Factors associated with community-acquired urinary tract infections among adults attending assessment centre, Mulago Hospital Uganda

Abstract

Background: Urinary tract infections (UTI) are a common medical problem affecting the general population and thus commonly encountered in medical practice, with the global burden of UTIs at about 150 million people. Because uropathogens largely originate from colonic flora, they are easy to predict, and this is the rationale for empirical treatment in Community Acquired-UTI (CA-UTIs). With the increasing prevalence of drug-resistant bacteria among adults with CA-UTI in Uganda, it is no longer adequate to manage CA-UTIs on empiric regimen without revising the susceptibility patterns of common CA-UTI causative agents. Thus in this study we set out to identify: The factors associated with CA-UTIs, the common uropathogens and the drug sensitivity patterns of the common uropathogens cultured. Methodology: This was a cross-sectional study that was conducted in adults who presented with symptoms of a UTI at Mulago Hospital, assessment center. There were 139 patients who consented to the study and were recruited, an interviewer administered questionnaire was used to collect information from the study participants as regards demographic, social and clinical characteristics and Mid Stream Urine (MSU) samples were collected for urinalysis, culture and antibiotic susceptibility testing using the Kirby-Bauer disc diffusion technique was applied to the isolates.Numeric data were summarized using measures of central tendency while the categorical data was summarized using proportions and percentages. Results: Age, female sex and marital status were factors that were significantly associated with CA-UTIs. Fifty four (54) cultures were positive for UTI with 26 giving pure growths. The commonest uropathogen isolated was Escherichia coli at 50%, this was followed by Staphylococcus aureus at 15.4%. The sensitivity of Escherichia coli to Ampicillin and Nitrofurantoin were78.6%, 64.3% respectively, and the sensitivity of Staphylococcus aureus to ciprofloxacin, Nitrofurantoin and gentamycin were 100%, 66.7% and 66.7% respectively. Conclusion: There are known factors associated with CA-UTIs such as age, female sex. There was generally high sensitivity to nitrofurantoin and gentamycin by most of the uropathogens isolated, and high resistance to the common antibiotics such as nalidixic acid and erythromycin thus a need for a bigger study that can be used to effect the change of the current recommendations in the Uganda Clinical Guidelines as regards empirical management of CA-UTIs.

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

“…This substantial sensitivity of nitrofurantoin shown in this study is in conformity with previous reports of Odoki et al (2015) and Ekwealor et al (2016) who reported 78/103 (75.7%) and 191/212 (90.1%) sensitivities respectively. The sensitivity shown by nitrofurantoin in our study is in agreement with study done by Kabugo et al (2016) who reported 12/18 (66.7%) sensitivity of uropathogens to nitrofurantoin. This study demonstrated that the prevalence of MDR strains observed in the Klebsiella spp.…”

“…The Gram negative bacteria demonstrated 56/56 (100.0%) resistance to erythromycin, this finding is more similar to previous reports by Kyabaggu et al (2007); Kibret and Abera, (2011) and Adwan et al (2014). The Gram positive bacteria resistance to erythromycin of 18/30 (60.0%) reported in this study is more comparable to previous report by Kabugo et al (2016). The resistance of 74/86 (86.0%) to co-trimoxazole in this study is in agreement with previous reports of Odoki et al 2015 Katongole et al (2015) who reported 90/103 (87.4%), 10/14 (71.4%) and 7/8 (87.5%) respectively.…”

“…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. Finally, this study demonstrated considerable sensitivity of 69/86 (80.2%) of nitrofurantoin to the bacterial uropathogens tested.…”

“…The increase in the rise of drug resistant bacteria resulted into MDR strains (Li and Webster, 2018). 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.…”

“…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).…”