Frequency of bacterial isolates and antimicrobial sensitivity pattern in urogenital fistulae: An eight years audit

Abstract

Objective: To determine the frequency of urinary tract infection, distribution of microorganisms and their antimicrobial susceptibility pattern in urogenital fistula patients. Place and duration of study: Eight years (April 2007–June 2015) at Mother And Child Health Centre, Shaheed Zulfiqar Ali Bhutto Medical University–Pakistan Institute of Medical Sciences (SZABMU–PIMS), Islamabad, a regional fistula center. Study design: Descriptive study. Patients and methods: All fistula patients entertained in MCH Center PIMS from April 2007 to June 2015 underwent detailed evaluation workup including baseline investigations. The specimen of urine was taken in sterile culture bottle and sent to a laboratory for biological evaluation. The data of all the patients was prospectively maintained from 2007–2015 and was analyzed using the statistical package for social sciences (SPSS) version 21. The main outcome measures included the frequency of urinary tract infection, distribution of bacterial isolates, and their susceptibility to antibiotics. Results: During the study period 407 patients presented with urogenital fistula. The majority, n = 322, 79.1%, patients were of the reproductive age, i.e., below 40 years. The majority n = 342, 84% were Illiterate and n = 383, 94% were housewives. The culture result was available in 259 (64%). Of these bacterial isolates were found in 169 (65.2%) patients, Candida species in 8 (3%) patients while no organisms were found in remaining patients. Of 169 bacterial isolates, gram-negative isolates were found in 160 (94%) patients followed by gram-positive isolates in 6 (3.5%) and both, gram positive and gram negative isolates in 3 (2%) patients. Klebseilla and E.coli was the most frequently occurring organisms (33% and 29%, respectively) followed by Pseudomonas. The highest sensitivity of bacterial isolates was found for Amikacin, imipenem, piperacillin, and tazobactam. The highest resistance was seen for amoxicillin + clavulanic acid, third generation antibiotics, quinolones, and nalidixic acid. Conclusion: Urinary tract infection is prevalent among urogenital fistula patients. The resistance to most commonly prescribed low-cost oral antibiotics highlight the importance of prescribing antibiotics according to culture and sensitivity pattern and avoidance of injudicious use of antibiotics in fistula patients.