The prevalence and susceptibility patterns of uropathogens in a private teaching hospital: A six years retrospective study at GAMBY teaching hospital, Bahir Dar, Ethiopia

Abstract

Background: Urinary tract infection (UTI) is humans' second most common bacterial infection. Indiscriminate use of antibiotics is a common practice in underdeveloped and many developing countries that often leads to the emergence of resistant microorganisms to one or several of these agents with gradual narrowing of scope for effective molecules to combat bacterial infections including UTIs. As a common practice, empirical antimicrobial treatment is initiated before the laboratory results of urine culture are available which may lead to the emergence and spread of antimicrobial-resistant strains. Therefore, this study was conducted to identify the common bacterial uropathogens associated with urinary tract infection and their susceptibility to antibiotics.

Objectives: This study aims to analyze the prevalence of culture-positive isolates and determine the susceptibility patterns of bacterial uropathogens to antibiotics at GAMBY Teaching General Hospital, Bahir Dar, Ethiopia.

Methods: An institution-based retrospective study was conducted at GAMBY Teaching General Hospital (GTGH) for patients who had UTIs, from November 1, 2015, to December 30, 2021 G.C. Antimicrobial sensitivity tests were done using the disc diffusion technique as per the standard of the Kirby-Bauer method.

Results: A total of 1,714 urine samples were processed. Of the total urine samples collected, 974 (56.8%) were from women and 456 (26.6%) revealed a positive culture. Among the positive isolates, the gram-negative was 340 (74.6 %), which makes it the most prevalent type. E. coli, 276 (60.5%) and S. saprophyticus, 78 (17.1%) were the two most prevalent uropathogens isolated. The highest percentage of susceptibility to antimicrobial agents was seen with nitrofurantoin 338 (91.4%), Clindamycin 72 (83.7%), Norfloxacin 244 (79.2%), and Cefoxitin 22 (78.6%). Ampicillin 48 (100%), Piperacillin 6(100%), Cefixime 6 (100%), Clarithromycin 6 (100%), Amoxicillin 96 (96%), Amoxicillin/clavulanic acid 242 (89.6%), and Penicillin 12 (85.7%) had the highest percentage of resistance among all isolates to the antimicrobial agents.

Conclusions and recommendations: Urinary tract infections are mostly caused by Gram-negative bacteria predominantly in females and Escherichia coli is the most common isolated bacteria. Nitrofurantoin, Norfloxacin, cefoxitin, and clindamycin are considered appropriate antimicrobials for the empirical treatment of urinary tract infections. The majority of uropathogens were resistant to antibiotics commonly used in clinical practice. The resistance pattern to all of the microorganisms incriminated showed there was a progressive increment of resistance to the common antibiotics over the study period. Empirical treatment of UTIs should be guided on the newer culture and sensitivity pattern and more importantly, prescriptions should be revised following the culture and sensitivity results.

Keywords: Ethiopia; GAMBY Teaching Hospital; UTI; antibiotics; uropathogen.