E Coli urine super bug and its antibiotic sensitivity-A prospective study

Objectives: To determine the sensitivity patterns of E Coli to various antibiotics by urine culture and sensitivity in patients with Urinary Tract Infection (UTI), and to recommend the appropriate empirical antibiotics for UTI while awaiting culture results. Materials and Methods: This prospective study was conducted in Medical E Unit of Khyber Teaching Hospital, Peshawar, Pakistan from May 2007 to Oct 2009. A total of 354 urine cultures was performed. Urine culture was done using conventional microbiological techniques. Biochemical techniques were used to identify the organisms and antibiotic sensitivity was determined by Kirby Bauer method. Results: Out of 354 urine cultures, 276 grew E Coli. The gender distribution was 173(62.6%) females as compared to 103(37.31%) males, with age range of 14-70 years. Urine culture of 270 (97.82%) patients was sensitive to Meropenem, 263 (95.28%) to Piperacillin-Tazobactam, 258 (93.49%) to Cefoperazone-Sulbactam, 260 (94.20%) to Imipenem, 257 (93.11%) to Amikacin, 254 (90.57%) to Ceftazidime, 222 (80.43%) to Ceftriaxone, 62 (22.4%) to Co-Amoxiclav, 37 (13.40%) to Pipedemic Acid, 63 (22.8%) to Ciprofloxacin, 85 (30.79%) to Gentamicin and 53 (19.20%) to Cefotaxime. Conclusion: E Coli resistance against most commonly used antibiotics is on the rise and we recommend using Amikacin or Cefoperazone-Sulbactam as the initial empirical antibiotic of choice for treating UTI while awaiting culture results. We do not recommend using Meropenem, Piperacillin-Tazobactam or Imipenem as initial empirical antibiotic of choice because of the much higher cost as compared to Amikacin or Cefoperazone-Sulbactam.