Bacteriological Profile of Urinary Tract Infections at the Avicenne Military Hospital in Marrakech

Abstract

Urinary tract infection is the attack of a tissue of the urinary tract by one or more micro-organisms. It is a major public health problem. The objective of this work is to propose, based on updated data, the microbial ecology of urinary tract infection at the Avicenne Military Hospital in Marrakech, and to follow the antibiotic sensitivity profile of uropathogenic bacteria. This is a retrospective descriptive study over 4 years from January 2014 to December 2018, which was conducted on urinary cytobacteriological examinations from hospitalized patients and outpatients, treated at the microbiology laboratory of the Military Hospital Avicenne of Marrakech. Of the 17607 ECBUs that were examined, the diagnosis of urinary tract infection was retained in 2349 (13%). 75% of the ECBUs came from hospitalized patients and 25% from outpatients, with a sex ratio of 1.1. The analysis of the ECBU showed that Enterobacteriaceae constituted 80% of the positive urine isolates, with a predominance of Escherichia coli (62%), followed by Klebsiella pneumoniae (13%). The reading and interpretation of the antibiograms showed that Escherichia coli was resistant to aminopenicillin associated with clavulanic acid in 51% of the cases against 55% for Klebsiella pneumoniae. The resistance of enterobacteriaceae to fluoroquinolones is about 33% for Escherichia coli, 30% for Klebsiella spp, while for the Trimmethoprim+Sulfamethoxazole combination more than half of the strains were resistant. On the other hand, aminoglycosides still have a good activity profile on enterobacteriaceae. The prevalence of BMR is 6.5%, represented by enterobacteriaceae producing extended spectrum betalactamases (ESBL) isolated in 89% of cases, with a predominance of Escherichia coli (52%) followed by klebsiella pneumoniae (22%) and Enterobacter cloacae (16%). Then the ceftazidime-resistant Pseudomonas aeruginosa (PARC) occupies the 2nd place with 5%, and finally methicillin-resistant Staphylococcus aureus (MRSA) and imipenem-resistant Acinetobnacter baumanii (ABRI) which occupy the 3rd place with rates at 3%. These BMR constitute a worrying problem, hence the need for rigorous application of hygiene rules and rational prescription of antibiotics. The knowledge of bacteriological profiles and the use of targeted antibiotic susceptibility testing will allow a management adapted to each hospital context.