Antimicrobial Susceptibility of Community-Acquired Urine Bacterial Isolates in French Amazonia

Abstract

Bacterial resistance in community-acquired urinary tract infections (UTIs) is increasing worldwide. Our study aimed to assess the microbiological epidemiology and antimicrobial susceptibility patterns of community-acquired urine bacterial isolates in French Amazonia. Our study is retrospective. It was conducted from January 2015 to December 2019 in the microbiology laboratory of the Cayenne General Hospital (French Guiana). It includes all positive urine samples from adult (> 18 years) outpatients (N = 2,533). Isolated microorganisms were Gram-negative rods in 83.9%, mainly Enterobacterales (98.4%). The main isolated bacteria were Escherichia coli (58.7%) and Klebsiella pneumoniae (13.3%). Among the isolated E. coli, 37.2% were susceptible to amoxicillin, 77.9% to amoxicillin/clavulanic acid, 94.9% to cefotaxime, 78.9% to ofloxacin, and 98.9% to nitrofurantoin. In 106 cases (5.1%), isolated Enterobacterales were extended-spectrum β-lactamase producers (5% of E. coli and 8.9% of K. pneumoniae). Overall, high levels of cross- and co-resistance were registered. The main isolated Gram-positive bacteria was Staphylococcus saprophyticus (28.9%). It was resistant to oxacillin in 52.5% of cases and susceptible to nitrofurantoin in 99.1% of cases. Patients with S. saprophyticus were young women in almost all cases. In conclusion, the most isolated microorganisms from outpatient urinalyses were E. coli and K. pneumoniae. They showed a high resistance rate to amoxicillin, but they were susceptible to the most remaining antibiotics. S. saprophyticus was isolated mainly in young women and was resistant to oxacillin in half of the cases. Interestingly, nitrofurantoin was active against most isolated organisms and can be considered as empirical treatment in uncomplicated UTIs.

Prevalence and antimicrobial resistance profile of pathogens isolated from patients with urine tract infections admitted to a university hospital in a medium-sized Brazilian city

“…The Gram-negative nonfermenting species P. aeruginosa and the Gram-positive E. faecalis were the fourth and fifth most common species, respectively. These same agents were observed in several other studies, with some local variations [21][22][23][24][25][26][27][28] . This same ranking was seen within each sex group, separately.…”

Nitrofuran Derivatives Cross-Resistance Evidence—Uropathogenic Escherichia coli Nitrofurantoin and Furazidin In Vitro Susceptibility Testing

“… Overview of data on Escherichia coli urine isolates nitrofurantoin resistance in the 21st century worldwide reports [ 2 , 7 , 8 , 10 , 13 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. …”

“…Staphylococcus aureus and other coagulase-negative staphylococci (with the predominance of Staphylococcus saprophyticus ) are also visible in the statistics of the etiology of UTI. A summary of the most common etiology of UTI depending on the source of infection (CAI vs. HAI) is presented in Table 1 [ 1 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 15 , 16 , 17 , 18 ]. Some analyses [ 6 , 18 , 19 , 20 ] also indicated a significant percentage (1–11%) of Streptococcus agalactiae among the Gram-positive etiological factors of UTI; however, due to limited reports (and a lack of information on healthcare or community sources), they are not included in Table 1 .…”

“…Figure 1 summarizes the resistance rate to nitrofurantoin among strains of E. coli causing UTI. The results come from studies performed in different regions of the world, in different periods, and in groups of different sizes [ 2 , 7 , 8 , 10 , 13 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. In most cases, the percentage of resistance to nitrofurantoin was low and often did not exceed 3%.…”

“…A summary of the most common etiology of UTI depending on the source of infection (CAI vs. HAI) is presented in Table 1 [1,[6][7][8][9][10][11][12][13][15][16][17][18]. Some analyses [6,[18][19][20] also indicated a significant percentage (1-11%) of Streptococcus agalactiae among the Gram-positive etiological factors of UTI; however, due to limited reports (and a lack of information on healthcare or community sources), they are not included in Table 1.…”