“To Study the Uropathogenic Profile and its Antibiotic Susceptibility Pattern among Immunocompromised Patients at a Tertiary Care Centre in Kashmir, India”.

Abstract

Introduction: Immunocompromised patients have a higher tendency of developing all infections, especially infections of the genitourinary tract. Urinary tract infections cause considerable morbidity in immunocompromised patients, and if complicated, increase in the mortality. In Kashmir, the magnitude of immunocompromise-associated urinary tract infections have increased in the past few years. The successful management of urinary tract infections depends upon the identification of risk factors in the immunocompromised population.

Aim and Objectives:To study the uropathogenic profile and its antibiotic susceptibility pattern among immunocompromised patients at a tertiary care centre in Kashmir.

Material and Methods:This was a facility based cross-sectional study carried out in the Department of Microbiology, conducted on 405 immunocompromised patients visiting the study centre from April, 2021 to 31^st March, 2022. Demographic data was collected through structured face-to-face interview. The Standard microbiological methods were used for identification of uropathogens and the antibiotic susceptibility testing was done by the Modified Kirby–Bauer disk diffusion technique according to the CLSI guidelines 2020. The study participants were stratified into 6 categories in order to evaluate the patternof antibiotic resistance among the heterogeneous immunocompromised patient population. Univariate logistic regression was used assess the significance of each factor level with respect to UTI positivity with p-value<0.05 as statistically significant. Adjusted and unadjusted odds ratios for risk factors along with 95% confidence intervals were reported.

Results: In the present study a total of 405 immunocompromised patients were screened with the overall prevalence of UTI 34.81% (141/405). The mean age was observed to be 33.09 ± 23.73 years, with the maximum number of patients in the age group of 51-60 years of age group with the highest proportion of the immunocompromised UTI positive patients (29/141; 20.56%). Females accounted for 58.2% (82/141) of the patients with UTI as compared to 41.8% (59/141) of males.Amongst the 141 samples testing positive for UTI, 61 (43.26%) tested positive for bacterial isolates whereas, 80 (56.73%) tested positive for candida species. Among the bacterial isolates 46 (75.40%) were gram negative and 15 (24.59%) gram positive. The results also reflected high prevalence of UTI (68/141; 48.22%) among the diabetes mellitus category of immunocompromised patients

The most typically grown organisms were E.coli (26%) followed by E.faecalis (14%) and K.pneumoniae (10%). The antibiotics Amikacin, piperacillin/tazobactam, cefoperazone/sulbactam, and carbapenems were all effective against Gram-negative isolates, while nitrofurantoin, linezolid, and vancomycin were effective against Gram-positive cocci.

Conclusion: For empirical treatment, we cannot rely on commonly used oral antibiotics and specific groups such as fluoroquinolones, cephalosporins (excluding those containing sulbactam), and ampicillin. Those organisms were found in both controlled and uncontrolled diabetic groups and showed a similar pattern of antibiotic resistance. These findings emphasise the necessity of glycemic control in diabetic patients to minimise UTIs, independent of age or gender.