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Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 20-27

Mixed flora in the urine of hospitalized and elderly patients: Contamination or True infection?

1 Department of Microbiology; Sri Aurobindo Institute of Medical Sciences Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India
2 Department of Biochemistry; Indira Gandhi National Open University, New Delhi, India
3 Sri Aurobindo Institute of Medical Sciences Medical College and Post Graduate Institute, Indore, Madhya Pradesh; Department of Biochemistry, Indira Gandhi National Open University, New Delhi, India

Correspondence Address:
Trupti Bajpai
Department of Microbiology, Sri Aurobindo Institute of Medical Sciences Medical College and Post Graduate Institute, MR-10 Crossing, Indore-Ujjain Highway, Indore, Madhya Pradesh - 453 111
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2348-0149.135722

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Background: Bacteriuria in potentially complex group of patients (those including geriatric population and patients with an anatomically abnormal urinary tract or with significant medical or surgical co morbidities) needs to be managed appropriately. In such clinical settings, polymicrobial bacteriuria is frequently considered remarkable especially due to its adverse effects on the subject. Aim: The aim of the study was to report the common pathogens and to evaluate the clinical significance of polymicrobial bacteriuria (mixed flora) from urine samples of elderly and hospitalized (catheterized) patients and study the drug resistance mechanisms revealed by the isolates from mixed flora and possibly reassessing the current diagnostic standard procedure. Materials and Methods: The present study was conducted in the Department of Microbiology of a teaching tertiary care hospital located in central India, from July 2013 to December 2013. All the uropathogenic isolates were identified up to species level by conventional and automated methods. The samples with mixed flora were picked up as significant based on patient's age, clinical conditions, hospitalization status, pyuria, and significant bacteriuria. Drug resistance mechanisms were detected in all the isolates. Results and Discussion: Urine samples from 1471 male and female, inpatients and outpatients were studied. Six hundred and eight (41.3%) samples were found to be positive with 59 (9.7%) confirmed with mixed flora (two pathogens). Among the 59 samples with mixed flora, 44 patients were grouped as catheterized (18 patients were elderly and catheterized both), one was elderly but not catheterized, eight patients had urological while six had gynaecological problems. Study revealed that Escherichia coli were frequently replaced by other organisms (other Gram negative bacilli, Gram positive cocci, and Candida) in urine samples from male patients. The isolates exhibited considerable ranges of antibiotic resistance. Conclusion: The pathogens present in the urine samples with mixed flora that are frequently dismissed as contaminants may constitute important drug resistant mechanisms. As a result, the patients with the mixed flora in their urine may be left untreated or inadequately treated. Therefore, there is an urgent need to modify the guidelines for urinary tract infection (UTI) diagnosis with respect to high risk patients.

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