Department of Microbiology, Edna Adan University, Hargeisa, Somaliland.
Department of Medical Microbiology, College of Medicine & Health Sciences, Bahir Dar University, Ethiopia.
Ethiop J Health Sci. 2021 May;31(3):645-652. doi: 10.4314/ejhs.v31i3.22.
The emergence and spread of antimicrobial resistance (AMR) among uropathogens is increasing, especially in resource limited settings due to a number of reasons. The production of Extended Spectrum β-Lactamase (ESBL) by some strains of E. coli and methicillin resistant Staphylococcus species, limits the choice of antimicrobials in the treatment of urinary tract infection (UTI) globally. However, little is known about the type of uropathogenes and their current AMR profile among pregnant women in Hargeisa, Somaliland.
Clean-catch mid-stream urine samples were collected and processed for bacteriological culture and antimicrobial sensitivity testing (AST). Ceftazidime (30µg) and Cefotaxime (30µg) disks were used for ESBL screening as per CLSI guideline and each ESBL screening positive isolate were phenotypically confirmed by a combination disk test.
Among 376 study participants, 79 (21.0%) had significant bacteriuria (SBU). Majority at 58(73.4%) of the isolates were Gram-negative. The most predominant isolate was E.coli, 36(45.6%) followed by K. pneumonea 16(20.3%) and S. aureus at 9(11.4 %). The proportion of ESBL producing isolates was 25(32.9%). Gram-negatives showed high level resistance to ampicillin, amoxicillin, cefotaxime, and cephalexin at 87%, 85%, 57%, and 52%, respectively. Previous history of UTI, monthly income, educational status and having dysuria were significantly associated with SBU (p<0.05).
Relatively high prevalence of uropathogens and an increased level of drug resistance were documented. Therefore, continued surveillance on the type of uropathogens and their AMR pattern is needed to ensure appropriate recommendations for the rational empirical treatment of UTI and for policy input.
由于多种原因，包括产超广谱β-内酰胺酶（ESBL）的大肠杆菌和耐甲氧西林葡萄球菌在内的尿路病原体的出现和传播日益增加，尤其是在资源有限的环境中。 全球范围内，尿路感染（UTI）的治疗选择受到一些大肠杆菌菌株和耐甲氧西林葡萄球菌产生的 ESBL 的限制。然而，人们对索马里兰哈尔格萨孕妇的尿路病原体类型及其当前的 AMR 情况知之甚少。
采集清洁中段尿样进行细菌培养和抗菌药物敏感性试验（AST）。根据 CLSI 指南，使用头孢他啶（30µg）和头孢噻肟（30µg）纸片进行 ESBL 筛选，每个 ESBL 筛选阳性分离株通过联合纸片试验进行表型确认。
在 376 名研究参与者中，79 名（21.0%）有明显的菌尿症（SBU）。大多数分离株为革兰氏阴性菌，占 58 例（73.4%）。最主要的分离株是大肠杆菌，共 36 例（45.6%），其次是肺炎克雷伯菌 16 例（20.3%）和金黄色葡萄球菌 9 例（11.4%）。产 ESBL 分离株的比例为 25 例（32.9%）。革兰氏阴性菌对氨苄西林、阿莫西林、头孢噻肟和头孢氨苄的耐药率分别高达 87%、85%、57%和 52%。UTI 既往史、月收入、教育程度和尿痛与 SBU 显著相关（p<0.05）。
本研究记录了相对较高的尿路病原体流行率和更高水平的耐药性。因此，需要对尿路病原体的类型及其 AMR 模式进行持续监测，以确保对 UTI 的合理经验性治疗和政策制定提出适当建议。
