Microbiological Spectrum and Antibiogram of Urinary Tract Infection in a Tertiary Care Center from the Kingdom of Bahrain

Abstract

Urinary tract infection is the second-most common after respiratory infections. This is a single-center retrospective study conducted in Bahrain Specialist Hospital, Bahrain. Urine culture data from November 2011 until December 2020 was obtained from the hospital database. Out of 28082, 4849 (17.3%) cultures were positive. One hundred and thirty-four (2.8%) showed the growth of multiple organisms. The male-to-female ratio was 3.7. Most of the patients [1872 (39.7%)] were 20–40 years. Men and women were 53.84 ± 25.85 and 43.41 ± 23.89 years, respectively; P <0.001. 4118/4715 (87.3%) were Gram-negative. Five hundred and sixty-four (11.9 %) and 33 (0.7%) were Gram-positive cocci and fungi, respectively. Escherichia coli (E. coli) was the most common and Klebsiella species were second-most common, accounting for 2916 (61.8%) and 586 (12.4%), respectively. 30.2% of all E. coli and 130 (22.2%) of all Klebsiella species were extended-spectrum beta-lactamase (ESBL) producers. ESBL Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterococcus faecalis were present more in inpatients (P <0.001). P. aeruginosa was found more in women (P <0.001). E. coli was resistant to cotrimoxazole, ciprofloxacin, and levofloxacin in 28%, 17.3%, and 18.1%, respectively. ESBL E. coli and ESBL K. pneumoniae were resistant to amoxicillin-clavulanate, cotrimoxazole, ciprofloxacin, and levofloxacin in 73.8%, 62.3%, 62.4%, 58.4% and 68.2%, 62.6%, 55.7%, and 41.8% respectively. There is a high incidence of ESBL E. coli and ESBL K. pneumoniae. There is alarmingly increased resistance of P. aeruginosa to carbapenems. Amoxicillin-clavulanate, cefixime, and cefuroxime are suitable oral antibiotics for empirical treatment. For sick patients, piperacillin-tazobactam, aminoglycosides, and carbapenems should be considered. Antibiotic stewardship is the need of an hour.