1

BACTERIOLOGICAL PROFILE OF COMMUNITY ACQUIRED

URINARY TRACT INFECTION

PLAN OF THESIS
FOR APPROVAL OF THE SUBJECT OF THESIS
TO BE SUBMITTED IN PARTIAL FULFILMENT OF REQUIREMENTS FOR
THE DEGREE OF M.Sc. MEDICAL MICROBIOLOGY

MAHARISHI MARKANDESHWAR UNIVERSITY

DEEMED TO BE UNIVERSITY
MULLANA (DISTT. AMBALA)

JAIDEV
Roll No. 16207945
SESSION: 2020-23
DEPARTMENT OF MICROBIOLOGY
MAHARISHI MARKANDESHWAR INSTITUTE OF MEDICAL SCIENCES &
RESEARCH
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APPROVAL PROFORMA BY RESEARCH AND ETHICAL COMMITTEE

MAHARISHI MARKENDESHWAR INSTITUTE OF MEDICAL SCIENCES

AND RESEARCH
Name of Candidate JAIDEV

Department Dept. of Microbiology

Topic of thesis BACTERIOLOGICAL PROFILE OF

COMMUNITY ACQUIRED URINARY
TRACT INFECTION

Likely date of appearing in the examination June 2023

Date of enrolment August 2020

Name of Head of Department Dr. Narinder Kaur

Name of the Supervisor & Designation Dr. Rosy Bala

Assoc. Professor
Dept. of Microbiology

Approved: Yes/No Approved: Yes/No

Chairperson Member Secretary

PG board of Studies concerned Institutional Ethics committee/IEC

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APPLICATION FORM FOR APPROVAL OF SUBJECT OF THESIS

FOR M.Sc. MEDICAL MICROBIOLOGY OF

MAHARISHI MARKANDESHWAR DEEMED TO BE UNIVERSITY,

MULLANA (DISTT.AMBALA)

1. Name of candidate JAIDEV

2. Father's Name Hari Ram
3. Mother's Name Shakuntla
4. Correspondence Address of The House no. 139,VPO Saran, district
Candidate Yamuna nagar, Tehsil Jagadhiri
5. Month and year of passing B.Sc. August 2016
Examination
6. Name of the University from MMDU, Mullana
Where Graduated

7. Present Designation/Posting P.G. Student,

Department of Microbiology
8. Date of joining PG course. August 2020
9. Likely date of Appearing for PG June 2023
Examination
10. Proposed Subject of Thesis BACTERIOLOGICAL PROFILE OF
COMMUNITY ACQUIRED
URINARY TRACT INFECTION

11. Facilities for The Subject of thesis Adequate material and guidance
available
12. Name and Designation of The Dr. Rosy Bala
Supervisor Assoc. Professor,
Department of Microbiology

Date.23-03-2016 Signature of the candidate

Place: Mullana
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CERTIFICATE OF CONSENT OF SUPERVISOR AND AVAILABILITY OF

FACILITIES FOR WORK

It is certified that facilities for the work on the subject of thesis entitled
“BACTERIOLOGICAL PROFILE OF COMMUNITY ACQUIRED URINARY
TRACT INFECTION” do exist in the Department of Microbiology, MMIMSR,
Mullana, Ambala and will be provided to the candidate. I will see that the data being
included in the thesis will be genuine and collected by the candidate him/herself
under my supervision and guidance.

It is further certified that the research work on the subject of thesis has not been
carried out earlier in this institution.

Dr. Rosy Bala

Assoc. Professor
Department of Microbiology
MMIMSR, Mullana
(SUPERVISOR)
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(THROUGH PROPER CHANNEL)

To

The Chairman,
P.G. Board of studies in Microbiology
-Cum- Principal,
M.M. Institute of Medical Sciences & Research,
Mullana (Ambala)

Respected sir,

The Thesis plan submitted by JAIDEV titled “BACTERIOLOGICAL PROFILE

OF COMMUNITY ACQUIRED URINARY TRACT INFECTION” has been
discussed and approved in the meeting held in Department of Microbiology,
MMIMSR, Mullana Facilities for the subject of thesis exist in the department and will
be provided to the candidate.

It is further certified that the research work on the subject of thesis has not been
carried out earlier in this institution.

I forward this plan of thesis for your kind approval and necessary action.

Dr. Narinder Kaur

MD Microbiology
Professor and Head
Dept. of Microbiology
MMIMSR, Mullana
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M.M. INSTITUTE OF MEDICAL SCIENCES & RESEARCH MULLANA (AMBALA)

CONSENT FORM

Whole study “BACTERIOLOGICAL PROFILE OF COMMUNITY ACQUIRED

URINARY TRACT INFECTION” and its procedure have been well explained
in the language I can best understand. I hereby consent voluntarily to
participate as a study subject.

(Signature/Thumb print of subject)

Full name of the subject ……………………

Signature of candidate …………………….

Date : ………………

Place : ……………..
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INTRODUCTION

Urinary tract infections (UTIs) are among the most often detected bacterial illnesses in community

health settings. Because point-of-care bacterial testing is not accessible, community-acquired

urinary tract infections are frequently treated empirically with broad-spectrum antibiotics. Several

investigations have found regional differences in the causative agents of UTIs and associated

antibiotic resistance patterns. (1)

Antimicrobial susceptibility testing results for urinary tract infections are normally obtained two

to three days following sample collection. As a result, in the vast majority of community-acquired

UTI (CAUTI) patients, treatment decisions are made empirically based on the predicted spectrum

of etiological microorganisms and accessible data on antibiotic resistance in previous infections.

(2) Given that, like with many other community-acquired illnesses, resistance to antimicrobials

routinely used in UTI treatment is rising, and microorganism susceptibility varies significantly by

geography.(3) To aid clinicians in empiric treatment, investigations targeted at increasing

knowledge of local etiologic agents of UTIs and their resistance patterns to antibiotics are required.

Recent investigations demonstrate that antibiotic resistance is on the rise demanding the ongoing

monitoring of uropathogen antibiotic susceptibility.(4) The goal of this study is to identify the most

common bacterial etiologic agents linked to community-acquired infections. UTIs and their

susceptibilities to commonly empirically pre- scribed antibiotics in cases of UTIs to generate data

that will improve the efficacy of empiric treatment of this infection.

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REVIEW OF LITERATURE

1.) Marcus N et al (2008) - In their study they encounter about 351 episodes of UTI in which
28 (8%) was caused by pseudomonas species. They also observed pseudomonas UTI was
most common in children above 5yrs. Pseudomonas isolates shows resistance to various
group of antibiotics as well. (5)

2.) Dr. Shobha KL et al (2011) - They proceed about 5146 midstream urine specimen of
patients suspected for UTI. Out of 5146 specimen, 1271 specimen show positive culture
growth. Among 1271 positive culture specimen non fermenter gram -ve bacilli was 120
measure about 9.44% and remaining positive culture includes fermenter gram negative
bacilli and gram +ve cocci. In case of non-fermenter GNBs, the number of Pseudomonas
spp. was 97 (07.63 %) and Acinetobacter spp. 23 (01.80 %). (6)

3.) K.K Benachinmardi et al (2012) – During their study period they received 307 specimen
of urine. 12 specimens show positive culture growth. Pseudomonas species are most
common isolates which are followed by the Acinetobacter species. Most isolates of
pseudomonas species showed high sensitivity to Amikacin and least sensitive to
Piperacillin. Acinetobacter isolates showed sensitivity to most of the antibiotics. (7)

4.) Sanjeev H et al (2013) - In their study 2240culture positive samples were reported with
46 isolates of acinetobacter were recorded from UTI patients. Most sensitive antibiotics
was found to be tigecycline (91%) followed by imipenem (69.5%), meropenem (67.3%)
and gatilfoxacin (63%). (8)

5.) Rachana Solanki (2015) – They processed 10198 urine samples for quantitative culture
in their study. From this study 15.6 percentage of culture significantly showed growth and
primarily enterobactereace has been isolated from the culture +ve sample and from the
culture positive sample about 2.1% were non-fermenter isolates. (9)

6.) Gore. S et.al (2015) – During their study period they received about 4146 sample for
bacteriological isolation. Out of 4146 sample 150(37.33%) non fermenters gram negative
bacilli were isolated. Pseudomonas 0aeruginosa (62.66%) was the most predominant
isolate followed by 0Acinetobacter 0baumunii (23.33%). (10)
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7.) Jose Luis Lamas 0Ferreiro et.al (2017) – In their study they collected specimens from
62 patients with an average age of 75 years of patients. Out of 62 patients percentage of
male was 51.In their study, mortality rate was 17.7% and 33.9% at 30 days and 90 days
respectively. In 30 days decreased survivability factors were associated with septic shock,
D. mellitus, liver disease, chronic renal failure.. 0Charlson index > 3 and in-adequate
definitive antibiotic treatment. Advanced chronic liver impairment, D. mellitus, renal
failure and insufficient definitive antimicrobial treatment were the self-determining factors
for mortality in multivariate analysis. (11)

8.) Shobha KL et. al (2017):- During their study 107 urine samples were processed of
Pseudomonas species in which MALDI attain from 69 male (64.48%) and 38 (35.51%) female
patients. In patients were 90 (84.11%) and 17 (15.88%) were outpatient department (OPD)
patients. Pseudomonas aeruginosa were isolated from 90 samples (84.11%) and Pseudomonas
putida in 17 (15.88%). In the age of 60 years, significant bacteriuria was seen in both genders
.it was Susceptible to gentamicin was 52 (48.59%), ceftazidime 56 (52.33%), and imipenem
was 58 (54.20%). Organism was multidrug resistant in 49 (45.79%) samples. (12)
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AIM & OBJECTIVES

 To determine the prevalence of bacterial etiologic agents associated with community-

acquired UTIs
 To determine the antimicrobial sensitivity patterns of the isolates.
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MATERIAL & METHOD

Study will conducted on urine sample collected from Patients with urinary tract infection at
MMIMSR & hospital.

STUDY APPROACH – The study will be conducted on patients screened for community
acquired urinary tract infection.

STUDY DESIGN – It will be cross sectional study carried out in the Department of Microbiology,
M.M Institute of Medical Sciences and Research Mullana, Ambala.

STUDY PERIOD – It will be study of one year 2022-23

INCLUSION CRITERIA-

1. All the patients with urinary tract infection will be recruited in the study.

EXCLUSION CRITERIA-

1. Age Less than 18 years

2. Patients with indwelling catheter
3. Immunosuppressed patients

STUDY POPULATION: -

On the basis of above mentioned inclusion and exclusion criteria the study populations will
recruited. Minimum of 100 patients were screened for community acquired urinary tract infection.

ETHICS CONSIDERATION:

The current study will not enforced any financial liability to the participants. Informed and written
consent will be taken from the participants before conducting the study. Permission will be taken
from the Institutional Ethical Committee (IEC) before starting the study.

SAMPLE COLLECTION

Mid-stream Urine sample will be collected from the suspected patients. Urine sample will be then
cultured on blood agar and MacConkey agar for isolation of bacteria.
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PROCESSING OF SAMPLE:-

1. Direct wet mount

2. Culture on Blood agar & MacConkey agar
3. Antimicrobial sensitivity testing

Microscopy of urine: -Microscopic examination of urine will be done by wet film preparation. It
is done principally to detect the presence of polymorphs (pyuria) as an indication of infection in
the urinary tract when the culture may fail to show significant bacteriuria.

Culture:– The Urine samples which will received from OPD & IPD patients will be inoculated
on Blood agar and MacConkey agar ( by streaking with sterile Nichrome wire loop (4 mm,
Calibrated 0.01 ml) and will be incubated at 370 C for 18-24 hours, aerobically. Organisms grown
in culture and in major number (>105cfu/ml) for midstream urine samples will be recognized by
standard biochemical tests and antibiotic susceptibility will be done by Kirby-Baurer disc diffusion
method.

Significant bacteriuria- When bacterial count is more than 105 /ml of a single species.

Doubtful significance - Between 104 to 105 bacteria per ml.

No significant growth- < 103 bacteria per ml and will be regarded as contaminant.
Gram staining: Gram staining will be done from the pure growth of Blood agar and MacConkey
agar.
BIO-CHEMICAL TEST

GRAM POSITIVE BACTERIA GRAM NEGATIVE BACTERIA

Catalase Catalase

Coagulase Oxidase

Optochin sensitivity testing Oxidation fermentation test

Bacitracin sensitivity testing Nitrate reduction test

Bile esculin test Indole

Mannitol motility test

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MR / VP

Citrate utilization test

Urease

TSI test

The further microbiology lab investigation will be done as per standard operating protocol.
After culture and biochemical test will be done, AST will be performed as per CLSI
guidelines.

Microbiology lab Investigations:

Specimen

Wet mount Pus cell RBC Bacteria Fungal Crystal Wax/casts Other
element

Culture findings Blood agar MacConkey agar

Biochemical Catalase Coagul Optochin Bacitracin Bile Oxidation Nitrate

identification ase sensitivity sensitivity esculin fermentation reduction
test test test test test
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oxidase Indole Mannitol MR/ VP Citrate Urease TSI

motility utilisation
test test

ANTIBIOTICS SENSITIVITY PATTERN

Suspected
organism

Resistance Intermediate Sensitive

NOTE:
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BIBLIOGRAPHY
1. TAN C, CHLEBICKI M. URINARY TRACT INFECTIONS IN ADULTS. SINGAPORE
MED J [INTERNET]. 2016 SEP;57(09):485–90. AVAILABLE FROM:
HTTP://WWW.SMJ.ORG.SG/ARTICLE/URINARY-TRACT-INFECTIONS-ADULTS
2. FARRELL DJ, MORRISSEY I, DE RUBEIS 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.
3. VENTOLA CL. THE ANTIBIOTIC RESISTANCE CRISIS: CAUSES AND THREATS:
PART 1: CAUSES AND THREATS. PHARM THER [INTERNET]. 2015;40(4):277–83.
AVAILABLE FROM:
HTTP://WWW.NCBI.NLM.NIH.GOV/PUBMED/25859123%5CNHTTP://WWW.PUB
MEDCENTRAL.NIH.GOV/ARTICLERENDER.FCGI?ARTID=PMC4378521%5CNHT
TP://WWW.NCBI.NLM.NIH.GOV/PUBMED/25859123%5CNHTTP://WWW.PUBME
DCENTRAL.NIH.GOV/ARTICLERENDER.FCGI?ARTID=PMC4378521
4. BADER MS, LOEB M, BROOKS AA. AN UPDATE ON THE MANAGEMENT OF
URINARY TRACT INFECTIONS IN THE ERA OF ANTIMICROBIAL RESISTANCE.
POSTGRAD MED. 2017;129(2):242–58.
5. MARCUS N, ASHKENAZI S, SAMRA Z, COHEN A, LIVNI G 2008 OCT;36(5):421-6.
DOI: 10.1007/S15010-008-7328-4.
6. KL S, RAO GG, KUKKAMALLA AM. PREVALENCE OF NON-FERMENTERS IN
URINARY TRACT INFECTIONS IN A TERTIARY CARE HOSPITAL.
WEBMEDCENTRAL MICROBIOLOGY 2011;2(1):WMC001464
7. BENACHINMARDI KK, PADMAVATHY M, MALINI J, NAVENEETH B V.
PREVALANCE OF NON FERMENTING GRAM NEGATIVE BACILLI AND THEIR
ANTIBIOTIC SUCEPTIBILITY PATTERN AT A TERTIARY CARE TEACHING
HOSPITAL. J SCI SOC 2014;41:162-6
8. SANJEEV H. , SWATHI N. , ASHA PAI , REKHA R. , VIMAL K. & GANESH H.R
NUJHS VOL. 3, NO.4,(7-9). DECEMBER 2013, ISSN 2249-7110
9. SOLANKI R, DAWAR R, AGGARWAL DK, RANI H, IMDADI F, ET AL. (2015)
NONFERMENTING GRAM-NEGATIVE BACILLI AND URINARY TRACT
INFECTION -SORTING THE MYSTERY OF INFECTIONS CAUSED. J MED MICROB
DIAGN 4:210. DOI: 10.4172/2161-0703.1000210
10. GORE SHALINI, PAI CHITRA. INT.J.CURR.MICROBIOL.APP.SCI (2015) 4(11): 623-
629
11. LAMAS FERREIRO JL, ÁLVAREZ OTERO J, GONZÁLEZ GONZÁLEZ L, ET AL.
PSEUDOMONAS AERUGINOSA URINARY TRACT INFECTIONS IN
HOSPITALIZED PATIENTS: MORTALITY AND PROGNOSTIC FACTORS. PLOS
ONE. 2017;12 (5):E0178178. PUBLISHED 2017 MAY 26.
DOI:10.1371/JOURNAL.PONE.0178178
12. SHOBHA KL1, RAMACHANDRA L, AMITA SHOBHA RAO, ANAND KM,
GOWRISH RAO. ASIAN J PHARM CLIN RES, VOL 10, ISSUE 11, 2017, 50-51
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M.M. INSTITUTE OF MEDICAL SCIENCES & RESEARCH MULLANA

(AMBALA)

CONSENT FORM

Whole study “EVALUATION OF DEVICE ASSOCIATED NOSOCOMIAL INFECTION

IN INTENSIVE CARE UNIT” and its procedure have been well explained in the
language I can best understand. I hereby consent voluntarily to participate as
a study subject.

(Signature/Thumb print of subject)

Full name of the subject ……………………
Signature of candidate …………………….

Date : ………………
Place : ……………..
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