PREVALENCE, DISTRIBUTION AND DETERMINANTS OF ESCHERICHIA COLI RESISTANCE TO CEFTRIAXONE IN ADULT INDOOR UTI POPULATION OF DISTRICT PESHAWAR, PAKISTAN

Ubed Ullah; Kiran Javed; Muhammad Asim Khan; Imran Ullah; Noor Ul Iman

doi:10.46903/gjms/18.02.869

PREVALENCE, DISTRIBUTION AND DETERMINANTS OF ESCHERICHIA COLI RESISTANCE TO CEFTRIAXONE IN ADULT INDOOR UTI POPULATION OF DISTRICT PESHAWAR, PAKISTAN

Ubed Ullah, Kiran Javed, Muhammad Asim Khan, Imran Ullah, Noor Ul Iman

Abstract

ABSTRACT

Background: Escherichia coliresistance to ceftriaxone in UTIs is an emerging health problem.Our objectives were to determine prevalence, distribution and determinants of E. coliresistance to ceftriaxone in adult indoor UTI population of District Peshawar, Pakistan.

Materials & Methods:This cross-sectional study was conducted in Department of Medicine, Khyber Teaching Hospital, Peshawar, Pakistan from 1^st January 2017 to 30^th June 2017. 380 UTIs cases were selected from population at riskconsecutively.Sex and age groups were demographic, while presence of E. coli resistance to ceftriaxone was research variable. All variables were nominal.Prevalenceand distribution were analyzed by count, percentage and confidence intervals for proportion for population. Hypotheses for distribution were substantiated by chi-square goodness-of-fit and of association by chi-square test of association.

Results: Out of 380 patients with UTI, 136 (35.80%) were men,244(64.20%) women, 262 (68.95%) in age group 18-45 years and 118 (31.05%) in age group 46-65 years. Frequency/ prevalence of E. coli resistance was 287/380 (75.53%, 95%CI 71.20-79.85). Out of 287 patients with E. coli resistance to ceftriaxone, 101 (26.58%) were men and 186 (48.95%) women, 198 (52.11%) in age group 18-45 years and 89 (23.42%) in age group 46-65 years. Our prevalence of E. coli resistance to ceftriaxone was higher than expected (p<.00001), our distribution by sex(p<.00125) and age groups (p<.00001) were different than expected. Presence of E. coli resistance to ceftriaxone was not associated to sex (p=.669333) and age groups (p=.975097).

Conclusion:Prevalence of E. coli resistance to ceftriaxone in adult UTI population of District Peshawar, Pakistan was alarmingly high 75.53%. Prevalence was more in women than men and more in younger age group (18-45 years) than older age group (46-60 years) population.Overall prevalence of E. coli resistance to ceftriaxone was higher than expected. Distribution by sex showed higher prevalence than expected in men and lower than expected in women, and higher than expected in younger age group and lower than expected in older age group. Presence of E. coli resistance to ceftriaxone was not associated to sex and age groups respectively in adult UTI population of District Peshawar, Pakistan.

Keywords

Urinary Tract Infections; E. coli; Ceftriaxone Resistance; Antibiotic Sensitivity; Anti-microbial Resistance; Adult; Chi-square Goodness of fit Test; Chi-square Test of Association; Peshawar; Pakistan

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References

Gonzalez CM, Schaeffer AJ. Treatment of urinary tract infection: what's old, what's new, and what works. World J Urol1999 Dec 1; 17(6):372-82. https://doi.org/10.1007/s003450050163

Khan G, Ahmad S, Anwar S. Frequency of uropathogens in different gender and age groups. Gomal J Med Sci 2013 Jan-Jun; 11(1): 20-3.

Momtaz H, Karimian A, Madani M, Safarpoor Dehkordi F, Ranjbar R, Sarshar M, et al. Uropathogenic Escherichia coli in Iran: Serogroup distributions, virulence factors and antimicrobial resistance properties. Ann Clin Microbiol Antimicrob 2013 Apr 29; 12:8. https://doi.org/10.1186/1476-0711-12-8

Humayun T, Iqbal A. The culture and sensitivity pattern of urinary tract infections in females of reproductive age group. Ann Pak Inst Med Sci 2012;8(1):19-22.

Linhares I, Raposo T, Rodrigues A, Almeida A. Frequency and antimicrobial resistance patterns of bacteria implicated in community urinary tract infections: a ten-year surveillance study (2000-2009). BMC Infect Dis 2013 Jan 18; 13:19. https://doi.org/10.1186/1471-2334-13-19

Sohail M, Khurshid M, Saleem HG, Javed H, Khan AA. Characteristics and antibiotic resistance of urinary tract pathogens isolated from Punjab, Pakistan. Jundishapur J Microbiol 2015 Jul;8 (7):e19272. https://doi.org/10.5812/jjm.19272v2

Shahzad KA, Ullah F, Muhammad K, Khatoon F, Qazi M, Ahmed I. Multiple drug resistance patterns in urinary tract infection patients in District Peshawar, Khyber Pukhtunkhwa (KPK) Pakistan. J Inf Mol Biol 2013; 1(4):67-70.

Jamil J, Haroon M, Sultan A, Khan MA, Gul N, Kalsoom. Prevalence, antibiotic sensitivity and phenotypic screening of ESBL/MBL producer E. coli strains isolated from urine; District Swabi, KPK, Pakistan. J Pak Med Assoc 2018 Nov 1; 68(11):1704-7.

Dash M, Padhi S, Mohanty I, Panda P, Parida B. Antimicrobial resistance in pathogens causing urinary tract infections in a rural community of Odisha, India. J Family Community Med 2013 Jan; 20(1): 20-6. https://doi.org/10.4103/2230-8229.108180

Sabir S, Anjum AA, Ijaz T, Ali MA, Khan MR, Nawaz M. Isolation and antibiotic susceptibility of E. coli from urinary tract infections in a tertiary care hospital. Pak J Med Sci 2014 Mar; 30(2):389-92. https://doi.org/10.12669/pjms.302.4289

Pondei K, Oladapo O, Kunle-Olowu OE. Anti-microbial susceptibility pattern of micro-organisms associated with urinary tract infections in a tertiary health institution in the Niger Delta Region of Nigeria. African J Microbiol Res 2012 Jun 21; 6(23):4976-82. https://doi.org/10.5897/AJMR12.086

Picozzi SCM, Casellato S, Rossini M, Paola G, Tejada M, Costa E, et al. Extended-spectrum beta-lactamase-positive E. Coli causing complicated upper urinary tract infection: Urologist should act in time. Urology Annals 2014 Apr; 6(2):107-12. https://doi.org/10.4103/0974-7796.130536

Dehbanipour R, Rastaghi S, Sedighi M, Maleki N, Faghri J. High prevalence of multidrug-resistance uropathogenic Escherichia coli strains, Isfahan, Iran. J Nat Sc Biol Med 2016; 7:22-6. https://doi.org/10.4103/0976-9668.175020

Ahmad W, Jamshed F, Ahmad W. Frequency of Escherichia coli in patients with community acquired urinary tract infection and their resistance pattern against some commonly used anti bacterials. J Ayub Med Coll Abbottabad 2015 Jun 20; 27(2):333-7.

Dadi BR, Abebe T, Zhang L, Mihret A, Abebe W, Amogne W. Drug resistance and plasmid profile of uropathogenic Escherichia coli among urinary tract infection patients in Addis Abeba. J Infect Dev Ctries 2018 Aug 31; 12(08):608-15. https://doi.org/10.3855/jidc.9916

Niranjan V, Malini A. Antimicrobial resistance pattern in Escherichia coli causing urinary tract infection among inpatients. Indian J Med Res 2014 Jun; 139(6): 945-8.

Prakash D, Saxena RS. Distribution and antimicrobial susceptibility pattern of bacterial pathogens causing urinary tract infection in urban community of Meerut City, India. ISRN Microbiol 2013 Oct 29; 2013: 749629. https://doi.org/10.1155/2013/749629

Alam MJ, Mousumi SJ, Rana R, Islam MS, Akter MS, Juliana FM, et al. Ceftriaxone resistance patterns of uropathogens isolated from urinary tract infection patients in selected areas of Dhaka city, Bangladesh. IOSR J Nursing Health Sci 2017;6(5):28-34.

Goddard J, Turner AN. Kidney and urinary tract disease. In: Walker BR, Colledge NR, Ralston SH, Penman ID, editors. Davidson's Principles and Practice of Medicine. 22nded. New Delhi: Elsevier; 2014. p. 461-523.

Raosoft® sample size calculator [internet]. Seattle, WA, USA: Raosoft Inc.; 2004. [accessed 2018 Aug 13]. Available at: http://www. raosoft.com/samplesize.html

Statistics Kingdom. Proportion confidence interval calculator [internet]. Statistics Kingdom; Melbourne, Australia 2007. [accessed 2018 May 27]. Available at: http://www.statskingdom.com/41_proportion_confidence_interval.html

Zar JH. Biostatistical Analysis. 5th ed. New York: Prentice-Hall, Inc.

Daniel WW. Biostatistics: A Foundation for Analysis in the Health Sciences. 7th ed. Singapore: John Wily; 2005

Social Science Statistics. Statistical Tests Calculators [Internet]. [accessed 2017 Oct 12].. Available from: https://www.socscistatistics.com/tests/goodnessoffit/default2.aspx

Social Science Statistics. Statistical Tests Calculators [Internet]. [accessed 2017 Oct 12]. Available from: https://www.socscistatistics.com/tests/chisquare2/default2.aspx

Ghori MR, Khan H, Marwat M. Distribution of non-malignant hematological disorders by sex, age groups and type of disease based on bone marrow aspiration in population of Khyber Pakhtunkhwa, Pakistan. Gomal J Med Sci 2019 Apr-Jun; 17 (2): 29-36. https://doi.org/10.46903/gjms/17.02.1926

Butt M, Rehman MU, Khan AR, Abrar A. Frequency of triple-vessel coronary artery disease in adult type 2 diabetics versus non-diabetics in coronary artery disease population of Islamabad, Pakistan. Gomal J Med Sci 2019 Apr-Jun; 17(4).37-41. https://doi.org/10.46903/gjms/17.02.2029

Ain N, Khan S, Marwat M, Khan N, Ahmad I, Ramzan F, et al. Frequency, distribution and determinants of hypertension in adult stroke population of D.I.Khan Division, Pakistan. Gomal J Med Sci 2019 Jul-Sep; 17 (3):81-9. https://doi.org/10.46903/gjms/17.03.2076

Akhtar A, Ali SM, Naqi SA, Aziz T, Shinwari W, Shah SFH. Efficacy of acetic acid versus ciprofloxacin ear drops in achieving dry ears in chronic suppurative otitis media in adult population of Islamabad, Pakistan: a non-randomized control trial. Gomal J Med Sci 2019 Jul-Sep; 17 (3): 90-94. https://doi.org/10.46903/gjms/17.03.2007

Marwat M, Ahmad I, Ashiq F, Ali S, Zamir S, Rehman MU, et al. Frequency, distribution and determinants of diabetes mellitus in adult acute coronary syndrome population of D.I.Khan Division, Pakistan. Gomal J Med Sci 2019 Oct-Dec; 17 (4):131-43. https://doi.org/10.46903/gjms/17.04.2106

DOI: https://doi.org/10.46903/gjms/18.02.869