Need of area-specific monitoring of antimicrobial sensitivity of Uropathogens especially ESBL producers: A lesson from Malda, West Bengal, India

Antibiotic resistance of urinary pathogens especially the extended-spectrum β-lactamase (ESBL) producing organisms has emerged as a global challenge to clinicians trying to formulate an empirical therapy. Choice of the correct antimicrobial agent and constructing an antibiotic policy has also become very difficult in recent years. Area-specific monitoring studies are essential to gather knowledge of the prevailing microbes and their sensitivity patterns. The present endeavor studies the antibiotic sensitivity pattern of 468 culture-positive urine samples amongst a total of 4466 samples from outdoor patients from Malda, a small town in West Bengal, India. Females of reproductive age group were mostly affected. Gram negative organisms dominated the organisms with Escherichia coli having the greatest share accompanied by Klebsiella sp, Proteus sp, Pseudomonas sp etc. Fluoroquinolones were only moderately sensitive (50-60% sensitivity) against Gram negative organisms. Trimethoprim-sulphamethoxazole and nitrofurantoin also had unsatisfactory levels of sensitivity (<50%). Carbapenems, aminoglycosides and tetracyclines were consistently sensitive against most organisms. Amongst the 441 organisms tested for ESBL 241 were ESBL positive. Most of the ESBL negative organisms were susceptible to ampicillin-sulbactam and piperacillin-sulbactam. Staphylococcus aureus was reasonably sensitive to co-amoxiclav, nitrofurantoin, cotrimoxazole, tetracyclines, vancomycin, linezolid and clindamycin. Fluoroquinolones which are presently being prescribed widely have lost their effectiveness. Overall, very few choices of oral antibiotics remain to be empirically prescribed for urinary infections. ESBL positive gram negative organisms are very much on the rise.