肯尼亚医疗机构治疗的尿路感染患者的细菌病因及其对常用抗生素的耐药性。

Bacterial etiology of urinary tract infections in patients treated at Kenyan health facilities and their resistance towards commonly used antibiotics.

机构信息

Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.

School of Biomedical Sciences, Makerere University, Kampala, Uganda.

出版信息

PLoS One. 2023 May 26;18(5):e0277279. doi: 10.1371/journal.pone.0277279. eCollection 2023.

DOI:10.1371/journal.pone.0277279

PMID:37235625

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10218719/

Abstract

BACKGROUND

Evidence-based empirical antibiotic prescribing requires knowledge of local antimicrobial resistance patterns. The spectrum of pathogens and their susceptibility strongly influences guidelines for empirical therapies for urinary tract infections (UTI) management.

OBJECTIVE

This study aimed to determine the prevalence of UTI causative bacteria and their corresponding antibiotic resistance profiles in three counties of Kenya. Such data could be used to determine the optimal empirical therapy.

METHODS

In this cross-sectional study, urine samples were collected from patients who presented with symptoms suggestive of UTI in the following healthcare facilities; Kenyatta National Hospital, Kiambu Hospital, Mbagathi, Makueni, Nanyuki, Centre for Microbiology Research, and Mukuru Health Centres. Urine cultures were done on Cystine Lactose Electrolyte Deficient (CLED) to isolate UTI bacterial etiologies, while antibiotic sensitivity testing was done using the Kirby-Bauer disk diffusion using CLSI guidelines and interpretive criteria.

RESULTS

A total of 1,027(54%) uropathogens were isolated from the urine samples of 1898 participants. Staphylococcus spp. and Escherichia coli were the main uropathogens at 37.6% and 30.9%, respectively. The percentage resistance to commonly used drugs for the treatment of UTI were as follows: trimethoprim (64%), sulfamethoxazole (57%), nalidixic acid(57%), ciprofloxacin (27%), amoxicillin-clavulanic acid (5%), and nitrofurantoin (9%) and cefixime (9%). Resistance rates to broad-spectrum antimicrobials, such as ceftazidime, gentamicin, and ceftriaxone, were 15%, 14%, and 11%, respectively. Additionally, the proportion of Multidrug-resistant (MDR) bacteria was 66%.

CONCLUSION

High resistance rates toward fluoroquinolones, sulfamethoxazole, and trimethoprim were reported. These antibiotics are commonly used drugs as they are inexpensive and readily available. Based on these findings, more robust standardised surveillance is needed to confirm the patterns observed while recognising the potential impact of sampling biases on observed resistance rates.

摘要

背景

循证经验性抗生素处方需要了解当地的抗菌药物耐药模式。病原体的种类及其敏感性强烈影响着尿路感染（UTI）管理的经验性治疗指南。

目的

本研究旨在确定肯尼亚三个县 UTI 病原体的流行情况及其相应的抗生素耐药谱。这些数据可用于确定最佳的经验性治疗方法。

方法

在这项横断面研究中，从以下医疗机构出现 UTI 症状的患者中采集尿液样本：肯雅塔国家医院、基安布医院、马加迪、马库埃尼、纳纽基、微生物学研究中心和穆库鲁保健中心。使用胱氨酸乳糖电解质缺乏（CLED）进行尿液培养以分离 UTI 细菌病因，同时根据 CLSI 指南和解释性标准使用 Kirby-Bauer 圆盘扩散法进行抗生素敏感性试验。

结果

从 1898 名参与者的尿液样本中总共分离出 1027 株（54%）尿路病原体。葡萄球菌属和大肠埃希菌分别为主要的尿路病原体，占 37.6%和 30.9%。常用于治疗 UTI 的常用药物的耐药率如下：甲氧苄啶（64%）、磺胺甲噁唑（57%）、萘啶酸（57%）、环丙沙星（27%）、阿莫西林克拉维酸（5%）和呋喃妥因（9%）和头孢克肟（9%）。对头孢他啶、庆大霉素和头孢曲松等广谱抗生素的耐药率分别为 15%、14%和 11%。此外，多药耐药（MDR）细菌的比例为 66%。