Etiological Agents of Urinary Tract Infection and 7 Years Trend of Antibiotic Resistance of Bacterial Uropathogens in Sudan

Abstract

Introduction: Bacterial infections of the urinary tract represent a major cause of outpatient visits as well as hospital-acquired infections. As the prevalence of multidrug-resistant uropathogens is increasing, updated knowledge of the commonest bacterial causes and their susceptibility patterns is crucial for the proper selection and use of antimicrobial drugs and the development of effective local prescribing guidelines. Methods: Handling of urine samples, identification of organisms and antimicrobial susceptibility testing were made according to guidelines in Monica Cheesbrough 2000, 2006. The prevalence of resistance of the pathogens against each antibiotic was calculated as the proportion of resistant isolates over the entire tested isolates. Data were analyzed using Epi info; the chi-square test and Fisher exact test were used to assess the statistical significance of results. Results: In this study, 774 samples were cultured from patients with suspected urinary tract infection (UTI), 705 (91%) urinary isolates showed significant growth (>105 CFU /L) while the other 69 samples showed no significant growth. 431 (61%) of the patients were female, while the other 274 (39%) were males. 13 types of pathogens were identified in 705 urinary isolates. E.Coli was the main bacterial uropathogen identified. Microbiological susceptibility of a total of 28 antibiotics was tested; for each urinary isolate, different sets of these antibiotics were used. 601(96%) of the bacteria were resistant to at least one antibiotic. 17 antibiotics were found to have a bacterial resistance rate of more than 50%, including all B lactams (except cefuroxime), Nalidixic acid, Ciprofloxacin, Norfloxacin, Clindamycin, Co-Trimoxazole and Tetracyclines(Tetracycline and Doxycycline). Other antibiotics were found to have resistance rates of less than 50%. Amikacin & Imipenem had the highest susceptibility rates. Throughout the 7 years, resistance to most of the antibiotics showed an incremental pattern. Conclusion: Current empirical antibiotic therapy for UTI should be modified, and new guidelines should be established based on local resistance rates. This study comes up with precious regional data for evidence-based empirical antibiotic treatment, but a national sentinel surveillance system and regional antibiograms should be established to track the bacterial susceptibility profiles in Sudan.

Antimicrobial resistance trend of bacterial uropathogens at the university of Gondar comprehensive specialized hospital, northwest Ethiopia: A 10 years retrospective study

“…In general, the overall resistance rate surpasses 50% over the study period (Fig 1). Moreover, there were vancomycinresistant Enterococcus species (33.3%) in this study, which was a higher prevalence than a report (14.8%) by Melese et al in Ethiopia [36] but lower than 54% resistance reported in Sudan [29]. In addition, 6(50%) nitrofurantoin resistant Enterococcus species were isolated in this study which was higher than (9.8%) vancomycin and (0-40%) nitrofurantoin resistant Enterococcus species reported in England [37].…”

“…conducted in Bahir Dar, Ethiopia (30.5%) [26], India (38.84%) [27], India ((28.2%) [28], Sudan (91%) [29], but higher than the prevalence studies conducted in Iran (15%) [20] and India (15.9%) [30]. Geographic and population differences, study design, or the laboratory method used among studies may explain the difference in the prevalence rate.…”

Monitoring of distribution of antibiotic-resistant strains of microorganisms in patients with dysbiosis of the urogenital tract

“…The conducted researches revealed increase in frequency of detection of strains of uropathogenic bacteria resistant to currently used antibiotic preparations occurring in 2019-2019 compared with the data of 2017: 10.3% and 6.4% increases in resistances representatives of the Mycoplasmataceae family to ciprofloxacin and ofloxacin respectively, 4.8% and 4.0% in Enterobacteriaceae to chloramphenicol and ampicillin respectively, and 8.9% in Staphylococcus genus to vancomycin. The data we obtained correlate with the results of the studies carried out by Patwardhan et al (2017) and Saad et al (2020).…”

“…According to the data of Кarou et al (2012), bacteria of Escherichia coli, Klebsiella pneumoniae and K. ozenae, isolated from the clinical samples from patients suffering dysbiotic malfunctions of the reproductive system, were characterized by the highest level of resistance to ampicillinrespectively 60%, 72% and 50% of the strains, also 55%, 49% and 50% were resistant to amoxicillin/clavulanate, 63%, 50% and 30% to trimetaprim-sulfamethoxazole, 30%, 32% and 25% of the cultures to chloramphenicol. Saad et al (2020) revealed that in the conditions of quantitative and qualitative changes in the composition of microbiota of the urogenital tract of men and women of reproductive age, more than 60% of all isolates of enterobacteria were characterized by resistance to β-lactam antibiotics and preparations of the tetracycline group; 40-60% of the cultures were resistant to fluoroquinolones and around 30% of strains -to chloramphenicol. Over 70% of the isolates of Staphylococcus aureus were resistant to penicillins (including methicillin), co-trimoxazole, clindamycin and nalidixic acid.…”

“…Therefore, Patwardhan et al (2017), during a study of the dynamics of annual changes (2009 to 2014) in the levels of resistance to antibiotics exerted by uropathogens isolated from patients at a hospital in North India, determined increase in the level of resistance of the bacterial cultures to norfloxacin from 30.0% to 41.4%. Saad et al (2020) demonstrated that for a seven-year period (2009)(2010)(2011)(2012)(2013)(2014)(2015), in Sudan, the frequency of detection of strains of uropathogenic bacteria of Staphylococcus, Pseudomonas, Escherichia, Klebsiella, Proteus genera resistant to such antimicrobial drugs as amoxicillin/clavulanate, ampicillin/sulbactam, cefalexin, nitrofurantoin, co-trimoxazole, chloramphenicol, clindamycin, ciprofloxacin and norfloxacin increased from 2.0% (to ampicillin) to 15.0% (to cefalexin, clindamycin, chloramphenicol, norfloxacin). On the other hand, according to the data of Li et al (2017), who analyzed the levels of resistance to antibiotics of uropathogens during 6 years in Southern China, Grampositive bacteria, including those of the Staphylococcus genus, were the most susceptible to linezolid and vancomycin, which contradicts the results we obtained.…”