Antibiotic resistance pattern of bacterial isolates from cases of urinary tract infections among hospitalized and out-patients at a tertiary health facility in South Western Nigeria

Abstract

Aim: Urinary tract infections (UTIs) are among the most common human infections with distribution of causative agents and their susceptibility pattern to antibiotics varying from region to region. This study aimed at determining the bacterial uropathogens and their antibiotic resistance profile among patients in a Nigerian tertiary health care facility. Materials and Methods: Appropriate urine specimens (midstream/catheter specimen urine) of all suspected cases of UTI by clinicians were processed in the medical microbiology laboratory for detection of significant bacteriuria. Bacteria uropathogens isolated were identified by standard biochemical tests and antibiotic susceptibility test to eight antibiotics was carried out on them using Kirby-Bauer disc diffusion technique. Methicillin-resistant Staphylococcus aureus (MRSA) was identified by cefoxitin disc diffusion technique and extended-spectrum beta-lactamase (ESBL) producing enterobacteria were detected using double-disc synergy test. Results: Of the total 157 males and 189 females investigated, 35.7% and 66.1% respectively had significant bacteriuria. Escherichia coli was the most commonly isolated bacterial pathogen both among in- and out-patients (52.6% vs. 65.5%). Other isolated organisms were S. aureus (13.4% vs. 19.0%), Pseudomonas aeruginosa (10.3% vs. 2.4%), Klebsiella pneumoniae (7.2% vs. 7.1%) and K. aerogenes (7.2% vs. 1.2%). Resistance rate of uropathogens to antibiotics was higher among in-patients. Resistance rate to ofloxacin, ceftazidime and ceftriaxone was generally very low compared to other tested antibiotics. Multiple resistant bacteria: MRSA and ESBL-producing enterobacteria were detected among both in-and out-patient with no significant difference in isolation rate. Conclusion: There is a need for continuous monitoring of uropathogens and their antibiotic sensitivity profile for evidence-based empirical treatment of UTI. There is an urgent need for the establishment of antibiotic stewardship programs in healthcare facilities in Nigeria.