H I Magale1, I A Kassim2, S A Odera3, M J Omolo4, W G Jaoko5, P E Jolly6. 1. The University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, Arizona, United States. 2. The Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville, North Carolina, United States. 3. Department of Medical Microbiology, University of Nairobi, P. O. Box 19676-00202, Nairobi, Kenya. 4. Department of Medical Microbiology, University Of Nairobi, P. O. Box 19676-00202, Nairobi, Kenya. 5. Department of Medical Microbiology, University of Nairobi, P. O. Box 19676-00202, Nairobi, Kenya, Kenya AIDS Vaccine Initiative (KAVI), School of Medicine, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya. 6. Department of Epidemiology, University of Alabama in Birmingham School of Public Health, 1665 University Blvd, Birmingham, Alabama, United States.
Abstract
BACKGROUND: Changes in susceptibility patterns of bacterial pathogens isolated from urinary tract infections emphasize the need for regional surveillance to generate information that can be used in management of patients. Knowledge on the current status of antimicrobial resistance in uropathogens, and the prevalence of expanding spectrum beta-lactamases (ESBLs) in the isolates will guide policy formulations and encourage prudent use of antimicrobials. OBJECTIVE: Identify bacterial pathogens causing UTI and determine the association between the pathogens isolated from patients attending KNH. Determine antimicrobial susceptibility patterns of the UTI pathogens and the prevalence of ESBL in the isolated pathogens. DESIGN: Laboratory-based study. SETTING: Department of Medical Microbiology University of Nairobi and Kenyatta National Hospital microbiology laboratory, Nairobi, Kenya. SUBJECTS: Nine hundred and forty eight patients presenting directly to the Kenyatta National Hospital's diagnostic lab. Patients were only classified as in-patients if at the time of specimen collection they were being admitted to one of KNH wards. RESULTS: Out of the 948 urine samples processed, 189 in-patients and 37 out-patients samples had significant bacterial growth. The uropathogens identified from in-patient specimens were Escherichia coli (56), Klebsiellapneumoniae (33), Enterococcus spp. (34) and Entrobacter (16) making up 30%, 18%, 18% and 9% respectively. ESBL isolates were found to be resistant to the locally administered antibiotics; Augmentin (37%), Levofloxacin (37%), Cefoperazone (37%), Ampicillin (39%), Doxycyline (41%), Gentamicin (30%) and Nalidixic Acid (38%). CONCLUSION: The increased prevalence of multidrug resistant ESBL pathogens poses challenges for health care providers at KNH and signifies the need for new approach to treat UTI. It would be prudent for laboratories to include specialized tests for detection of ESBL producing pathogens from isolates obtained from in-patients. Further studies on the mechanisms and pathways utilized by these bacteria to cause UTI will highlight other avenues in patient management.
BACKGROUND: Changes in susceptibility patterns of bacterial pathogens isolated from urinary tract infections emphasize the need for regional surveillance to generate information that can be used in management of patients. Knowledge on the current status of antimicrobial resistance in uropathogens, and the prevalence of expanding spectrum beta-lactamases (ESBLs) in the isolates will guide policy formulations and encourage prudent use of antimicrobials. OBJECTIVE: Identify bacterial pathogens causing UTI and determine the association between the pathogens isolated from patients attending KNH. Determine antimicrobial susceptibility patterns of the UTI pathogens and the prevalence of ESBL in the isolated pathogens. DESIGN: Laboratory-based study. SETTING: Department of Medical Microbiology University of Nairobi and Kenyatta National Hospital microbiology laboratory, Nairobi, Kenya. SUBJECTS: Nine hundred and forty eight patients presenting directly to the Kenyatta National Hospital's diagnostic lab. Patients were only classified as in-patients if at the time of specimen collection they were being admitted to one of KNH wards. RESULTS: Out of the 948 urine samples processed, 189 in-patients and 37 out-patients samples had significant bacterial growth. The uropathogens identified from in-patient specimens were Escherichia coli (56), Klebsiellapneumoniae (33), Enterococcus spp. (34) and Entrobacter (16) making up 30%, 18%, 18% and 9% respectively. ESBL isolates were found to be resistant to the locally administered antibiotics; Augmentin (37%), Levofloxacin (37%), Cefoperazone (37%), Ampicillin (39%), Doxycyline (41%), Gentamicin (30%) and Nalidixic Acid (38%). CONCLUSION: The increased prevalence of multidrug resistant ESBL pathogens poses challenges for health care providers at KNH and signifies the need for new approach to treat UTI. It would be prudent for laboratories to include specialized tests for detection of ESBL producing pathogens from isolates obtained from in-patients. Further studies on the mechanisms and pathways utilized by these bacteria to cause UTI will highlight other avenues in patient management.