Main Article Content
Urinary tract infections (UTIs) caused by bacteria occupy the second highest rank of common infectious diseases in the world. Empirical use of antibiotics may give rise to multidrug-resistant (MDR) bacteria because of irrational prescription. Choice of antibiotics to treat UTIs is limited because of MDR bacteria. Thus, this study was conducted to investigate the bacterial antibiotic susceptibility patterns in inpatients and outpatients in Jakarta and Tangerang.
Bacterial isolates were obtained from midstream urine specimens from 43 inpatients and 43 outpatients with UTIs in Jakarta and Tangerang. Bacteria were isolated on blood and MacConkey agar media using colony count method. Isolate identification and their susceptibility patterns were performed using VITEK2 compact system according to manufacturers’ instructions. Data were analyzed using Chi-square test.
A total of 89 bacterial isolates consisting of 15 bacterial species were successfully isolated from 86 specimens. Gram-negative bacteria were the most common etiology of UTIs in inpatients and outpatients. MDR bacteria were found in 52 of the 89 isolates. ESBL-producing E. coli was the most common MDR bacteria. ESBL-producing E. coli and other MDR bacteria showed good susceptibility to ertapenem, meropenem, amikacin, and tigecycline. There were no significant differences regarding the MDR bacterial count in inpatients and outpatients (p=0.521).
E. coli was found to be the most common MDR bacteria causing UTIs in inpatients and outpatients in Jakarta and Tangerang. Higher resistance to many antibiotics was found in MDR bacterial isolates in inpatients compared to outpatients. MDR bacteria in outpatient UTIs were highly resistant to commonly used antibiotics.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The journal allows the authors to hold the copyright without restrictions and allow the authors to retain publishing rights without restrictions.
Shah C, Baral R, Bartaula B, Shrestha LB. Virulence factors of uropathogenic Escherichia coli (UPEC) and correlation with antimicrobial resistance. BMC Microbiol 2019;19:1–6. https://doi.org/10.1186/s12866-019-1587-3.
Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol 2015;13:269–84. http://dx.doi.org/10.1038/nrmicro3432.
Sasongkowati R, Chitraningtyas D, Christyaningsih J. The study on the susceptibility of Enterococcus faecalis and Klebsiella ozaenae cause UTI to antibiotics in East Java, Indonesia. Res J Pharm Biol Chem Sci 2015;6:1539–44.
Medina M, Castillo-Pino E. An introduction to the epidemiology and burden of urinary tract infections. Ther Adv Urol 2019;11:3–7. doi: 10.1177/1756287219832172.
Ahmed SS, Shariq A, Alsalloom AA, Babikir IH, Alhomoud BN. Uropathogens and their antimicrobial resistance patterns: Relationship with urinary tract infections. Int J Health Sci (Qassim) 2019;13:48–55.
Gajdács M, Ábrók M, Lázár A, Burián K. Comparative epidemiology and resistance trends of common urinary pathogens in a tertiary-care hospital: a 10-year surveillance study. Medicina (Lithuania) 2019;55:1–15. doi: 10.3390/medicina55070356.
Sugianli AK, Ginting F, Kusumawati RL, et al. Antimicrobial resistance in uropathogens and appropriateness of empirical treatment: A population-based surveillance study in Indonesia. J Antimicrob Chemother 2017;72:1469–77. doi: 10.1093/jac/dkw578.
Rosana Y, Ocviyanti D, Halim M, et al. Urinary tract infections among Indonesian pregnant women and its susceptibility pattern. Infect Dis Obstet Gynecol 2020, Article ID 9681632, 7 pages. https://doi.org/10.1155/2020/9681632.
Durkin MJ, Keller M, Butler AM, et al. An assessment of inappropriate antibiotic use and guideline adherence for uncomplicated urinary tract infections. Open Forum Infect Dis 2018;5:ofy198. doi: 10.1093/ofid/ofy198
Silago V, Moremi N, Mtebe M, et al. Multidrug-resistant uropathogens causing community acquired urinary tract infections among patients attending health facilities in Mwanza and Dar es Salaam, Tanzania. Antibiotics 2022;11:1718. https://doi.org/10.3390/antibiotics11121718
Horumpende PG, Sonda TB, van Zwetselaar M, et al. Prescription and non-prescription antibiotic dispensing practices in part I and part II pharmacies in Moshi Municipality, Kilimanjaro Region in Tanzania: a simulated clients approach. PLoS One 2018;13:e0207465. doi: 10.1371/journal.pone.0207465
Ndaki PM, Mushi MF, Mwanga JR, et al. Dispensing antibiotics without prescription at community pharmacies and accredited drug dispensing outlets in Tanzania: a cross-sectional study. Antibiotics (Basel) 2021;10:1025. doi: 10.3390/antibiotics10081025
Al-Hasan MN, Eckel-Passow JE, Baddour LM. Bacteremia complicating gram-negative urinary tract infections: a population-based study. J Infect 2010 ;60:278–85. doi:10.1016/j.jinf.2010.01.007.
Nabti LZ, Sahli F, Radji N, et al. High prevalence of multidrug-resistant Escherichia coli in urine samples from inpatients and outpatients at a tertiary care hospital in Sétif, Algeria. Microb Drug Resist 2019;25:386-93. doi: 10.1089/mdr.2018.0314.
Fatima S, Muhammad IN, Usman S, Jamil S, Khan MN, Khan SI. Incidence of multidrug resistance and extended-spectrum beta-lactamase expression in community-acquired urinary tract infection among different age groups of patients. Indian J Pharmacol 2018 ;50:69–74. doi: 10.4103/ijp.IJP_200_17.
Fernando MM, Luke WA, Miththinda JK, et al. Extended spectrum beta lactamase producing organisms causing urinary tract infections in Sri Lanka and their antibiotic susceptibility pattern -a hospital based cross sectional study. BMC Infect Dis. 2017 ;17:138. doi: 10.1186/s12879-017-2250-y.
Vachvanichsanong P, McNeil EB, Dissaneewate P. Extended-spectrum beta-lactamase Escherichia coli and Klebsiella pneumoniae urinary tract infections. Epidemiol Infec 2020;149:e12, 1–7. https://doi.org/10.1017/S0950268820003015
Akhavizadegan H, Hosamirudsari H, Pirroti H, Akbarpour S. Antibiotic resistance: a comparison between inpatient and outpatient uropathogens. East Mediterr Health J 2021 ;27:124-30. doi: 10.26719/emhj.20.08.
Saperston KN, Shapiro DJ, Hersh AL, Copp HL. A comparison of inpatient versus outpatient resistance patterns of pediatric urinary tract infection. J Urol 2014;191:1608–13. doi: 10.1016/j.juro.2013.10.064.
Ikeda Y, Shigemura K, Nomi M, et al. Infection control following an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae isolated from catheter-associated urinary tract infection. Jpn J Infect Dis 2018;71:158-61. doi: 10.7883/yoken.JJID.2017.330..
Latifpour M, Gholipour A, Damavandi MS. Prevalence of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae isolates in nosocomial and community-acquired urinary tract infections. Jundishapur J Microbiol 2016;9:e31179. doi: 10.5812/jjm.31179.
Laila Urmi U, Jahan N, Nahar S, et al. Gram-positive uropathogens: Empirical treatment and emerging antimicrobial resistance. Biomed Res Clin Pract 2019;4:1-4. doi: 10.15761/BRCP.1000182.
Wang QY, Li RH, Shang XH. Urinary tract infection caused by Enterococcus isolates: aetiology and antimicrobial resistance patterns. J Chemother 2015;27:117–9. doi: 10.1179/1973947814Y.0000000192.
Zavala-Cerna MG, Segura-Cobos M, Gonzalez R, et al. The clinical significance of high antimicrobial resistance in community-acquired urinary tract infections. Can J Infect Dis Med Microbiol 2020;2020:2967260. doi: 10.1155/2020/2967260.
Rosana Y, Ocviyanti D, Akbar W. Bacterial susceptibility patterns to cotrimoxazole in urinary tract infections of outpatients and inpatients in Jakarta, Indonesia. Med J Indones 2020;29:316-21. https://doi.org/10.13181/mji.oa.204305.
Soltani R, Ehsanpoor M, Khorvash F, Shokri D. Antimicrobial susceptibility pattern of extended-spectrum â-lactamase-producing bacteria causing nosocomial urinary tract infections in an Iranian referral teaching hospital. J Res Pharm Pract 2014;3:6-11. DOI: 10.4103/2279 042X.132703.
Fasugba O, Gardner A, Mitchell BG, Mnatzaganian G. Ciprofloxacin resistance in community- and hospital-acquired Escherichia coli urinary tract infections: A systematic review and meta-analysis of observational studies. BMC Infect Dis 2015;15:545. doi: 10.1186/s12879-015-1282-4.
Rahimi A, Saragih RH, Nainggolan R. Antimicrobial resistance profile of urinary tract infection at a secondary care hospital in Medan, Indonesia. 2018 IOP Conf Ser: Earth Environment Sci 125 012034. doi:10.1088/1755-1315/125/1/012034.