<p>Community acquired urinary tract infections among adults in Accra, Ghana</p>

Abstract

Background: Urinary tract infection (UTI) is one of the most common bacterial infectious diseases encountered in clinical practice, and accounts for significant morbidity and high medical costs. To reduce its public health burden, there is the need for local research data to address aspects of prevention and management of UTI. The aim of this study was to investigate community-acquired UTI among adults in Accra, Ghana, including the risk factors, etiological agents, and antibiotic resistance. Methods: This was a cross-sectional study involving 307 patients clinically diagnosed with UTI at the Korle Bu and Mamprobi polyclinics in Accra. Urine specimens were collected from the study participants and analyzed by culture, microscopy, and dipstick. The bacterial isolates were identified using standard microbiological methods and tested against a spectrum of antibiotics by the Kirby Bauer method. Multidrug resistant Enterobacteriaceae isolates were screened for Extended Spectrum β-lactamase (ESBL) production by the double disc method, and isolates that tested positive were analyzed by Polymerase Chain Reaction for ESBL genes. Demographic information and clinical history of study participants were collected. Results: Based on the criteria for laboratory confirmed UTI, 31 (10.1%) of the 307 specimens were positive and the main risk factor of UTI among the study participants was pregnancy ( P =0.02, OR=2.43). The most common uropathogen isolated was Escherichia coli (48.9%), followed by Klebseilla sp. (16.1%). Prevalence of resistance was highest for Piperacillin (87.1%) and Amoxicillin+Clavulanic Acid (87.1%) and lowest for Amikacin (12.9%). Prevalence of multidrug resistance among the uropathogens was 80.1% (25) and the most common ESBL gene detected was CTX-M-15. Conclusion: Pregnant women constitute the key risk population of UTI in Accra, while Amikacin remains a suitable drug for the treatment of febrile UTI. The high prevalence of multidrug resistance among the uropathogens highlights the need for surveillance of antimicrobial resistance among these pathogens.

Clonal Clusters, Molecular Resistance Mechanisms and Virulence Factors of Gram-Negative Bacteria Isolated from Chronic Wounds in Ghana

“…The gene bla CTX-M-15 was identified as the determinant of the detected extended spectrum beta-lactamase (ESBL) expression in ESBL positive Enterobacterales [ 23 ]. This is in line with previous reports from both human and livestock-associated ESBL positive Enterobacterales in Ghana [ 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. In P. aeruginosa and K. pneumoniae , bla SCO-1 , which has initially been described from an Acinetobacter baumannii isolate from Argentina [ 35 ], was observed.…”

“…Thereby, known high-risk clones [ 25 , 26 , 27 ] played only a minor role. Observed resistance patterns and mechanisms were in line with the spectrum expected from previous reports [ 23 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ].…”

Antibiotic Susceptibility and Molecular Characterization of Uropathogenic Escherichia coli Associated with Community-Acquired Urinary Tract Infections in Urban and Rural Settings in South Africa

“…Assuming minimal Gram-positive etiology in UTIs, this study showed a potential over-diagnosis of UTIs based on clinical assessments, mostly by primary healthcare nurses in CHCs. Such over-misdiagnosis would result in the unnecessary administration of empirical antibiotics, leading to several adverse consequences such as an increase in antibiotic resistance as well as cost to the hospitals and patients [ 23 ].…”

Macroscopy and Microscopy Urinalysis: A Vital Screening Procedure for Urinary Tract Infections (UTIs) in a Hospital in Awka, Nigeria

“…The loop used transfers an inoculum of 0.002ml. The calibrated loop was used aseptically to transfer specimens on Cystein Lactose Electrolyte Deficient (Rapid Labs) media and incubated aerobically at 37°C for 18-24 hours (Cheesbrough, 2006;Donkor et al, 2019). Following incubation, significant bacterial growth was taken as any count of uniform colonies equal to or in excess of 10 4 CFU per milliliter of urine (Alao and Akintunde, 2012;Emiru et al, 2013;Akter et al, 2014;Mina et al, 2017).…”

“…Some inexpensive screening methods (involving dipstick test and microscopy) are useful in fast detection of people who are at high risk of UTI (Kabugo et al, 2016;Agbagwa and Ifeanacho, 2015). Several research findings at Ghana (Donkor et al, 2019), Cameroun (Charlotte et al, 2019), Iran (Mina et al, 2017), Kenya (Nabbugodi et al, 2015) and Benin (Alfred et al, 2013) have reported on the use of routine macroscopy and microscopy to screen for UTI in pregnancy. It is vital to ensure that pregnant women attain the highest level of health because this goes a long way to determine the outcome of pregnancy (Alfred et al, 2013).…”