Predominance of multidrug-resistant (MDR) bacteria causing urinary tract infections (UTIs) among symptomatic patients in East Africa: a call for action

In low- and middle-income countries, antibiotics are often prescribed for patients with symptoms of urinary tract infections (UTIs) without microbiological confirmation. Inappropriate antibiotic use can contribute to antimicrobial resistance (AMR) and the selection of multi-drug resistant (MDR) bacteria. Data on antibiotic susceptibility patterns of cultured bacteria are important in drafting empirical treatment guidelines and monitoring resistance trends, which can prevent the spread of AMR. In East Africa, antibiotic susceptibility data are sparse. To fill the gap, this study reports common microorganisms and their susceptibility patterns isolated from patients with UTI-like symptoms in Kenya, Tanzania, and Uganda in 2019-2020. Microbiologically confirmed UTI was observed in 2,653 (35.0%) of the 7583 patients studied. The predominant bacteria were Escherichia coli (37.0%), Staphylococcus spp. (26.3%), Klebsiella spp. (5.8%) and Enterococcus spp. (5.5%). E. coli contributed 982 of the isolates with an MDR proportion of 52.2%. Staphylococcus spp. contributed 697 of the isolates with an MDR rate of 60.3%. The overall proportion of MDR bacteria (n=1,153) was 50.9%. MDR bacteria are common causes of UTI in patients attending healthcare centres in East African countries, which emphasizes the need for investment in laboratory culture capacities and diagnostic algorithms to improve accuracy of diagnosis that will lead to appropriate antibiotic uses to prevent and control AMR.

[1]  D. Aanensen,et al.  Unravelling patient pathways in the context of antibacterial resistance in East Africa , 2023, BMC Infectious Diseases.

[2]  Sathish Kumar Jayapal,et al.  Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019 , 2022, The Lancet.

[3]  Bing-hui Li,et al.  Global and Regional Burden of Bacterial Antimicrobial Resistance in Urinary Tract Infections in 2019 , 2022, Journal of clinical medicine.

[4]  Alan D. Lopez,et al.  Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis , 2022, The Lancet.

[5]  K. Burián,et al.  Interplay between Phenotypic Resistance to Relevant Antibiotics in Gram-Negative Urinary Pathogens: A Data-Driven Analysis of 10 Years’ Worth of Antibiogram Data , 2021, Life.

[6]  M. Holden,et al.  Dispensing Antibiotics without Prescription at Community Pharmacies and Accredited Drug Dispensing Outlets in Tanzania: A Cross-Sectional Study , 2021, Antibiotics.

[7]  K. Kaye,et al.  Antimicrobial Resistance Trends in Urine Escherichia coli Isolates From Adult and Adolescent Females in the United States From 2011 to 2019: Rising ESBL Strains and Impact on Patient Management , 2021, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[8]  J. Horcajada,et al.  Risk Factors for Amoxicillin-Clavulanate Resistance in Community-Onset Urinary Tract Infections Caused by Escherichia coli or Klebsiella pneumoniae: The Role of Prior Exposure to Fluoroquinolones , 2021, Antibiotics.

[9]  L. Molinier,et al.  Surveillance of antimicrobial resistance in low- and middle-income countries: a scattered picture , 2021, Antimicrobial Resistance & Infection Control.

[10]  Kwaku Poku Asante,et al.  Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach , 2021, The Lancet. Global health.

[11]  Ngonzi Joseph,et al.  Prevalence and bacteriology of culture-positive urinary tract infection among pregnant women with suspected urinary tract infection at Mbarara regional referral hospital, South-Western Uganda , 2021, BMC Pregnancy and Childbirth.

[12]  D. Aanensen,et al.  Protocol for an interdisciplinary cross-sectional study investigating the social, biological and community-level drivers of antimicrobial resistance (AMR): Holistic Approach to Unravel Antibacterial Resistance in East Africa (HATUA) , 2020, BMJ Open.

[13]  A. Lazar,et al.  Increasing relevance of Gram-positive cocci in urinary tract infections: a 10-year analysis of their prevalence and resistance trends , 2020, Scientific Reports.

[14]  C. Dolecek,et al.  The challenges of estimating the human global burden of disease of antimicrobial resistant bacteria , 2020, Current opinion in microbiology.

[15]  R. Öztürk,et al.  Epidemiology of urological infections: a global burden , 2020, World Journal of Urology.

[16]  Manfred S. Green,et al.  Association between urinary community-acquired fluoroquinolone-resistant Escherichia coli and neighbourhood antibiotic consumption: a population-based case-control study. , 2019, The Lancet. Infectious diseases.

[17]  T. Smieszek,et al.  Association between use of different antibiotics and trimethoprim resistance: going beyond the obvious crude association , 2018, The Journal of antimicrobial chemotherapy.

[18]  G. Cornaglia,et al.  Multi-drug-resistant Gram-negative bacteria causing urinary tract infections: a review , 2017, Journal of chemotherapy.

[19]  G. Snyder,et al.  Clinical Management of an Increasing Threat: Outpatient Urinary Tract Infections Due to Multidrug-Resistant Uropathogens. , 2016, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[20]  S. Geerlings.  Clinical Presentations and Epidemiology of Urinary Tract Infections , 2016, Microbiology spectrum.

[21]  M. P. Chlebicki,et al.  Urinary tract infections in adults. , 2016, Singapore medical journal.

[22]  A. Lewis,et al.  Gram-Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract , 2016, Microbiology spectrum.

[23]  D. Akena,et al.  Household antimicrobial self-medication: a systematic review and meta-analysis of the burden, risk factors and outcomes in developing countries , 2015, BMC Public Health.

[24]  J. Rodríguez-Baño,et al.  Healthcare-associated, community-acquired and hospital-acquired bacteraemic urinary tract infections in hospitalized patients: a prospective multicentre cohort study in the era of antimicrobial resistance. , 2013, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[25]  H. Harrabi.  Uncomplicated urinary tract infection. , 2012, The New England journal of medicine.

[26]  T. Hooton.  Clinical practice. Uncomplicated urinary tract infection. , 2012, The New England journal of medicine.

[27]  M. Falagas,et al.  Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. , 2012, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[28]  Alastair D Hay,et al.  Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis , 2010, BMJ : British Medical Journal.

[29]  David M. Aanensen,et al.  EpiCollect: Linking Smartphones to Web Applications for Epidemiology, Ecology and Community Data Collection , 2009, PloS one.

[30]  D. Cardo,et al.  Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002 , 2007, Public health reports.

[31]  G. Mccracken,et al.  Urinary tract infections in young infants. , 1982, Pediatrics.

[32]  M. Bennie,et al.  Risk factors for resistance and MDR in community urine isolates: population-level analysis using the NHS Scotland Infection Intelligence Platform , 2018, The Journal of antimicrobial chemotherapy.