Multidrug-resistant uropathogens causing community acquired urinary tract infections among patients attending health facilities in Mwanza and Dar es salaam, Tanzania
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
MDPI
Abstract
In low-income countries, the empirical treatment of urinary tract infections (UTIs) without
laboratory confirmation is very common, especially in primary health facilities. This scenario often
leads to unnecessary and ineffective antibiotic prescriptions, prompting the emergence and spread
of antimicrobial resistance. We conducted this study to examine the antibiogram of uropathogens
causing community-acquired urinary tract infections among outpatients attending selected health
facilities in Tanzania. Method: This was a cross-sectional health centre-based survey conducted for a
period of five months, from July to November 2021, in the Mwanza and Dar es Salaam regions in Tan-
zania. We enrolled consecutively a total of 1327 patients aged between 2 and 96 years with a median
[IQR] age of 28 [22–39] from Dar es Salaam (n = 649) and Mwanza (n = 678). Results: Significant bac-
teriuria was observed in 364 (27.4% [95%CI: 25.0–29.9]) patients, from whom 412 urinary pathogens
were isolated. Gram-negative bacteria contributed to 57.8% (238) of the 412 uropathogens isolated, of
which 221 were Enterobacterales, and Escherichia coli was the most frequent. Staphylococcus aureus and
Staphylococcus haemolyticus were the most frequently isolated among Gram-positive uropathogens
(n = 156). Generally, resistance among Escherichia coli ranged from 0.7% (meropenem) to 86.0% (ampi-
cillin) and from 0.0% (meropenem) to 75.6% (ampicillin) in other Enterobacterales. Moreover, about
45.4% (108) of Enterobacterales and 22.4% (35) of Gram-positive bacteria were multidrug resistant
(MDR), p = 0.008. We observed 33 MDR patterns among Gram-negative bacteria, predominantly
AMP-CIP-TCY (23/108; 21.3%), and 10 MDR patterns among Gram-positive bacteria, most com-
monly CIP-GEN-TCY (22/35; 62.9%). Conclusion: the presence of a high number of wide-ranging
uropathogens that are multidrug resistant to a variety of antibiotics points to the need to strengthen
the laboratory diagnostic systems for the regular surveillance of the antimicrobial resistance of
uropathogens to guide and update empirical treatment guidelines.
Description
Journal article
Keywords
Antimicrobial resistance, Community acquired urinary tract infections, Multidrug resistant bacteria, Surveillance, Uropathogens
Citation
doi.org/10.3390/antibiotics11121718