Common uropathogens and their antimicrobial susceptibility patterns at a tertiary care hospital in Pakistan

  • Faraz Basharat Khan FCPS trainee at AFIU,Rwp
  • Khubaib Shahzad consultant urologist AFIU
  • Nida Basharat Khan
  • Zaufishan Kokab FCPS trainee at AFIP,Rwp
  • Zahoor Iqbal consultant urologist AFIU
  • Khurram Mansoor consultant nephrologist AFIU.Rwp
Keywords: Uropathogens; antibiotics; urine; culture; sensitivity.


Introduction: Urinary tract infections (UTIs) are one of the most frequent infections encountered by doctors. It can be a significant source of morbidity for some patients. Microbes are growing resistant to commonly prescribed antimicrobials and UTIs are becoming more difficult to treat day by day. The study aimed to investigate the common uropathogens encountered in our geographical region and to study their antibacterial susceptibility patterns.
Material and Methods: It was a retrospective descriptive study carried out in the Armed Forces Institute of Urology, in collaboration with the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, during the year 2019. Positive reports for urine culture and sensitivity performed during the last two years were studied to document various isolates and their antimicrobial sensitivity.
Results: A total of 3191 positive urine cultures in the last two years (2017-2019) were studied. Escherichia coli (66%), followed by Klebsiella Pneumonia (12%) were the most frequently encountered organisms. Overall resistance to Ciprofloxacin was 66%, Cotrimoxazole was 62%, Gentamycin was 40%, Fosfomycin (9.5%) followed by Meropenem (28%) and Nitrofurantoin (35%) were the most sensitive antibiotics.
Conclusion: Gram-negative bacilli are the predominant organisms responsible for urinary tract infections. These uropathogens show significant resistance to routinely used antibiotics. Fosfomycin and Nitrofurantoin are suitable oral anti-bacterials for patients with UTI, whereas Meropenem is suitable if an injectable therapy is required. Our study may act as a guide for the choice of empiric antibiotics based on local resistant patterns.



1. A Singhal, R Sharma, M Jain, and L Vyas. Hospital and Community Isolates of Uropathogens and their Antibiotic Sensitivity Pattern from a Tertiary Care Hospital in North West India. Ann Med Health Sci Res. 2014 Jan-Feb; 4(1): 51–56. DOI: 10.4103/2141-9248.126611
2. Szasz M, Lehotkai N, Kristóf K, Szabó D, Nagy K. Prevalence and antimicrobial resistance of uropathogens in different inpatient wards. Acta Microbiol Immunol Hung. 2009;56:375–87. DOI: 10.1556/amicr.56.2009.4.7
3. Hansel DE, McKenney JK, Stephenson AJ, Chang SS. The Urinary Tract: A Comprehensive Guide to Patient Diagnosis and Management, New York: Springer; 2012. 64 p DOI: 10.1007/978-1-4614-5320-8
4. Mittal S, Kumar A, Govil N, Urinary tract infections: General considerations. SM Journals, Dec 2015. DOI: 10.5005/jp/books/18034_9
5. Stark RP, Maki DG. Bacteriuria in a catheterized patient. N Eng J Med 1984; 311:560–4. DOI: 10.1056/NEJM198408303110903
6. Hickling DR, SUN TT and WU XR. Anatomy and Physiology of the Urinary Tract: Relation to Host Defense and Microbial Infection. Microbiol Spectr. 2015 Aug; 3(4): 10.1128/microbiolspec.UTI-0016-2012. DOI: 10.1128/9781555817404.ch1
7. Kucheria R, Dasgupta P, Sacks SH, et al Urinary tract infections: new insights into a common problem Postgraduate Medical Journal 2005;81:83-86. DOI: 10.1136/pgmj.2004.023036
8. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA. Infections of the urinary tract. In: Wein AJ, editor. Campbell-Walsh Urology. 10th edition. Philadelphia: Elsevier; 2012. 261 p DOI: 10.1111/j.1749-771X.2007.00017.x
9. Alabi AS, Frielinghaus L, Kaba H, Koster K, Huson MA, Kahl BC, et al. Retrospective analysis of antimicrobial resistance and bacterial spectrum of infectionin Gabon, Central Africa. BMC Infect Dis. 2013;13:455. DOI:10.1186/1471-2334-13-455
10. Tahir Hameed, Abdullah Al Nafeesah, Syed Chishti, Mohammed Al Shaalan, and Khaled Al Fakeeh. Community-acquired urinary tract infections in children: Resistance patterns of uropathogens in a tertiary care center in Saudi Arabia. Int J Pediatr Adolesc Med. 2019 Jun; 6(2): 51–54. DOI: 10.1016/j.ijpam.2019.02.010
11. Khan S, Ahmed A. Uropathogens and their susceptibility patterns; A retrospective analysis. J Pak Med Assoc 2005;51(2):98–100.
12. Moroh JLA, Fleury Y, Tia H, et al. Diversity and antibiotic resistance of uropathogenic bacteria from Abidjan. Afr J Urol. 2014;20:18–24. DOI: 10.1016/j.afju.2013.11.005
13. Niranjan V, Malini A. Antimicrobial resistance pattern in Escherichia coli causing urinary tract infection among inpatients. Indian J Med Res. 2014;139:945–8. DOI: 2014/139/6/945/138080
14. Farrell DJ, Morrissey I, De Rubies D, Robbins M, Felmingham D. A UK Multicentre study of the antimicrobial susceptibility of bacterial pathogens causing urinary tract infection. J Infect 2003;46(2):94–100. DOI: 10.1053/jinf.2002.1091
15. Ahmed NH, Raghuraman K, Baruah FK, Grover RK. Antibiotic Resistance Pattern of Uropathogens: An Experience from North Indian Cancer Patient. J Glob Infect Dis. 2015;7(3):113–115. DOI: 10.4103/0974-777x.161742
16. Chiu CC, Lin TC, Wu RX, Yang YS, Hsiao PJ, Lee Y, Lin JC, Chang FY. Etiologies of community-onset urinary tract infections requiring hospitalization and antimicrobial susceptibilities of causative microorganisms. Journal of Microbiology, Immunology and Infection. 2017 Dec 1;50(6):879-85. DOI: 10.1016/j.jmii.2016.08.008
17. Naz Z, Batool A, Rauf A. High resistance in uropathogens isolated from children at Pakistani hospital. Journal of University Medical & Dental College. 2018 Apr 3;9(1):26-32.
18. Setu SK, Sattar AN, Saleh AA, Roy CK, Ahmed M, Muhammadullah S, Kabir MH. Study of Bacterial pathogens in Urinary Tract Infection and their antibiotic resistance profile in a tertiary care hospital of Bangladesh. Bangladesh Journal of Medical Microbiology. 2016;10(1):22-6. DOI: 10.3329/bjmm.v10i1.31449
19. Valavi E, Nikfar R, Ahmadzadeh A, Kompani F, Najafi R, Hoseini R. The last three years antibiotic susceptibility patterns of uropathogens in southwest of Iran. DOI: 10.5812/jjm.4958.
20. Duława J. Urinary tract infection-2003. Rocz Akad Med Bialymst. 2004;49:182-4.
21. Obiofu EN, Ige OH, Iroro O. Antimicrobial susceptibility pattern of urinary isolates from outpatients suspected for urinary tract infection. GSC Biological and Pharmaceutical Sciences. 2018;5(3):001-11.DOI: 10.30574/gscbps.2018.5.3.0124
22. Mitiku SY. Bacterial uropathogens and their antibiotic susceptibility pattern at Dessie regional health laboratory. J Microbiol Biotechnol Res. 2017;3:1-9. DOI: 10.3390/molecules22081255
23. Lakshminarayana SA, Chavan SK, Prakash R, Sangeetha S. Bacterial pathogens in urinary tract infection and antibiotic susceptibility pattern from a Teaching Hospital, Bengaluru, India. Int J Curr Microbiol Appl Sci. 2015;4(11):731-6.
24. Shaifali I, Gupta U, Mahmood SE, Ahmed J. Antibiotic susceptibility patterns of urinary pathogens in female outpatients. North American journal of medical sciences. 2012 Apr;4(4):163. DOI: 10.4103/1947-2714.94940
25. Michalopoulos AS, Livaditis IG, Gougoutas V. The revival of fosfomycin. International journal of infectious diseases. 2011 Nov 1;15(11):e732-9. DOI: 10.1016/j.ijid.2011.07.007
How to Cite
Khan F, Shahzad K, Khan N, Kokab Z, Iqbal Z, Mansoor K. Common uropathogens and their antimicrobial susceptibility patterns at a tertiary care hospital in Pakistan. JRMC [Internet]. 30Dec.2020 [cited 1Oct.2022];24(4):306-10. Available from: