Multidrug-Resistant Uropathogens Causing Community Acquired Urinary Tract Infections among Patients Attending Health Facilities in Mwanza and Dar es Salaam, Tanzania

Abstract

In low-income countries, the empirical treatment of urinary tract infections (UTIs) without laboratory confirmation is very common, especially in primary health facilities. This scenario often leads to unnecessary and ineffective antibiotic prescriptions, prompting the emergence and spread of antimicrobial resistance. We conducted this study to examine the antibiogram of uropathogens causing community-acquired urinary tract infections among outpatients attending selected health facilities in Tanzania. Method: This was a cross-sectional health centre-based survey conducted for a period of five months, from July to November 2021, in the Mwanza and Dar es Salaam regions in Tanzania. We enrolled consecutively a total of 1327 patients aged between 2 and 96 years with a median [IQR] age of 28 [22–39] from Dar es Salaam (n = 649) and Mwanza (n = 678). Results: Significant bacteriuria was observed in 364 (27.4% [95%CI: 25.0–29.9]) patients, from whom 412 urinary pathogens were isolated. Gram-negative bacteria contributed to 57.8% (238) of the 412 uropathogens isolated, of which 221 were Enterobacterales, and Escherichia coli was the most frequent. Staphylococcus aureus and Staphylococcus haemolyticus were the most frequently isolated among Gram-positive uropathogens (n = 156). Generally, resistance among Escherichia coli ranged from 0.7% (meropenem) to 86.0% (ampicillin) and from 0.0% (meropenem) to 75.6% (ampicillin) in other Enterobacterales. Moreover, about 45.4% (108) of Enterobacterales and 22.4% (35) of Gram-positive bacteria were multidrug resistant (MDR), p = 0.008. We observed 33 MDR patterns among Gram-negative bacteria, predominantly AMP-CIP-TCY (23/108; 21.3%), and 10 MDR patterns among Gram-positive bacteria, most commonly CIP-GEN-TCY (22/35; 62.9%). Conclusion: the presence of a high number of wide-ranging uropathogens that are multidrug resistant to a variety of antibiotics points to the need to strengthen the laboratory diagnostic systems for the regular surveillance of the antimicrobial resistance of uropathogens to guide and update empirical treatment guidelines.

Gram-Negative Bacteria in Some Clinical Specimens and their Antibiotics Resistance Profiles, Sana’a, Yemen

“…Of these, a signi cant proportion (32.85) of specimens were obtained from patients aged between 41 and 50 years; 54.29% of them were female; 56.33% of them were from urban regions; 30.48% had a secondary school certi cate; and 30% of the specimens originated from urine. This is similar to the results of a recent investigation [20,21].…”

Molecular Characterizations of the Coagulase-Negative Staphylococci Species Causing Urinary Tract Infection in Tanzania: A Laboratory-Based Cross-Sectional Study

“…As reported recently by Vitus et al [ 23 ], S. haemolyticus was the most predominant CoNS detected as a uropathogen in the current study. S. haemolyticus is among the normal skin microbiota commonly found in the perineum and inguinal area, making it easy for them easy to ascend and cause UTI [ 30 , 31 ].…”

“…In Tanzania, significant bacteriuria cases due to CoNS have been reported to range from 6.2% to 16.7% among women with diabetic and febrile children [ 21 , 22 ], without delineating the specific species involved and their antimicrobial resistance or virulence genes determinants. A recent study in Tanzania using VITEK MS identified S. haemolyticus to be the second most common Gram-positive uropathogen causing community UTIs [ 23 ].…”

“If You Do Not Take the Medicine and Complete the Dose…It Could Cause You More Trouble”: Bringing Awareness, Local Knowledge and Experience into Antimicrobial Stewardship in Tanzania

“…In another study at Bugando Medical Centre (BMC), the prevalence of MDR-Gram-Negative-Bacteria (GNB) isolated from blood culture and GNB third-generation cephalosporins isolated from neonatal colonization, cots and mothers' hands were 96.6, 100, 100 and 94.6%, respectively [21]. Additionally, a study found that MDR uropathogens caused community-acquired urinary tract infections in patients attending health facilities in Mwanza and Dar es Salaam [22]. In animals, E. coli isolates from poultry and pigs were found to be highly resistant to tetracycline (63.5%), nalidixic acid (53.7%), ampicillin (52.3%), and trimethoprim/sulfamethoxazole (50.9%) [23].…”