Culture Requests and Multi-Drug Resistance among Suspected Urinary Tract Infections in Two Tertiary Hospitals in Freetown, Sierra Leone (2017–21): A Cross-Sectional Study

Abstract

In sub-Saharan Africa, there is limited information about the use of microbiology laboratory services in patients with suspected urinary tract infections (UTIs). This cross-sectional study assessed the requests for urine culture in patients with suspected UTI in two tertiary (maternal and paediatric) hospitals—Freetown and Sierra Leone, during May 2017–May 2021—and determined antimicrobial resistance (AMR) patterns among bacterial isolates. One laboratory served the two hospitals, with its electronic database used to extract information. Overall, there were 980 patients, of whom 168 (17%) had cultures requested and performed. Of these, 75 (45%) were culture positive. During 2017–2019, there were 930 patients, of whom 156 (17%) had cultures performed. During 2020–2021, when services were disrupted by the COVID-19 pandemic, there were 50 patients, of whom 12 (24%) had cultures performed. The four commonest isolates were Escherichia coli (36), Klebsiella pneumoniae (10), Staphylococcus aureus (9), and Pseudomonas spp. (6). There were high levels of AMR, especially for trimethoprim-sulfamethoxazole (47%), nalidixic acid (44%), nitrofurantoin (32%) and cefotaxime (36%). Overall, 41 (55%) bacterial isolates showed multidrug resistance, especially E. coli (58%), Pseudomonas spp. (50%), and S. aureus (44%). These findings support the need for better utilization of clinical microbiology services to guide antibiotic stewardship and monitoring of trends in resistance patterns.

Newly Isolated Virulent Salmophages for Biocontrol of Multidrug-Resistant Salmonella in Ready-to-Eat Plant-Based Food

“…Paratyphi A, B, or C), or salmonellosis (various other S. enterica serovars) [ 4 , 5 , 6 , 7 ]. Due to irrational antibiotic stewardship and the lack of a proper antibiotic policy, an increase in the incidence of the multidrug resistance (MDR) of bacteria has been observed recently [ 7 , 8 , 9 ]. One of the vectors of antibiotic resistance is the food chain through which bacteria can acquire antibiotic resistance genes (ARGs) [ 10 , 11 , 12 ].…”

“…One of the main bacterial pathogens transmitted through food and water is Salmonella-the etiological agent of diseases such as typhoid (caused by S. Typhi), paratyphoid (S. Paratyphi A, B, or C), or salmonellosis (various other S. enterica serovars) [4][5][6][7]. Due to irrational antibiotic stewardship and the lack of a proper antibiotic policy, an increase in the incidence of the multidrug resistance (MDR) of bacteria has been observed recently [7][8][9]. One of the vectors of antibiotic resistance is the food chain through which bacteria can acquire antibiotic resistance genes (ARGs) [10][11][12].…”

Frequency of healthcare-associated urinary tract infections in a tertiary care hospital: microbiological profile

“…Healthcare-associated infections (HAIs) are defined by the World Health Organization (WHO) as "an infection that is acquired by a patient during care delivery in a hospital or other health care facility that was not present or incubating on admission" 1 . HAIs are a global concern for public health since microorganism resistances are increasingly becoming a real challenge for management in critical care patients 2 .…”