Emergence of Antimicrobial Resistance in Uropathogens in Butembo, Democratic Republic of Congo: A 5 Years Retrospective Study

Abstract

Background Antimicrobial resistance is a global challenging issue in children and adults. Finding the extent of resistance is the first step in finding an appropriate way to combat it. This study aimed to assess the antibiotic resistance patterns of different bacterial isolates in urine specimens from children and adults. Methods This retrospective cross-sectional study was done from January 1, 2014, to December 30, 2018, and used data from bacterial cultures collected and processed at the Centre Universitaire de Diagnostic au Graben (CUDG), located in Butembo in the Eastern part of the Democratic Republic of Congo. Conventional standard urine culture followed by bacteria identification based on conventional methods (colony morphology, Gram stain, and biochemical tests) were performed. Standard disc diffusion drug susceptibility testing was performed using CLSI M 100-S22 guidelines. Findings Of 1620 urine specimens collected, 1041 (64.3%) showed positive microorganism growth. The three most isolated bacterial microorganisms were S. aureus (561 [53.9%]), E. coli (124 [11.9%]), and Streptococcus spp (74 [7.1%]). Resistance of S. aureus was as follows: amoxicillin/clavulanic acid 50.3% (234 of 465 isolated tested), gentamicin 37.9% (167/441), ceftriaxone (329/469), ciprofloxacin (207/509), doxycycline (232/524), nalidixic acid (73/92) and meropenem (64/88). The resistance profile of E. coli was as follows: amoxicillin/clavulanic acid 77.8% (70/90), gentamicin % (44/95), ceftriaxone (45/108), ciprofloxacin (55/113), doxycycline (78/108), nalidixic acid (56/73) and meropenem (33/55). Resistance of Streptococci spp was amoxicillin/clavulanic acid 34.9% (23/66), gentamicin % (26/56), ceftriaxone (28/62), ciprofloxacin (28/66), doxycycline (28/64), nalidixic acid (14/17) and meropenem (7/8). Among the isolated bacteria, 66.8% (695/1041) were multidrug-resistant. Conclusion Antimicrobial resistance is prevalent among isolated uropathogenic bacteria, especially to first-line and second-line antibiotics. Continued surveillance and a tracking system for multidrug-resistant bacteria are needed. Judicious and rational antibiotic usage is recommended.