Spectrum of antibiotic resistance in UTI caused by Escherichia coli among HIV-infected patients in Uganda: a cross-sectional study

Abstract Background Antimicrobial drug resistance is one of the top ten threats to global health according to the World Health Organization. Urinary tract infections (UTIs) are among the most common bacterial infections and main reason for antibiotic prescription. The incidence of UTIs appears to be...

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Autores principales:	George Abongomera, Maurice Koller, Joseph Musaazi, Mohammed Lamorde, Marisa Kaelin, Hannington B. Tasimwa, Nadia Eberhard, Jan Hongler, Sabine Haller, Andrew Kambugu, Barbara Castelnuovo, Jan Fehr
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Urinary tract infections Antimicrobial resistance HIV Uganda Sub-Saharan Africa Infectious and parasitic diseases RC109-216
Acceso en línea:	https://doaj.org/article/f6a2451d3b464a22b21d8e2b08fec13f
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spelling	oai:doaj.org-article:f6a2451d3b464a22b21d8e2b08fec13f2021-11-28T12:41:50ZSpectrum of antibiotic resistance in UTI caused by Escherichia coli among HIV-infected patients in Uganda: a cross-sectional study10.1186/s12879-021-06865-31471-2334https://doaj.org/article/f6a2451d3b464a22b21d8e2b08fec13f2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12879-021-06865-3https://doaj.org/toc/1471-2334Abstract Background Antimicrobial drug resistance is one of the top ten threats to global health according to the World Health Organization. Urinary tract infections (UTIs) are among the most common bacterial infections and main reason for antibiotic prescription. The incidence of UTIs appears to be high among people living with HIV. We sought to determine the most common UTI pathogens among HIV infected patients and evaluate their susceptibility towards antibiotics. Methods We performed a cross-sectional study among HIV-infected patients aged ≥ 18 years presenting at an HIV care specialized clinic with symptoms suggestive of a urethritis. Urine cultures were subjected to antibiotic susceptibility testing according to Clinical Laboratory Standards Institute. The data was analyzed using STATA, we performed Pearson’s Chi-square and Fisher’s exact tests to compare differences between proportions. Results Out of the 200 patients, 123 (62%) were female. The median age was 41.9 years (IQR 34.7–49.3). Only 32 (16%) urine cultures showed bacterial growth. Escherichia coli was the most commonly isolated uropathogen (72%), followed by Klebsiella pneumoniae (9%). E. coli was completely resistant to cotrimoxazole and ampicillin; resistance to ciprofloxacin and ceftriaxone was 44% and 35% respectively; 9% to gentamicin; no resistance detected to nitrofurantoin and imipenem. Conclusions Our findings are congruent with the Uganda national clinical guidelines which recommends nitrofurantoin as the first line antibiotic for uncomplicated UTI. Significant ciprofloxacin and ceftriaxone resistance was detected. In the era of emerging antibiotic resistance, understanding the local susceptibilities among sub-populations such as HIV infected patients is crucial. Further investigation is needed to address reasons for the low bacterial growth rate observed in the urine cultures.George AbongomeraMaurice KollerJoseph MusaaziMohammed LamordeMarisa KaelinHannington B. TasimwaNadia EberhardJan HonglerSabine HallerAndrew KambuguBarbara CastelnuovoJan FehrBMCarticleUrinary tract infectionsAntimicrobial resistanceHIVUgandaSub-Saharan AfricaInfectious and parasitic diseasesRC109-216ENBMC Infectious Diseases, Vol 21, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Urinary tract infections Antimicrobial resistance HIV Uganda Sub-Saharan Africa Infectious and parasitic diseases RC109-216
spellingShingle	Urinary tract infections Antimicrobial resistance HIV Uganda Sub-Saharan Africa Infectious and parasitic diseases RC109-216 George Abongomera Maurice Koller Joseph Musaazi Mohammed Lamorde Marisa Kaelin Hannington B. Tasimwa Nadia Eberhard Jan Hongler Sabine Haller Andrew Kambugu Barbara Castelnuovo Jan Fehr Spectrum of antibiotic resistance in UTI caused by Escherichia coli among HIV-infected patients in Uganda: a cross-sectional study
description	Abstract Background Antimicrobial drug resistance is one of the top ten threats to global health according to the World Health Organization. Urinary tract infections (UTIs) are among the most common bacterial infections and main reason for antibiotic prescription. The incidence of UTIs appears to be high among people living with HIV. We sought to determine the most common UTI pathogens among HIV infected patients and evaluate their susceptibility towards antibiotics. Methods We performed a cross-sectional study among HIV-infected patients aged ≥ 18 years presenting at an HIV care specialized clinic with symptoms suggestive of a urethritis. Urine cultures were subjected to antibiotic susceptibility testing according to Clinical Laboratory Standards Institute. The data was analyzed using STATA, we performed Pearson’s Chi-square and Fisher’s exact tests to compare differences between proportions. Results Out of the 200 patients, 123 (62%) were female. The median age was 41.9 years (IQR 34.7–49.3). Only 32 (16%) urine cultures showed bacterial growth. Escherichia coli was the most commonly isolated uropathogen (72%), followed by Klebsiella pneumoniae (9%). E. coli was completely resistant to cotrimoxazole and ampicillin; resistance to ciprofloxacin and ceftriaxone was 44% and 35% respectively; 9% to gentamicin; no resistance detected to nitrofurantoin and imipenem. Conclusions Our findings are congruent with the Uganda national clinical guidelines which recommends nitrofurantoin as the first line antibiotic for uncomplicated UTI. Significant ciprofloxacin and ceftriaxone resistance was detected. In the era of emerging antibiotic resistance, understanding the local susceptibilities among sub-populations such as HIV infected patients is crucial. Further investigation is needed to address reasons for the low bacterial growth rate observed in the urine cultures.
format	article
author	George Abongomera Maurice Koller Joseph Musaazi Mohammed Lamorde Marisa Kaelin Hannington B. Tasimwa Nadia Eberhard Jan Hongler Sabine Haller Andrew Kambugu Barbara Castelnuovo Jan Fehr
author_facet	George Abongomera Maurice Koller Joseph Musaazi Mohammed Lamorde Marisa Kaelin Hannington B. Tasimwa Nadia Eberhard Jan Hongler Sabine Haller Andrew Kambugu Barbara Castelnuovo Jan Fehr
author_sort	George Abongomera
title	Spectrum of antibiotic resistance in UTI caused by Escherichia coli among HIV-infected patients in Uganda: a cross-sectional study
title_short	Spectrum of antibiotic resistance in UTI caused by Escherichia coli among HIV-infected patients in Uganda: a cross-sectional study
title_full	Spectrum of antibiotic resistance in UTI caused by Escherichia coli among HIV-infected patients in Uganda: a cross-sectional study
title_fullStr	Spectrum of antibiotic resistance in UTI caused by Escherichia coli among HIV-infected patients in Uganda: a cross-sectional study
title_full_unstemmed	Spectrum of antibiotic resistance in UTI caused by Escherichia coli among HIV-infected patients in Uganda: a cross-sectional study
title_sort	spectrum of antibiotic resistance in uti caused by escherichia coli among hiv-infected patients in uganda: a cross-sectional study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/f6a2451d3b464a22b21d8e2b08fec13f
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Spectrum of antibiotic resistance in UTI caused by Escherichia coli among HIV-infected patients in Uganda: a cross-sectional study

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