Antibiotic susceptibility patterns of community and hospital acquired urinary isolates of Escherichia coli

Background: Escherichia coli accounts for majority of community and hospital acquired urinary tract infections in many parts of the world. It has developed resistance against antimicrobial agents and it is necessary to have up to date knowledge of drug resistance pattern for treatment of UTIs caused by this organism. Objective: To determine and compare antimicrobial susceptibility patterns of urinary. E.coli isolated from patients with community and hospital acquired UTIs in Makkah Saudi Arabia. Materials and Methods: This prospective descriptive study was performed for a period of three months. A total of 92 Escherichia coli isolated from urine samples were collected from four hospitals of Makkah. The clinical and demographic information of the patients was collected using a predesigned questionnaire. Isolates were confirmed by using bacteriological methods and API 20E kits. All E.coli strains were subjected to in vitro susceptibility testing using Kirby Bauer disk diffusion method as described in CLSI guidelines. Results: The study was performed in patients of all age groups and both the genders. Majority of the patients were in age group1-10 years and 21-30 years in community acquired infections and1-10 years followed by 21-30 years and 70-80 years in hospital acquired infections. A predominance of female patients (73%) compared to male patients (27%) was seen. Majority of the urinary tract infections were community acquired (55%) compared to hospital acquired (45).Over all antibiotic resistance data of 92 isolates showed low to high resistance to all drugs tested (2.17-100%). The highest resistance was exhibited by ampicillin (100%) followed by cephalothin (65.2%) and trimethoprim/sulphamethoxazole (64.1%). The rates of drug resistance for other antibiotics were: cefuroxime 36.9%, norfloxan29.3%, levofloxacin 28.2%, ceftazidime 18.4 %, amoxicillin/clavulanic acid 14.1%and cefoxitin 11.9%. Among all antibiotics tested imipenem showed lowest resistance (2.17%). In summary, highest resistance was seen against ampicillin followed by cephalothin and trimethoprim/sulphamethoxazole and least resistance was shown against imepenim. Moreover, higher resistance was seen in hospital acquired infections compared tocommunity acquired infections. Very high level of MDR was also seen (60%) among isolates from all the hospitals. Conclusion: This study showed low to high drug resistance of E.coli isolates from various hospitals of Makkah. Alarming rates of MDR among community acquired as well as nosocomial isolates call for continuous periodic monitoring in Makkah region to know the developing resistance pattern which, will help in deciding the most adequate therapy for E.coli urinary tract infections.