Nitrofurantoin Revisited for Uropathogens: Easing out Therapeutic Dilemma for Clinicians in an Upcoming Super Speciality Hospital

Abstract

Introduction: Urinary Tract Infection (UTI) which is caused by antibiotic resistant uropathogens has become a major health jeopardy in recent years as it is difficult to treat, causing an increase in morbidity and mortality. Knowledge regarding the local antibiogram of the specific area would provide better treatment options for the clinicians while tackling drug resistant uropathogens. Aim: To review the susceptibility pattern of the uropathogens isolated from the patient population referred to the super speciality hospital in the East Delhi area. Materials and Methods: The retrospective study was conducted in the Department of Microbiology of an upcoming super speciality hospital from January 2017 to December 2017. A total of 2362 samples included clean-catch mid-stream urine, aspirates from catheter tube or suprapubic aspirate collected aseptically. Semi quantitative culture was performed by inoculating urine on Cysteine-Lactose-Electrolyte-Deficient agar (CLED) media using a calibrated nichrome loop. The plates were aerobically incubated at 37°C overnight. Pure growth of a single isolate in a count of ≥105 Colony Forming Units (CFU) per millilitre of urine was considered as significant bacteriuria. Antimicrobial Susceptibility Tests (AST) of the isolates was done by VITEK-2 Compact (BioMerieux, France) system as per Clinical and Laboratory Standards Institute 2017 (CLSI) guidelines. Data collected was compiled and entered into Microsoft excel sheets, and percentages were used to interpret and analyse the findings. Results: Escherichia coli (E.coli) was the most frequent uropathogen accounting to 155/247 (62.75%) followed by Klebsiella species 41/247 (16.59%) and Pseudomonas aeruginosa 20/247 (8.09%). Nitrofurantoin sensitivity was shown by 73/90 (81.1%) of Non-Extended Spectrum Beta Lactamase (ESBL) producing and 52/65 (80%) of ESBL producing E. coli isolates. Amongst Klebsiella species, 13/20 (65%) of Non ESBL producing and 10/21 (47.6%) of ESBL producing were sensitive to Nitrofurantoin. Conclusion: The drug nitrofurantoin definitely fared well in the sensitivity pattern over high resistance potential antibiotics like fluoroquinolones in the present study. In an era of antibiotic overtreatment and fostering resistant bugs; bringing out local antibiogram would ease out the therapeutic dilemma for clinicians and assuredly avert the antibiotic menace.

Keywords

• escherichia coli
• extended spectrum beta lactamase
• klebsiella pneumoniae
• urinary tract infection