Distribution and Antibiotic Resistance Pattern of Bacteria Isolated from Patients with Community-acquired Urinary Tract Infections in Iran: A Cross-sectional Study


  • Fatemeh Fallah 1 1. Dept. of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Soha Parhiz 1 1. Dept. of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Leila Azimi 2 2. Pediatric Infection Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • marjan rashidan 3 3. School of medicine, Shahroud University of Medical Sciences, Shahroud, Iran.




Urinary tract infections, Prevalence, Antibiotic resistance


Background: Urinary tract infections (UTIs) remain the common infections diagnosed in outpatients as well as hospitalized patients. Multi-drug resistance (MDR) and extensively-drug resistance (XDR) in bacteria is an alarming problem in the world. The aim of this study was to detection of etiologic agents associated with community-acquired urinary tract infections (CA-UTIs) and investigation of antibiotic susceptibility patterns.

Methods: This study was performed from September 2014 to March 2015 on outpatients, which referred to Labbafinejad Hospital Clinic, Tehran, Iran. The bacterial pathogenic diversity identified by standard laboratory methods. The antimicrobial resistance rates were performed by Kirby Bauer disc diffusion methods.

Results: A total of 303 patients were enrolled in this study, from which 204 (67.3%) were female and 99 (32.5%) were male patients. Escherichia coli was the dominant species (69%), followed by Enterococcus faecalis (12.8%) and Klebsiella pneumoniae (4.6%). High resistance rate to nalidixic acid (73.8%), trimethoprim/Sulfamethoxazole (54.3%), ciprofloxacin (54.3%) in E. coli,  and tetracycline (89.7%) in E. faecalis strains and high susceptibility rate to meropenem (96.6%), imipenem (95.2%), amikacin (90.4%), cefoxtin (87.6%), and  nitrofurantoin (82.8%)  in E. coli,  and nitrofurantoin (100%)                                                                                                                                                                                                                                                                                                                                                                      in E. faecalis strains were observed. In addition, 43.5% of the strains were multidrug-resistant (MDR).

Conclusions: This study showed that E. coli was the predominant uropathogen of CA-UTIs in this geographical area. It also demonstrated the empirical treatment of urinary tract infections may be difficult due to high resistance to commonly used antibiotics. Continuous monitoring of MDR organisms and drug resistance patterns are needed to prevent treatment failure and reduce selective pressure. These findings suggest the use of nitrofurantoin, cefoxitin, and amikacin in this area of the country.



Gonzalez CM, Schaeffer AJ. Treatment of urinary tract infection: what's old, what's new, and what works. World journal of urology. 1999; 17:372-82.

Najar MS, Saldanha CL, Banday KA. Approach to urinary tract infections. Indian journal of nephrology. 2009; 19:129-39.

Mishra MP, Sarangi R, Padhy RN. Prevalence of multidrug resistant uropathogenic bacteria in pediatric patients of a tertiary care hospital in eastern India. Journal of infection and public health. 2016; 9:308-14.

Haque R, Akter ML, Salam MA. Prevalence and susceptibility of uropathogens: a recent report from a teaching hospital in Bangladesh. BMC research notes. 2015; 8:416.

Abejew AA, Denboba AA, Mekonnen AG. Prevalence and antibiotic resistance pattern of urinary tract bacterial infections in Dessie area, North-East Ethiopia. BMC research notes. 2014; 7:687.

Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature reviews Microbiology. 2015; 13:269-84.

Farajnia S, Alikhani MY, Ghotaslou R, Naghili B, Nakhlband A. Causative agents and antimicrobial susceptibilities of urinary tract infections in the northwest of Iran. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2009; 13:140-4.

Komolafe OO. Antibiotic resistance in bacteria - an emerging public health problem. Malawi medical journal : the journal of Medical Association of Malawi. 2003; 15:63-7.

Jahn LJ, Munck C, Ellabaan MMH, Sommer MOA. Adaptive Laboratory Evolution of Antibiotic Resistance Using Different Selection Regimes Lead to Similar Phenotypes and Genotypes. Frontiers in microbiology. 2017; 8:816.

Akoachere JF, Yvonne S, Akum NH, Seraphine EN. Etiologic profile and antimicrobial susceptibility of community-acquired urinary tract infection in two Cameroonian towns. BMC research notes. 2012; 5:219.

Mihankhah A, Khoshbakht R, Raeisi M, Raeisi V. Prevalence and antibiotic resistance pattern of bacteria isolated from urinary tract infections in Northern Iran. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences. 2017; 22:108.

Frieri M, Kumar K, Boutin A. Antibiotic resistance. Journal of infection and public health. 2017; 10:369-78.

D H Bergey JGH. Bergey's manual of determinative bacteriology. 9th ed. USA: Baltimore : Williams & Wilkins; 1994.

(CLSI). CaLSI. Performances Standards for Antimicrobial SusceptibilityTesting; Twenty-Fourth Informational Supplement. CLSI Document M100-S24, Wyne2014.

Cullen IM, Manecksha RP, McCullagh E, Ahmad S, O'Kelly F, Flynn RJ, et al. The changing pattern of antimicrobial resistance within 42,033 Escherichia coli isolates from nosocomial, community and urology patient-specific urinary tract infections, Dublin, 1999-2009. BJU international. 2012; 109:1198-206.

O'Brien TF, Stelling J. Integrated Multilevel Surveillance of the World's Infecting Microbes and Their Resistance to Antimicrobial Agents. Clinical microbiology reviews. 2011; 24:281-95.

Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2012; 18:268-81.

van Duin D, Paterson D. Multidrug Resistant Bacteria in the Community: Trends and Lessons Learned. Infectious disease clinics of North America. 2016; 30:377-90.

Orrett FA. Urinary tract infections in general practice in a rural community in South Trinidad. Saudi medical journal. 2001; 22:537-40.

Gupta S, Kapur S, Padmavathi D. Comparative Prevalence of Antimicrobial Resistance in Community-Acquired Urinary Tract Infection Cases from Representative States of Northern and Southern India. Journal of Clinical and Diagnostic Research : JCDR. 2014; 8:Dc09-12.

Baral P, Neupane S, Marasini BP, Ghimire KR, Lekhak B, Shrestha B. High prevalence of multidrug resistance in bacterial uropathogens from Kathmandu, Nepal. BMC research notes. 2012; 5:38.

Nozarian Z, Abdollahi A. Microbial Etiology and Antimicrobial Susceptibility of Bactria Implicated in Urinary Tract Infection in Tehran, Iran. Iranian Journal of Pathology. 2015; 10:54-60.

Schito GC, Naber KG, Botto H, Palou J, Mazzei T, Gualco L, et al. The ARESC study: an international survey on the antimicrobial resistance of pathogens involved in uncomplicated urinary tract infections. International journal of antimicrobial agents. 2009; 34:407-13.

Klingeberg A, Noll I, Willrich N, Feig M, Emrich D, Zill E, et al. Antibiotic-Resistant E. coli in Uncomplicated Community-Acquired Urinary Tract Infection. Deutsches Arzteblatt international. 2018; 115:494-500.

Cordoba G, Holm A, Hansen F, Hammerum AM, Bjerrum L. Prevalence of antimicrobial resistant Escherichia coli from patients with suspected urinary tract infection in primary care, Denmark. BMC infectious diseases. 2017; 17:670.

Seifu WD, Gebissa AD. Prevalence and antibiotic susceptibility of Uropathogens from cases of urinary tract infections (UTI) in Shashemene referral hospital, Ethiopia. BMC infectious diseases. 2018; 18:30.

Ehinmidu JO. Antibiotics susceptibility patterns of urine bacterial isolates in Zaria, Nigeria. Trop J Pharm Res. 2003; 2:223-8.

Lee SJ, Lee DS, Choe HS, Shim BS, Kim CS, Kim ME, et al. Antimicrobial resistance in community-acquired urinary tract infections: results from the Korean Antimicrobial Resistance Monitoring System. Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy. 2011; 17:440-6.

Nzalie RN, Gonsu HK, Koulla-Shiro S. Bacterial Etiology and Antibiotic Resistance Profile of Community-Acquired Urinary Tract Infections in a Cameroonian City. International journal of microbiology. 2016; 2016:3240268.

Sharma I, Paul D. Prevalence of community acquired urinary tract infections in Silchar Medical College, Assam, India and its antimicrobial susceptibility profile. Indian journal of medical sciences. 2012; 66:273-9.

Mirzarazi M, Rezatofighi, S.E., Pourmahdi, M., Mohajeri, M.R. Antibiotic Resistance of Isolated Gram Negative Bacteria From Urinary Tract Infections (UTIs) in Isfahan. Jundishapur J Microbiol. 2013; 6:1-5.

Ghanbari F, Khademi, F., Saberianpour, Sh., Shahin, M., Ghanbari, N., Naderi, K., Motalebi-Rad, T. An Epidemiological Study on the Prevalence and Antibiotic Resistance Patterns of Bacteria Isolated from Urinary Tract Infections in Central Iran. Avicenna J Clin Microb Infec. 2017:1-5.

Ramirez-Castillo FY, Moreno-Flores AC, Avelar-Gonzalez FJ, Marquez-Diaz F, Harel J, Guerrero-Barrera AL. An evaluation of multidrug-resistant Escherichia coli isolates in urinary tract infections from Aguascalientes, Mexico: cross-sectional study. Annals of clinical microbiology and antimicrobials. 2018; 17:34.

Thapa P, Parajuli, K., Poudel, A., Thapa, A., Manandhar, B., Laudari, D., Malla, H.B., Katiwada, R. Causative Agents and Susceptibility of Antimicrobials among Suspected Females with Urinary Tract Infection in Tertiary Care Hospitals of Western Nepal. Journal of Chitwan Medical College. 2013; 3:16-9.

Moroh J-LA, Fleury, Y., Tiac, H., Bahia, C., Lietard , C., Coroller, L., Edoh, V., Coulibaly, A., Labiab, R., Leguerinel, I. Diversity and antibiotic resistance of uropathogenic bacteria from Abidjan. African Journal of Urology. 2014; 20:18-24.

Ali I, Kumar N, Ahmed S, Dasti JI. Antibiotic Resistance in Uropathogenic E. Coli Strains Isolated from Non-Hospitalized Patients in Pakistan. Journal of Clinical and Diagnostic Research : JCDR. 2014; 8:Dc01-4.

Shilpi T, Ahmed, M.N., Ariful Huq, S.M., Baul, S.K., Khatun, M. Isolation of Bacteria Causing Urinary Tract Infections and their Antibiotic Susceptibility Profile at Anwer Khan Modern Medical College Hospital. Anwer Khan Modern Medical College Journal 2013; 4:23-7.

Kidwai SS, Nageen A, Ghaznavi S, Bashir F, Ara J. Antibiotic susceptibility in commonly isolated pathogens from urinary tract infection in a cohort of subjects from low socioeconomic strata. Pakistan journal of medical sciences. 2017; 33:254-9.

Akram M, Shahid M, Khan AU. Etiology and antibiotic resistance patterns of community-acquired urinary tract infections in J N M C Hospital Aligarh, India. Annals of clinical microbiology and antimicrobials. 2007; 6:4.

Kiffer CR, Mendes C, Oplustil CP, Sampaio JL. Antibiotic resistance and trend of urinary pathogens in general outpatients from a major urban city. International braz j urol : official journal of the Brazilian Society of Urology. 2007; 33:42-8; discussion 9.

Rashidan M, Ghalavand, G., Eslami, G., Gachkar, L., Rahbar, M., Khosravi, R., Ghandchi, Gh., Fallah, F. Molecular detection of antibiotic resistance genes among Enterococcus faecalis isolated from fecal and urine samples of patients with community-acquired urinary tract infections. Arch Pediatr Infect Dis. 2016; 4:1-8.

Khalid HM. Molecular detection of virulence factors of enterococcus faecalis isolated from urine samples in Duhok City, Kurdistan Region/Iraq. Sci J Univ Zakho. 2016; 4:63-72.

Singhal A, Sharma R, Jain M, Vyas L. Hospital and Community Isolates of Uropathogens and their Antibiotic Sensitivity Pattern from a Tertiary Care Hospital in North West India. Annals of Medical and Health Sciences Research. 2014; 4:51-6.

Asadpour L. Antibacterial drug resistance patterns in poultry isolated enterococci. Afr J Microbiol Res. 2012; 6:5857–61.







How to Cite

Distribution and Antibiotic Resistance Pattern of Bacteria Isolated from Patients with Community-acquired Urinary Tract Infections in Iran: A Cross-sectional Study. (2019). International Journal of Health Studies, 4(2). https://doi.org/10.22100/ijhs.v4i2.631