M Bullens1, A de Cerqueira Melo1, S Raziq1, J Lee1,2, G G Khalid3, S N Khan1, A Zada1, Y Wailly4, S M Zeshan5, N J Saad4, J Gil-Cuesta2,6, A Williams6,7. 1. Timurgara District Hospital Project, Médecins Sans Frontières Operational Centre Brussels (MSF OCB), Timurgara, Pakistan. 2. MSF OCB, Medical Department, Brussels, Belgium. 3. MSF OCB, Islamabad Mission Coordination, Islamabad, Pakistan. 4. Operations Department, MSF OCB, Brussels, Belgium. 5. Aga Khan Laboratory, Karachi, Pakistan. 6. Luxembourg Operational Research (LuxOR) Unit, MSF OCB, Luxembourg. 7. Middle East Medical Unit (MEMU), MSF Lebanon, Beirut, Lebanon.
Abstract
BACKGROUND: The level of antibiotic resistance of pathogens causing uncomplicated urinary tract infections (UTIs) is increasing. The 2017-2018 GLASS (Global Antimicrobial Resistance and Use Surveillance System) report indicated >70% resistance to ceftriaxone and ciprofloxacin in Escherichia coli in Pakistan. METHODS: A prospective study was conducted in the Médecins Sans Frontières (MSF) supported Timurgara District Hospital, Timurgara, Pakistan, from September 2017 to December 2018. Women aged 18-65 years presenting to the Emergency Department with symptoms of uncomplicated UTI (cystitis/pyelonephritis) were invited to participate. We conducted microbiological culture and sensitivity testing for samples with positive dipstick or nitrite test. RESULTS: Of the 200 patients who participated, 109 (54.5%) were diagnosed with pyelonephritis and 91 (45.5%) with cystitis. Forty-three samples (21.5%) were culture-positive: E. coli was isolated in 27 samples, Enterococcus spp. in 7 and Klebsiella pneumoniae in 6. Overall resistance to ciprofloxacin was observed in 51.8% of E. coli isolates, and ceftriaxone resistance in 66.7% of E. coli isolates and in 33.3% of K. pneumoniae. Resistance to fosfomycin was low (one E. coli isolate). CONCLUSIONS: This study found resistance to first- and second-line antibiotics for treating UTIs as per the MSF protocol. Heightened awareness and potential changes to local prescription practices are necessary to curb the spread of antimicrobial resistance pathogens causing UTIs.
BACKGROUND: The level of antibiotic resistance of pathogens causing uncomplicated urinary tract infections (UTIs) is increasing. The 2017-2018 GLASS (Global Antimicrobial Resistance and Use Surveillance System) report indicated >70% resistance to ceftriaxone and ciprofloxacin in Escherichia coli in Pakistan. METHODS: A prospective study was conducted in the Médecins Sans Frontières (MSF) supported Timurgara District Hospital, Timurgara, Pakistan, from September 2017 to December 2018. Women aged 18-65 years presenting to the Emergency Department with symptoms of uncomplicated UTI (cystitis/pyelonephritis) were invited to participate. We conducted microbiological culture and sensitivity testing for samples with positive dipstick or nitrite test. RESULTS: Of the 200 patients who participated, 109 (54.5%) were diagnosed with pyelonephritis and 91 (45.5%) with cystitis. Forty-three samples (21.5%) were culture-positive: E. coli was isolated in 27 samples, Enterococcus spp. in 7 and Klebsiella pneumoniae in 6. Overall resistance to ciprofloxacin was observed in 51.8% of E. coli isolates, and ceftriaxone resistance in 66.7% of E. coli isolates and in 33.3% of K. pneumoniae. Resistance to fosfomycin was low (one E. coli isolate). CONCLUSIONS: This study found resistance to first- and second-line antibiotics for treating UTIs as per the MSF protocol. Heightened awareness and potential changes to local prescription practices are necessary to curb the spread of antimicrobial resistance pathogens causing UTIs.
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Authors: Ali A Rabaan; Saad Alhumaid; Abbas Al Mutair; Mohammed Garout; Yem Abulhamayel; Muhammad A Halwani; Jeehan H Alestad; Ali Al Bshabshe; Tarek Sulaiman; Meshal K AlFonaisan; Tariq Almusawi; Hawra Albayat; Mohammed Alsaeed; Mubarak Alfaresi; Sultan Alotaibi; Yousef N Alhashem; Mohamad-Hani Temsah; Urooj Ali; Naveed Ahmed Journal: Antibiotics (Basel) Date: 2022-06-08