MOLECULAR INSIGHTS INTO UNCOMPLICATED UTI FROMCOMMUNITY SETTINGS

Background and Aim : Urinary tract infection (UTI) is one of the most common bacterialinfections in clinical practice worldwide in both community and healthcare settings, that causesignificant morbidity and mortality. Approximately ۱۵۰ million people are diagnosed with UTIevery year, costing in excess of ۶ billion dollars, worldwide. Escherichia coli and Klebsiella spp.are the two clinically relevant organisms accounting for ۷۵%-۹۰% of uncomplicated andcomplicated UTI. The distribution and susceptibility pattern of uropathogens may vary accordingto time, place and underlying condition. Routine urine culture testing is recommended prior toinitiation of treatment. Today, Antimicrobial Resistance (AMR) is a major threat to human healthand belongs to the priorities of World Health Organization. Widespread use of antibiotics withoutantibiotic susceptibility testing is a major reason for this. Uncomplicated UTI is one of the commonconditions at the community level treated empirically and regarded as a potential cause for theemergence of AMR. The increasing dissemination of Extended Spectrum β- Lactamases (ESBLs)producing uropathogens in the community renders clinical treatment difficult. Limited informationis available regarding community-acquired UTI from rural areas.Methods : We conducted a prospective multicentric-cross-sectional study at the community leveltargeting patients attending the Out Patients Department (OPD) of the rural health centers fromfour geographical regions (North, South, West and East) of India to determine the epidemiology,antibiogram profile, and identification of ESBL producers.Results : Total of ۳۹۷ out of ۵۲۹۷ (۷.۵%) urine samples from clinically suspected UTI patientswere found positive causing significant bacteriuria ( Adults:Paediatrics ۷.۹:۱, Male:Female ۱:۱.۸).Diabetes melitus was observed as the commonest risk factor followed by renal stone.Approximately ۷۹.۱% of total cases were caused by E.coli (۶۴%) and K. pneumoniae (۱۵.۱%) anduniformly predominated in all the geographical regions.Conclusion : This is alarming data from a large-scale nationwide community study indicating theincreasing prevalence of ESBL-producing and carbapenem-resistant E.coli isolates in thecommunity. This study outlines the UPEC isolates harbouring multidrug-resistant genes alongwith the high-risk clones. There is a high prevalence of virulence markers and resistance genesamong these isolates from both symptomatic and asymptomatic bacteriuria patients. Hence,regular AMR surveillance with judicious usage of antibiotics, and policy restriction is highlyessential to formulate the guidelines, especially in developing countries. Strict infection controlmeasures and regular surveillance is required to limit its spread in the community; therebypreventing the imminent threat of an epidemic of antimicrobial resistance in future.

کلیدواژه ها:

Urinary tract infection ، Escherichia coli ، Antimicrobial resistance