Antimicrobial Susceptibility Patterns of Uropathogen Isolated In Community Acquired Urinary Tract Infection (UTI) In Government Health Clinics In Klang

Introduction Community acquired UTI is common and a majority of patients are prescribed with antimicrobials. There is little knowledge about antibiotic susceptibility in urine samples from patients with UTI in government health clinics especially in a local setting. Local prevalent strains of uropathogens and it’s susceptible to antimicrobial is important in order to decide the antimicrobial usage. Inappropriate antimicrobial prescription for UTIs likely drives antimicrobial resistance. Hence this study is to see the local prevalent of uropathogen and its susceptibility in order to determine the best empirical treatment option.

Methods This is a retrospective cross sectional study on urinary samples of patients attending government health clinics in Klang, which were sent to Hospital Tengku Ampuan Rahimah (HTAR) for laboratory culture and sensitivity from January 2018 till December 2019. (universal sampling). The results were analysed with descriptive statistics. The Chi-square were applied for categorical variables. P-value < 0.05 is consider significant.

Results and Discussion Urine cultures were analysed in 412 samples • 386 (93.7%) with complete data were used for analysis • The majority of the UTI are caused by Escherichia coli (E.coli) (57%) followed by Klebsiella spp (18%)., Group B Streptococcus (7%), Enterococus (5%), and others (13%) (Chart 1). The common organisms causing UTI for all age groups and gender were E.coli (57.8%) and Klebsiella species (16.6%) which belong to Enterobacteriaceae family (Table 1). It is consistent with similar study from Singapore (3) • Female patients have a higher prevalence of UTI (89.6%) as compared to male (10.4%). The majority of them are age < 60 years old (82.6%). (Table 1). A recent study from UK showed female have higher incidence of UTI (85%) compared with male with median age 54 years. Our study showed that E.coli were susceptible to Nitrofurantoin (96.2%), and Amoxicillin-Clavulanate (85.5%) (Table 2). As for Klebsiella species was susceptible to Trimethoprim Sulfamethoxazole (83.8%), Ciprofloxacin (82.4%), and Amoxicillin-Clavulanate (79.7%) (Table 2). The limitation of this study is the samples were collected in a single centre which may not reflect the general population.

Conclusion Enterobacteriaceae family (E.coli and Klebsiella species) is the common organism causing UTI among patients attending government health clinics. For E.coli, it was susceptible to Nitrofurantoin and AmoxicillinClavulanate. Klebsiella species were susceptible to Trimethoprim Sulfamethoxazole, Ciprofloxacin, and Amoxicillin-Clavulanate. The local prevalence of uropathogen and antimicrobial susceptibility should be updated periodically in order to ensure optimal empirical antibiotic use, and opportunities for improvement of antimicrobial stewardship.