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Abstract

DETERMINATION OF DRUG RESISTANT STRAINS CAUSING URINARY TRACT INFECTIONS WITH MIC AND DISK DIFFUSION METHODS

Afsaneh Karami*, saideh Mazloom Zadeh, Ala Rastin, mehdi ojagh faghihi, Afroozeh Karami

ABSTRACT

Introduction: Urinary tract infection (UTI) is one of the most prevalent bacterial infections. Wide ranges of antibiotics are used for treatment of UTI. Studies revealed that the antimicrobial therapies are not effective many times and excessive use of antibiotics could result in development of multidrug resistance organisms. Determination of causative strains for infection and especially the pattern of antibiotic resistance in each area are essential to find a proper antibiotic for the first-line therapy and consequently preventing from more drug resistance by prescribing the better drugs. Materials and Methods: This cross sectional study was performed from 2011 to 2012 on the organisms collected from urine culture of UTI patients who were hospitalized at Vali-ye-Asr Hospital in Zanjan, Iran. To define the type of strains the organisms were cultured in differential medium and the type of strain was determined by adding anti serum and using tables for the type of strains. After determination of the strains of each organism for collected urine cultures, the drug resistance was assessed using MIC (Minimum Inhibitory Concentration) and disc diffusion methods. Results: among 223 patients, 58.7% were female, and their mean age was 64 ± 0.18 years old. The most common organisms were Escherchia coli (44.8%) and streptococcus (15.7%). The disk diffusion test showed highest resistance of vancomycin (83.3%), Nalidixic Acid (83%) and Ampicillin (80.7%). With the MIC method highest resistance was from Ampicillin, cephalexine, co-tromoxazole (each one with 92.4% resistancy). In disk diffusion method the most common Resistancy were in patients over 60 years old , and in MIC method resistancy was more common in 41-60 years old patients with vancomycin , cefixime , Gentamicin and co-Amoxiclave. In male patients Resistancy with ceftriaxone and Gentamicine and in female with vancomycin and co-Amoxiclave were the heighest. With underlyind diseases resistancy to co-trimoxazole, Ampicillin, co-Amoxiclave, cefixime, cephalexin, ceftriaxone, Nitrofurantoin, Gentamicin and ciprofloxacin was heighest, and in MIC method to ciprofloxacin and co-trimoxazole was more common. And the differences were statistically significant. The highest sensitivity of disk method was from nitrofurantoin with 84.7% sensitivity, and the highest specitivity was from nalidixic Acid (89.2%). The Correlation between MIC and disk diffusion method for diagnosis of nitrofurantoin, ofloxacin, nalidixic acid resistancy was observed. Conclusions: Because of high sensitivity of Nitrofurantoin, Imipenem and Gentamicin, with disk diffusion and MIC methods, it seems that these drugs are preffered for treatment and prevention of Urinary tract infections. As Gentamicin, cephalexin and co-trimoxazole showed high resistancy, it’s recommended to avoid using of them for those infections.

Keywords: Microbial Sensitivity Tests; Disk Diffusion Antimicrobial Tests; Urinary Tract Infections; Organism, Microbial Sensitivity Tests; Drug Resistance, Bacterial


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