Sexually transmitted infections and prior antibiotic use as important causes for negative urine cultures among adults presenting with urinary tract infection symptoms to primary care clinics in Zimbabwe: a cross-sectional study

Abstract

ObjectiveUrinary tract infections (UTIs) are common in primary care. The yield of urine cultures in patients with UTI symptoms can be considerably different between high-income and low-income settings. This study aimed to explore possible causes of negative urine cultures in patients presenting with symptoms of UTI to primary health clinics in Harare.DesignCross-sectional study.SettingNine primary health clinics in Harare, Zimbabwe.ParticipantsAdults presenting with symptoms of UTIs between March and July 2020.Primary outcome measuresUrine samples underwent dipstick testing, microscopy, culture, and testing for sexually transmitted infections (STIs) using GeneXpert and for the presence of antibiotic residues using an antibiotic bioassay. The primary outcomes were the number and proportion of participants with evidence of STIs, prior antibiotic exposure, leucocyturia and UTIs.ResultsThe study included 425 participants with a median age of 37.3 years, of whom 275 (64.7%) were women. Leucocyturia was detected in 130 (30.6%, 95% CI 26.2% to 35.2%) participants, and 96 (22.6%, 95% CI 18.7% to 26.9%) had a positive urine culture for a uropathogen. Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis were detected in 43/425 (10.1%, 95% CI 7.4% to 13.4%), 37/425 (8.7%, 95% CI 6.2% to 11.8%) and 14/175 (8.0%, 95% CI 4.4% to 13.1%) participants, respectively. Overall, 89 (20.9%, 95% CI 17.2% to 25.1%) participants reported either having taken prior antibiotics or having had a positive urine bioassay. In 170 (40.0%, 95% CI 35.3% to 44.8%) participants, all of the tests that were performed were negative.ConclusionsThis study found a high prevalence of STIs and evidence of prior antimicrobial use as possible explanations for the low proportion of positive urine cultures.

Urogenital pathogens in urine samples of clinically diagnosed urinary tract infected patients in Tanzania: A laboratory based cross-sectional study

“…In this study the most common urogenital pathogen was N. gonorrhoeae with a prevalence of 11.0%. The prevalence of N. gonorrhoeae is similar to the Zimbabwe study which reported a prevalence of 8.7% among adult patients presenting with urinary tract infection symptoms in primary health care clinic [3] . Moreover, the prevalence in this study is higher than that reported (6.7%) among pregnant adolescent girls in the city of Mwanza [19] and the 3.3% reported for reproductive aged women in sub-Saharan Africa [20] .…”

“…In the current study, 27.3% of urine samples were positive for at least one of the four urogenital pathogens tested. The prevalence in this study is relatively higher than the 19.5% reported among adult's patients presenting with urinary tract infection symptoms in primary health care clinic in Zimbabwe [3] and 20.8% reported from Kilifi, Kenya among pregnant women [17] . The variations in findings could be explained by the fact that the current study used urine samples from patients with clinical diagnosis of UTI and positive urine leucocytes (pyuria) while the previous study in Kilifi urine samples from pregnant women attending antenatal clinic not necessarily having pyuria [17] .…”

“…In HATUA project urine samples were stored under -80°c within two hours of collection. The minimum sample size of 138 urine samples was obtained using the Kish Leslie formula (1965) with 10% prevalence of urogenital pathogens obtained among adult patients presenting with UTI symptoms [3] . However, the current study enrolled 227 archived urine samples from patients with a sign and symptoms of UTI like fever, lower abdominal pain, flank/back pain, painful urination, dysuria, hematuria, increased frequency of urination but urine culture negative results with >125 leucocyte/μl, as shown in Fig.…”

“…Sterile pyuria has been linked with a number of causes including urogenital pathogens (like viruses, fungi, and atypical or fastidious bacteria causing sexual transmitted infections (STIs)), antibiotic use, genitourinary tuberculosis, interstitial cystitis, bladder cancer and cystitis [1] . The burden of sterile pyuria varies in the population due to a number of reasons including sex, causative agents, use of antibiotics and the frequency of laboratory testing for urogenital pathogens [3] . In the general population, sterile pyuria is positively associated with pregnancy, menopause, untreated urinary tract infections (UTI), and vaginal or penile discharge [2] .…”

Clinical and bacteriological outcomes in patients with urinary tract infections presenting to primary care in Harare, Zimbabwe: a cohort study

“…The yield of urine cultures was low in line with findings from other studies from sub-Saharan Africa 23,24 . This can be explained in part by the high prevalence of sexually transmitted infections and antibiotic exposure prior to seeking healthcare among patients included in this study 25 . The availability of rapid diagnostic tests at the point of care such as urinary dipstick or testing for sexually transmitted infections may improve patient care and optimise antibiotic use.…”