Urinary tract infections (UTIs) remain among the most common bacterial infections worldwide, with

Escherichia coli as the predominant uropathogen. This retrospective study analyzed culture and susceptibility

empirical use. These findings highlight the value of department-specific antibiograms for guiding rational

empirical therapy, preserving carbapenem efficacy, and supporting antimicrobial stewardship initiatives to

mitigate resistance in this secondary-care hospital setting.

Urinary tract infections (UTIs) represent one of the most common bacterial infections encountered in clinical

medicine, particularly in internal medicine and primary care practice. They affect individuals across all age

groups but are particularly frequent among women, older adults, and patients with comorbidities such as

diabetes and renal disease (1). Escherichia coli remains the predominant uropathogen worldwide, responsible

for up to 80–90% of community-acquired cases and a significant proportion of hospital-acquired infections

.

antimicrobial susceptibility profile of uro-pathogens is highly dynamic and varies considerably across regions,

institutions, and even within departments of the same hospital. This variability underscores the importance of

local surveillance through hospital- and department-level antibiograms. Globally, increasing resistance to

frontline antibiotics such as fluoroquinolones and aminopenicillins has limited their empirical utility in UTI

management

. The problem is particularly pressing in India, where irrational use of antibiotics, over-the-

counter availability, and lack of stewardship practices have accelerated antimicrobial resistance (AMR)

.Department-specific antibiogram data, which reflect the patient demographics and antibiotic exposure patterns

of that unit, are therefore crucial in guiding rational empirical therapy. Such data not only inform clinicians

Materials and Methods: This study was designed as a retrospective analysis of culture and sensitivity reports

generated in the microbiology laboratory of Zonal Hospital Dharamshala, focusing exclusively on the

Medicine Department. The study period spanned January to December 2024. Out of the 982 total clinical

samples processed in the hospital during this time, the Medicine Department contributed 455 samples (46%),

with urine specimens comprising the majority. Patient demographic analysis revealed that most samples were

submitted from the outpatient department (OPD, 58%), followed by the inpatient wards (IPD, 41%), while a

small proportion originated from the intensive care unit (ICU, 1%). All participants were advised to collect the

midstream urine sample in wide mouth sterile containers after urogenital cleaning with soap and water with

sterile gauze. Samples were processed within 1 hour of collection in microbiology laboratory.

inoculated on blood agar and mac-Conkey agar using a standard loop method (semi-quantitative method).

The plates were read after 24 hours of aerobic incubation at 37 C. They were further incubated for another

24 hours before a negative report is issued. A single organism obtained in counts of>100000 CFU/ml will be

considered as significant bacteriuria. Further identification of pathogen was done by standard biochemical

techniques.

Kirby Bauer disk diffusion technique was used for antibiotic susceptibility testing of gram

negative or gram-positive pathogens. Interpretation of results were done according to CLSI guidelines. ATCC

control strains were used.

The antibiotic panel tested included carbapenems, beta-lactam/beta-lactamase

majority were obtained from the outpatient department (58%), followed by inpatient wards (41%), with only a

small proportion originating from the intensive care unit (1%). Urine was the predominant specimen type,

consistent with the department’s clinical burden of urinary tract infections. Microbiological analysis revealed

that Escherichia coli (79.7%) was the leading pathogen, followed by Klebsiella pneumoniae (16.1%) and

Pseudomonas aeruginosa (1.7%) as depicted in Figure:1 . As the Escherichia coli was the predominant

pathogen susceptibility pattern is demonstrated for it as high sensitivity to carbapenems and certain first-line

agents, with Meropenem (91%), Piperacillin–Tazobactam (89%), Gentamicin (86%), Fosfomycin (84%), and

Imipenem (84%) showing the greatest effectiveness. Moderate susceptibility was observed for Nitrofurantoin

(78%), Cefepime (73%), and Amikacin (73%), indicating their continued utility in selected cases. However,

resistance was notable against several commonly prescribed antibiotics. Lower sensitivity rates were seen with

Piperacillin–Tazobactam

Gentamicin

Fosfomycin

Imipenem

Tetracycline

Ampicillin

This departmental antibiogram highlights a clear stratification of antibiotic efficacy for Escherichia coli

urinary tract infections (UTIs) managed in the Medicine Department. Carbapenems such as meropenem (91%)

and imipenem (84%), along with β-lactam/β-lactamase inhibitor combinations like piperacillin–tazobactam

(89%), demonstrated high effectiveness (>85%), reaffirming their role as reserve drugs in complicated

Similarly, ampicillin was largely ineffective (21%), mirroring findings from kaur H et.al that report ampicillin

resistance >75% in community and hospital isolates.

cefepime (73%) and ceftazidime (62%) showing limited reliability -a trend also reported from tertiary centres

in Delhi, Chandigarh, and Uttar Pradesh, where third-generation cephalosporin susceptibility for E. coli rarely

exceeds 65–70% due to high ESBL prevalence.

These findings emphasize the need for susceptibility-

guided use of cephalosporins to prevent treatment failures. Overall, these results mirror broader Indian AMR

surveillance trends, including those reported in the ICMR-AMRSN network, which consistently highlight

escalating fluoroquinolone and aminopenicillin resistance in E. coli, stable nitrofurantoin efficacy, and high

retained activity of carbapenems.

Our findings therefore reinforce the necessity of: Regular, department-