Urinary tract infections due to multi-drug-resistant bacteria at Mohammed VI University Hospital Center of Oujda-Morocco

Abstract

Aims: Multidrug-resistant bacteria urinary tract infections (MDR-UTI) are a global concern, leading to increased morbidity, mortality and financial costs. The aim of this study was to determine the prevalence of MDR-UTI and establish the epidemiological profile of UTI due to different phenotypes of MDR-UTI. Methodology and results: This is a retrospective study of MDR-UTI assessed at the microbiology laboratory of Mohammed VI University Hospital Center of Oujda over 37 months from March 2016 to April 2019. The study included all requests for cytobacteriological examination of urine (CBEU) according to the instructions of the medical microbiology guidelines. An agar medium was utilized for bacterial culture experimentation. Antibiotic susceptibility testing was performed according to the European Committee on Antimicrobial Susceptibility Testing guidelines. CBEU in UTIs allowed the isolation of 1078 isolates. They were dominated by Gram-negative bacteria (87.65%; n=945), followed by Gram-positive bacteria for 12.34% (n=133). This included 181 (16.80%) multidrug-resistant strains, which were dominated by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) (n=144; 79.55%). Young male adults exhibited a higher occurrence of isolated ESBL-E and carbapenem-resistant Acinetobacter baumannii (CRAB). As for the distribution by department, there was a near equality between the MDR isolates isolated from outpatients (n= 88; 49%) versus the inpatients (n= 93; 51%). Exactly 152 (84%) isolated MDR cases were observed in patients who did not have a urinary catheter, 157 (87%) and 141 (78%) cases of MDR of UTI were not associated with care and occurred in non-immunocompromised patients, respectively. Prior antibiotic exposure was observed in only 58 (32%) cases. Conclusion, significance and impact of study:This study confirmed the increasing prevalence of multidrug-resistant urinary tract infections in the community and hospitals. The fight against this problem will require all stakeholders' involvement to achieve the goals from one health perspective in line with international agenda.