Etiology and antibiotic susceptibility patterns of community- and hospital-acquired urinary tract infections in a general hospital in Kuwait

Abstract

Objective: Our purpose was to determine the bacterial profile and prevalence of antibiotic resistance patterns of uropathogens, as well as evaluate the problem with extended-spectrum β-lactamase (ESBL) producing isolates, causing urinary tract infections (UTIs) in Al-Amiri Hospital, Kuwait, over a 3-year period.

Materials and methods: Isolates (56,505) from symptomatic UTI cases from January 2005 to December 2007 were identified by conventional methods and the VITEK identification card system. Antimicrobial susceptibility testing was performed by disk diffusion method for Gram-positive organisms and an automated VITEK 2 machine for Gram-negative organisms. ESBL production by the Enterobacteriaceae was detected by the double-disk diffusion method and VITEK-2 system.

Results: Significant bacteriuria was detected in 15,064 (26.6%) of the 56,505 urine samples. Escherichia coli accounted for 4,876 (54.9%) from community-acquired UTI (CA-UTI) and 2,253 (36.4%) from hospital-acquired UTI (HA-UTI), followed by Streptococcus agalactiae (1,129, 12.7%) and Klebsiella pneumoniae (962, 10.8%) from CA-UTI cases. Candida spp. (973, 15.7%) and K. pneumoniae (747, 12.1%) were the second and third most prevalent isolates, respectively, in HA-UTI. High resistance rates were observed among the Enterobacteriaceae against ampicillin, cephalothin, ciprofloxacin, piperacillin and trimethoprim-sulfamethoxazole. About 855 (12%) and 291 (17%) of E. coli and K. pneumoniae, respectively, were resistant to ≥4 antibiotics. The prevalence of ESBL-producing E. coli and K. pneumoniae in CA-UTI was 12 and 17% and in HA-UTI 26 and 28%, respectively.

Conclusion: A high percentage of the uropathogens causing UTI in the Al-Amiri Hospital setting was highly resistant to the first- and second-line antibiotics for the therapy of UTI. ESBL-producing bacteria are highly prevalent in our hospital.