-line, cost-effective, and cost-effective oral treatment in UTI.
There was a considerable reduction in sensitivity pattern for imipenem, ceftriaxone, and amoxiclav in the years 2021, 2016, and 2011, presumably due to random usage of these antibiotics in the previous few years with inadequate dosage and duration. Antibiotic resistance in uropathogens has now become a public health problem in Bangladesh .
This steep increases in antibiotic resistance might be attributable to the irrational use of antibiotics for the treatment of various diseases without culture sensitivity test .This perilous state is the major cause of MDR infection in urinary tract infections. The resistance to cotrimoxazole was > 60% in all isolated Gram-negative organisms. Cotrimoxazole is the first-line empirical antibiotic recommended by the European Urology Association and the Infectious Disease Society of America (IDSA) for the treatment of uncomplicated community-acquired urinary tract infections (UTIs) where locally reported resistance percentages against uropathogens range from 10 to 20% . Regrettably, our study found the highest resistance rates to cotrimoxazole. This development in resistance may be a result of indiscriminate antibiotic usage and the medicines’ availability without a physician’s prescription.
Pseudomonas spp. is the most well-known gram-negative isolate responsible for hospital-acquired urinary tract infections, and traditional antimicrobials are typically ineffective against Pseudomonas infections. While nitrofurantoin has a high susceptibility to Pseudomonas UTI, it is only advised for uncomplicated UTI or prophylaxis. Although important antibiotics such as carbapenems are being used to treat Pseudomonas infections, we propose that their usage be limited to exceptional cases in order to retain their long-term efficacy.
Overall, UTI with E. coli was significantly increased in the year 2021. This study showed a steady increase in resistance to all studied antibiotics. Imipenem, meropenem, tazobactam, amikacin and nitrofurantoin are increasing their sensitivity pattern in this study. Comparative study of 2021, 2016 and 2011 shows significant resistance to different classes of antibiotics has been significantly increased over time in the study patients, especially in carbapenem and aminoglycoside group. Resistance to both imipenem and meropenem was almost 4% in 2021 while it was almost nil in previous years. Similar trend was observed in case of amikacin, gentamycin, amoxiclav and nitrofurantoin.
According to this Infectious Diseases Society of America (IDSA) guideline, the majority of antibiotics used in our study should not be administered empirically for acute UTI, and our current standard treatment guidelines for UTI are inadequate, requiring a large-scale investigation.