Trends and patterns of UTIs in Sindh, Pakistan with a focus on vancomycin-resistant enterococci

Urinary tract infections (UTIs) remain the most frequent clinical diagnosis and Vancomycin-resistant Enterococci (VRE) second-leading cause of UTIs. The aims of this study were to ascertain the patterns and prevalence of UTIs in Sindh and underlying resistance mechanisms for VRE. Bacterial colonies were identified traditionally from a total of 33272 urine samples. Enterococcus species were identified using Facklam and Collins scheme. Antibiotic susceptibility was determined by Kirby-Bauer method and minimum inhibitory concentration (MIC) by E-test. VRE phenotypes were checked using vancomycin and teicoplanin discs. UTIs prevalence during November-2022 to December-2023 is 22%. Reproductive-age women and elders affected most. Predominant Gram-negative pathogens were Escherichia coli (47.6%), Klebsiella spp. (15.7%), Pseudomonas aeruginosa (13.3%) and Morganella morganii (9.3%) while Enterococci were the leading Gram-positive pathogen (46%). E. faecium was the most prevalent (74.8%) followed by E. faecalis and motile Enterococci. VRE were noted 16.3%. All Enterococci were resistant to cefotaxime, ampicillin and co-amoxiclav and susceptible to linezolid. Each E. faecium was VanA phenotype while 20% E. faecalis were VanB phenotype. Vancomycin-resistance has increased by two-fold in Pakistan. The negligent-opportunistic M. morganii has emerged the fourth-leading cause of UTIs. We recommend focusing on VanRS system, a potential target of novel therapeutics for VRE.