Abstract
BackgroundUrinary tract infections (UTIs) are amongst the most common infections encountered globally and are usually treated empirically based on bacterial resistance to antibiotics for a given region. Unfortunately in Lesotho, no published studies are available to guide doctors in the treatment of UTIs. Treatment protocols for Western countries have been adopted, which may not be applicable for this region.AimTo determine the antimicrobial susceptibility profile of uropathogens in outpatients at the Maluti Adventist Hospital.SettingThe study was conducted at the outpatient department of the Maluti Adventist Hospital in Mapoteng, Lesotho.MethodsThis was a prospective cross-sectional study using consecutive sampling of patients with clinical symptoms of UTI. Midstream urine samples were screened through chemistry and microscopy, then positive urine samples were cultured. The isolated uropathogens underwent antimicrobial susceptibility testing and inclusion continued until 200 culture samples were obtained. Descriptive statistics were used in the data analysis.ResultsThe top five cultured uropathogens were Escherichia coli (61.5%), Staphylococcus aureus (14%), Pseudomonas species (6.5%), Enterococcus faecalis (5.5%) and Streptococcus agalactiae (5%). The isolated uropathogens showed low sensitivity to cotrimoxazole (32.5% – 75.0%) and amoxicillin (33.2% – 87.5%) and high sensitivity to ciprofloxacin (84.0% – 95.1%) and nitrofurantoin (76.9% – 100%)ConclusionIn the Maluti setting, cotrimoxazole and amoxicillin should be avoided as first-line drugs for the empirical treatment of community-acquired UTI. We recommend the use of nitrofurantoin as first choice.
Highlights
Urinary tract infections (UTIs) are a major cause of morbidity worldwide
In a study done at a tertiary hospital in South Africa, E. coli was found to be the most cultured microorganism but it represented only 39% of all the uropathogens isolated
Urine samples collected from 609 patients with symptoms of UTI were sent to the laboratory for urine microscopy and chemistry testing
Summary
Urinary tract infections (UTIs) are a major cause of morbidity worldwide. In a study done in Turkey on outpatient infections, UTIs were the second most common diagnosis after upper respiratory tract infections.[1] A UTI occurs when there is the presence of pathogenic microorganisms along the urinary tract, involving one or more of the following: urethra, prostate, bladder and/or kidneys.[2] Bacteria are by far the most common causative microorganisms of UTIs. Escherichia coli is the leading bacterial uropathogen in the world.[3] In a study on community-acquired infections, E. coli accounted for 68% of all the positive cultures for UTIs.[4] This was followed by Proteus mirabilis (12%), Staphylococcus aureus (10%), Enterococcus faecalis (6%) and Klebsiella aerogenes (4%).[4] These percentages and order of uropathogens after E. coli will vary from region to region, between men and women and between children and adults. Klebsiella spp. followed at 20.8% and Enterococcus faecalis at 8.2%.5. These differences highlight the importance of regional and institutional audits of antimicrobial susceptibility profiles. Treatment protocols for Western countries have been adopted, which may not be applicable for this region
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