Prevalence of multidrug-resistant urinary isolates of Enterobacter cloacae – A three year retrospective analysis

• Author Details:   
• Nidhi Mihirkumar Bhalodia ^*
• Mihir Bhalodia
• Rachana Patel
• Himani Pandya
• Tanuja Javadekar

---

Introduction: Urinary tract infections have emerged as both community acquired and health care associated infection that has caused global concern worldwide. ESKAPE pathogens have ability to evade antibiotics through various antimicrobial resistance mechanism. These MDR pathogens has increasingly been implicated in causing Urinary tract infections. Multidrug resistant Enterobacter cloacae have emerged as significant pathogen in causing majority of healthcare associated infections.
Aims and Objective: The main aim of the present study is to investigate the prevalence of multidrug-resistant Enterobacter cloacae as a significant pathogen causing urinary tract infection and to determine antibiotic-resistant pattern of Enterobacter cloacae among patient attending tertiary care hospital, Vadodara. And to identify MDRO and ESBL producing isolates.
Materials and Methods: This retrospective observational study was carried out at tertiary hospital, Vadodara for period of 3 years after obtaining ethical approval from institutional committee. A total of 1400 patients showing signs and symptoms of urinary tract were included in the present study. Result: A total of 1400 urine samples were collected from patients having symptoms of urinary tract infections. A total of 195 Enterobacter cloacae isolates were obtained from 1400 samples. The urinary catheterization was significant risk factor associated with Enterobacter cloacae infection with p-value 0.001348.
In our study there were 100 ESBL producers (51.2%) out of 195 total isolates. In our study prevalence among female patient (59%) was more as compared with male patient (41%). According to age group highest prevalence was among age group of 21-40 years (38.4%).
Out of total 195 Enterobacter cloacae isolates, 135 were multidrug resistant. Enterobacter cloacae showed highest resistance to ampicillin and third and fourth generation cephalosporins. Enterobacter cloacae showed least resistance to Fosfomycin (64.10%) which is drug of choice in our study.
Conclusion: The present study concluded that Urinary catheterization and Diabetes mellitus were significant risk factors leading to urinary tract infections. The current study implicates that proper surveillance system has to be established at rural based hospitals in order to tract emergence of multi drug resistant pathogens and for better patient outcome. And proper infection control measures should be implicated to reduce transmission of multidrug resistant pathogens.
 

Keywords: Enterobacter cloacae, ESBL, MDRO, Fosfomycin