Antibiograms from community-acquired uropathogens in Gulu, northern Uganda - a cross-sectional study

Abstract

BackgroundUrinary tract infections (UTI) are common in clinical practice and empirical treatment is largely employed due to predictability of pathogens. However, variations in antibiotic sensitivity patterns do occur, and documentation is needed to inform local empirical therapy. The current edition of the Uganda Clinical Guidelines recommends amoxicillin or cotrimoxazole as choice drugs for empirical treatment of community-acquired UTI. From our clinical observations, we suspected that this recommendation was not effective in our setting. In order to examine validity, we sought to identify bacteria from community-acquired infections and determine their susceptibility against these antibiotics plus a range of potentially useful alternatives for treatment of UTI.MethodsA cross-sectional study of mid-stream urine collected from 339 symptomatic patients over a three-month period at Gulu regional referral hospital. Qualitative culture and identification of bacteria and antibiotic sensitivity testing using the modified Kirby-Bauer disk diffusion method was done. Participants’ demographic and clinical characteristics were collected using a standard form. Results were analyzed by simple proportions among related variables and confidence intervals computed using binomial exact distribution.ResultsEighty two cultures were positive for UTI. Staphylococcus spp (46.3%) and Escherichia coli (39%) were the most common pathogens. There was high resistance to cotrimoxazole (73.2%), nalidixic acid (52.4%) and amoxicillin (51.2%). The most favorable antibiograms were obtained with gentamicin, amoxicillin-clavulanate and levofloxacin where 85.4%, 72.0%, 67.1% of isolates respectively, were either sensitive or intermediate. Only 51% of isolates were sensitive to ciprofloxacin.ConclusionThere was high resistance to most antibiotics tested in this study. The recommendations contained in the current edition of the Uganda Clinical Guidelines are not in tandem with antibiotic sensitivity pattern of uropathogens seen in our setting. Amoxicillin-clavulanate or gentamicin should be considered for replacement of amoxicillin and cotrimoxazole for empirical treatment of UTI in our setting.

Phylogenetic analysis of multidrug resistant E. coli isolates from the urinary tract in Bushenyi district, Uganda using the new Clermont phylotyping method

“…Furthermore, this study showed high sensitivity of bacterial uropathogens 69/83(83.1%) to gentamicin. The sensitivity of gentamicin demonstrated in this study is supported by previous study by Odongo et al (2013). The sensitivity shown by gentamicin in this study is slightly lower than 242.5/351 (69.1%) and 11/18 (61.1%) previously reported by Ali et al (2017) and Kabugo et al (2016) respectively.…”

“…In Uganda, the policy of treatment of UTIs was put in place but susceptibility patterns of these bacteria seem to be changing (Kabugo et al, 2016). Most of the previous studies in Uganda by Mwaka et al (2011), Odongo et al (2013), Odoki et al (2015), Katongole et al (2015), Ampaire et al (2015) and Kabugo et al (2016) focused much on the prevalence and antimicrobial susceptibility patterns of bacterial uropathogens neglecting MDR factors associated with these bacteria and their phylogenetic groups. Khawcharoenporn et al (2013) reported that, Infectious Diseases Society of America recent guidelines recommended that treatment of UTIs using antimicrobial therapy should be directly proportional to indigenous resistance profile of bacteria, drug availability and antimicrobial intolerance/allergy history of treated patients (Gupta et al, 2011).…”

Bacterial Aetiology and Antibiotic Resistance Pattern of Community-Acquired Urinary Tract Infections in Children in a Tertiary Care Hospital in Bangladesh

“…Resistance to cotrimoxazole, amoxicillin/clavulanic acid and ciprofloxacin is far above the 20% rate recommended for empirical use of antibiotics for communityacquired UTIs. 26 This result is consistent with findings from other studies in Uganda 27 and Buea 6 . Such high levels of resistance are probably due to antibiotic misuse by poorly trained health workers as has been documented in many developing countries.…”

Prevalence and antibiotic susceptibility of urinary tract infections in febrile children below ten years attending mulago hospital, Uganda

“…In this study, higher resistance rates to all antibiotics tested with the exception of imipenem and nitrofurantoin may be expounded by the high and uncontrolled usage of these antibiotics, especially third-generation cephalosporins, during the past few years in the country (20,21). Unfortunately, these antibiotics have been widely prescribed not only for urinary tract infections but also for other infections in Uganda (22) .…”