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area of Zenica-Doboj Canton, for the period of 2004th year in girls under. 6 years of age, isolated E. coli showed resistance to ampicillin in 74.6% of cases, and ...
Antimicrobial Susceptibility of Bacteria Isolated from Inpatients and Outpatients Urine Samples

Antimicrobial Susceptibility of Bacteria Isolated from Inpatients and Outpatients Urine Samples Senad Ljuca1, Sukrija Zvizdic2, Sadeta Hamzic2, Merlina Kalajdzija1, Asmira Ljuca1 Department of General surgery and Anesthesiology, Cantonal hospital Zenica, Bosnia and Herzegovina1 Institute of Microbiology, Parasitology and Virusology, Medical faculty of Sarajevo, Bosnia and Herzegovina2

Original paper SUMMARY Antibacterial resistance is generally regarded as a public health problem, not only in local terms, but also worldwide. The objective of this research work would be to analyze inpatient’s and outpatient’s antimicrobial resistance to a set of various agents. The patients have been medically treated in the region of Ze-do canton since 2005 until today. Total number of 164 patients was included in our research. Regarding the place of medical treatment, our patients were divided into two groups: a total number of 111 inpatients and a total number of 53 outpatients. 56 of them were males, rest females. Apart from the sex affiliation, the exeminees were divided into two groups, depending on the presence of the Foley’s catheter (inpatients only). We were obliged to determine the antimicrobial sensitivity of the isolated bacteria to certain representatives of antimicrobials. During the conducted testing, it has been proved that the phenomenon of polymicrobic infection found while testing inpatients is in immediate correlation to the catheterization. The inpatients urine tract infections

are duo to the most commonest agent – E.coli that is in terms of percentage 38,5%, followed closely by Proteus spp. – 19,3% , Pseudomonas spp. – 13,6% , Klebsiella pneumoniae, 12 ,5% , et cetera. The outpatients urine tract infections are due to the most common agent E.coli percentage is 81%, as well as to Klebsiella pneumoniae, 19,0%. During the testing of the antimicrobial sensitivity of the isolated bacteria, it has been determined that the urine tract infection agents (starting with E.coli and Klebsiella pneumoniae) isolated from the inpatients urine specimens are proved to have higher resistance to tested antimicrobials compared to the same agents isolated from the outpatient’s urine specimens. The differences refferring to resistance rates are ranging from 0,2% (trimetoprim-sulphametoksazol) to 25,9% (cephazolin) for E.coli, since the difference refferring resistance to Klebsiella pneumoniae is more noticeable and ranging from 0,8% (amoxicillin- clavulonic acid) to 65,0% (gentamicin). Key words: resistence, catheterization, Escherichia coli, Klebsiella pneumoniae.

Corresponding author: Senad Ljuca, MD. Department of General surgery and Anesthesiolgy, Cantonal hospital Zenica, Bosnia and Herzegovina

1. Introduction Bacterial resistance to antimicrobial drugs was present even before they are introduced into the human or veterinary practice. Experience gained in more than fifty years witness that the use of antibiotics that are introduced into clinical use and increased use of any antibiotic so far discovered, sooner or later will follow the isolation of resistant bacterial strains. Resistance to antibiotics is a growing worldwide problem and it is becoming evident even for new, more potent antibiotics. Worldwide, epidemics caused by mul-

piple resistant strains of microorganisms are being registered. In BiH, urinary tract infections are at the very top of the frequency of occurrence and are a significant cause of morbidity of patients treated in hospitals, as well as those treated on outpatient basis. Most of these infections are caused by Escherichia coli, and are treated empirically. Today, based on clinical experience there is noticeable increase in the number of resistant strains of certain species of bacteria that cause these infections ,that are treated by conventional therapy. Adoption of new knowledge

about microorganisms and their mechanisms to gain resistance is important for understanding the phenomenon, and the correct use of antibiotics, and their rational use.

2. Patients and methods The study included a total of 164 patients with urinary disturbances, divided into two groups. The first group was consisted of 111 hospitalized patients, treated in internal, neurological and urological departments 33 patients within internal departments, 39 patients within urological department and 39 patients within neurological departments) of cantonal hospital in Zenica. Hospitalization of the respondents took the period in 2005.–2007. year. The second group was consisted of 53 patients who were treated ambulatory, and all were from the area of Zenica municipality. All outpatients were treated at the same time period as well as hospitalized patients. One or more urine samples from each participant were taken and transported to the microbiological laboratory at the standard prescribed manner for a biological sample. In the microbiological laboratory urine samples were handled by standard procedure and total number and types of bacteria were identified. To determine the total number of bacteria in 1 ml of urine we used routine screening method-the Leigh and Williams blotting paper technique, as recommended by WHO, Geneva in year of

MED ARH 2010; 64(3) • Original papers

161

Antimicrobial Susceptibility of Bacteria Isolated from Inpatients and Outpatients Urine Samples

1991. The finding of more than 105 bacteria in 1 ml of urine indicated an infection of the urinary system, with one or two isolated bacterial pathogens. Single isolated colonies of bacteria were identified by examining certain biochemical and antigenic properties, and as a final test we performed the disk diffusion test to determine antimicrobial susceptibility of isolated pathogens to certain antibiotics. Bacterial serological identification was conducted by testing the antigenic structure of bacterial cells. In our work we used the method of agglutination on a glass slide in order to identify isolated representatives of enterobacteria and certain Grampositive bacteria. Each of the isolated pathogens was examined for its sensitivity / resistance to the appropriate representatives of a group of antimicrobial drugs by disk-diffusion method, as recommended by Kirby-Bauer and the NCCLS.

 

Isolated bacteria

azitromicin 0 0

imipenem cefuroxim pefloxacin

9,3

Isolated bacteria Escherichia coli Klebsiella pneumoniae Total:

4. Results In our work we examined total of 164 patients with urinary disorders, which were divided in two groups. The first group consisted of 111 hospitalized recumbent patients , that were divided in three subgroups. The first subgroup was consisted of 33 patients within internal departments, second subgroup was consisted of 39 patients within urological department and the third subgroup was consisted of 39 patients within neurological department of the Cantonal Hospital in Zenica. The other group was consisted of 53 patients who were treated ambulatory. All of the patients had positive urine samples. In 42,2

cloramfenikol tetraciklin gentamicin

16,6

ampicillin

inpatients outpatients

42,1

22,5 27

51,3 51,1 32 47,6

26,4

Chart 1 Escherichia coli antimicrobial

162

20

40

60

80

resistance , inpatients / outpatients

MED ARH 2010; 64(3) • Original papers azitromicin

60,6 66,6 79,4 71,1 69

amoxicillin 0

Total No 40 20 14 13 7 5 1 1 1 1 1 104

% 38,5 19,3 13,6 12,5 6,8 4,8 0,9 0,9 0,9 0,9 0,9 100

% 81 19 100

p p