Diagnosis and treatment of urinary tract infections in hospitalized adults in Ghana: The role of the clinical microbiology laboratory in improving antimicrobial stewardship

Abstract

Background: The inappropriate use of antibiotics is a global threat. Clinical microbiology laboratory testing can support optimal antibiotic prescribing for many conditions. The purpose of this study was to characterize antibiotic usage in the context of treatment of uncomplicated urinary tract infection (UTI) received through a Ghanaian Accident & Emergency, which found high rates of improper usage. Methods: A prospective cohort study recruited patients >18 years of age who were admitted to a large Ghanaian teaching hospital with suspected UTI. Eligible patients were identified through a daily review of admission logs. Data were collected through a review of medical records and microbiology laboratory urine data. Results: A total of 90 patients were enrolled, but urine cultures were obtained from only 50 (56%) patients. Most positive urine cultures grew typical urinary pathogens (21 of 25, 84%). The most common empiric regimens were cephalosporin-based and did not vary if additional infections were suspected or a urine culture was not sent. The majority of patients with confirmed UTI had isolates that were not susceptible to antibiotics selected for empiric treatment (18 of 21, 86%). Although more than half had their empiric regimen changed between admission and study follow up, only 42% (5 of 12) were switched to a regimen that included agent(s) to which their urinary isolate was known to be susceptible. Conclusions: Establishing hospital-wide guidelines regarding the evaluation and treatment of patients with suspected UTI may help improve antibiotic utilization and patient outcomes by increasing the use of urine cultures and tailoring therapy in response to culture results.

Culture Requests and Multi-Drug Resistance among Suspected Urinary Tract Infections in Two Tertiary Hospitals in Freetown, Sierra Leone (2017–21): A Cross-Sectional Study

“…Once implemented, the data from GLASS can be used for modifying standard treatment guidelines for empirical treatment of suspected UTI while awaiting culture AST results. Experience from countries such as Ghana and Thailand emphasize the use of clinical microbiology for setting up and improving antimicrobial stewardship [10,34]. Once an antimicrobial stewardship programme is set up, it needs to be fully supported and regularly evaluated.…”

“…Other published studies from sub-Saharan Africa over the last 5 years have focused on small numbers of patients presenting with suspected UTIs that included students, pregnant women, vulnerable people such as those with diabetes or cancer, and children. Management of UTIs was poor and a call has been made from the West African country Ghana for more utilization of urine culture and antibiotic resistance profiles and more tailored use of antibiotics in response to culture results [10].…”

High Resistance to Antibiotics Recommended in Standard Treatment Guidelines in Ghana: A Cross-Sectional Study of Antimicrobial Resistance Patterns in Patients with Urinary Tract Infections between 2017 -2021

“…In the same studies AMR rates as high as 95% have been reported to antibiotics used for treating UTIs [9][10][11] . Whilst there is limited information about the general national prevalence of UTIs in Ghana, two studies have reported 42.75% prevalence in pregnant women [13] and 86% among hospitalized adults [14]. The proportion of multi-drug resistant (MDR) UTIs have been reported to be as high as 93.6% in Ghana [10], [12].…”

High Resistance to Antibiotics Recommended in Standard Treatment Guidelines in Ghana: A Cross-Sectional Study of Antimicrobial Resistance Patterns in Patients with Urinary Tract Infections between 2017–2021

“…In the same studies, AMR rates to antibiotics used for treating UTIs as high as 95% have been reported [ 9 , 10 , 11 ]. Whilst there is limited information about the general national prevalence of UTIs in Ghana, two studies have reported 42.75% prevalence in pregnant women [ 12 ] and 86% among hospitalized adults [ 13 ]. The proportion of multi-drug resistant (MDR) UTIs has been reported to be as high as 93.6% in Ghana [ 10 , 14 ].…”