A Comparison of Antibiotic Susceptibility Patterns of Klebsiella Associated Urinary Tract Infection in Spinal Cord Injured Patients with Nosocomial Infection

Just regarding different risk factors for antibiotic resistant uropathogenes, it seems justice to improve diagnostic power for drug resistant uropathogenes and well appropriate empirical therapy. 300 and 145 cases of clinicopathologically diagnosed nosocomial and spinal cord injured (SCI) associated urinary tract infection (UTI), respectively, were considered as our samples included in our 24 months study (2005 and 2006). 50 (16.6%) and 26 (17.9%) correctly diagnosed Klebsiella, respectively, were cultured from our specimens . MIC pattern of this uropathogenes for 8 antibiotics was determined by gradient concentration method. The prevalence of antibiotic resistant Klebsiella was more among nosocomial associated UTI rather than SCI UTI (P<0.05). According to susceptibility cut-off point criteria of CLSI M7-A6 (Clinical and Laboratory Standard Institute), Klebsiella resistance rate of nosocomial and SCI were 40% and 0 in amikacin (P <0.0001), 86.2% and 16.7% in ceftazidime (P<0.001), 69% and 25% in ceftriaxon (P<0.005), 5.1% and 0 in imipenem (P<0.0001), 50% and 25% in ciprofloxacin (P< 0.05), 81% and 22.2% in gentamicin 100%and 62.5% (P<0.001) in trimethoprim/sulfamethoxazole (P<0.05 ) respectively. Only resistance to nalidixic acid was mildly higher in SCI Klebsiella (68.8%, 66.7%). MIC 50 of all antibiotics except nalidixic acid and trimethoprim/ sulfamethoxazole were higher in nosocomial Klebsiella (P<0.05). In conclusion although the whole risk factors for UTI in the cases of SCI associated UTI are more than for nosocomial UTI. Interestingly, the prevalence of Klebsiella resistant UTI was more in the second group.