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Fluoroquinolones resistance among uropathogens at a tertiary-care hospital, Ahmedabad

Anirudh Gupta, Bimal Chauhan, Jayshree Pethani, Parul Shah.

Abstract
Background: Urinary tract infection (UTI) is one of the most common infections in both outpatients and hospitalized patients. The progressive increase in antimicrobial resistance among patients with UTIs is of great concern.

Objective: To determine the resistance patterns of fluoroquinolones in UTIs.

Materials and Methods: This study was conducted at NHL Municipal Medical College, Ahmedabad, Gujarat, India, from October, 2013 to March, 2015. A retrospective analysis of data taken from all urine samples (6,545 patients suspected of UTI) was analyzed. A total of 1,744 isolates were found for which fluoroquinolones susceptibility was analyzed. Cultures with Candida growth were excluded from this analysis. Antimicrobial susceptibility was done by Kirby–Bauer’s disc diffusion method as per Clinical and Laboratory Standards Institute guidelines.

Result: Escherichia coli (55.1%) was the leading uropathogen, followed by Klebsiella spp. (22.3%), Pseudomonas aeruginosa (11.9%), Acinetobacter spp. (3.2%), Enterobacter spp. (2.3%), Citrobacter spp. (1.3%), Enterococcus spp. (1.2%), Proteus mirabilis (1.0%), and others (1.7%). Overall resistance to ciprofloxacin (85.5%) when compared with levofloxacin (53.8%) was higher. The levofloxacin resistance increased minimally from 55.6% overall in October 2013–March 2014 to 55.8% in October 2014–March 2015, whereas resistance to ciprofloxacin increased from 79.5% overall in October 2013–March 2014 to 90.3% in October 2014–March 2015.

Conclusion: Levofloxacin is still active against major pathogenic organisms, whereas ciprofloxacin has become largely inactive. So, it is time to reconsider the use of fluoroquinolones and develop clear strategies to counteract the development of further resistance.

Key words: Fluoroquinolones, urinary tract infection, antimicrobial resistance


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