Abstract
Introduction: Bacterial infections of the urinary tract represent a major cause of outpatient visits as well as hospital-acquired infections. As the prevalence of multidrug-resistant uropathogens is increasing, updated knowledge of the commonest bacterial causes and their susceptibility patterns is crucial for the proper selection and use of antimicrobial drugs and the development of effective local prescribing guidelines. Methods: Handling of urine samples, identification of organisms and antimicrobial susceptibility testing were made according to guidelines in Monica Cheesbrough 2000, 2006. The prevalence of resistance of the pathogens against each antibiotic was calculated as the proportion of resistant isolates over the entire tested isolates. Data were analyzed using Epi info; the chi-square test and Fisher exact test were used to assess the statistical significance of results. Results: In this study, 774 samples were cultured from patients with suspected urinary tract infection (UTI), 705 (91%) urinary isolates showed significant growth (>105 CFU /L) while the other 69 samples showed no significant growth. 431 (61%) of the patients were female, while the other 274 (39%) were males. 13 types of pathogens were identified in 705 urinary isolates. E.Coli was the main bacterial uropathogen identified. Microbiological susceptibility of a total of 28 antibiotics was tested; for each urinary isolate, different sets of these antibiotics were used. 601(96%) of the bacteria were resistant to at least one antibiotic. 17 antibiotics were found to have a bacterial resistance rate of more than 50%, including all B lactams (except cefuroxime), Nalidixic acid, Ciprofloxacin, Norfloxacin, Clindamycin, Co-Trimoxazole and Tetracyclines(Tetracycline and Doxycycline). Other antibiotics were found to have resistance rates of less than 50%. Amikacin & Imipenem had the highest susceptibility rates. Throughout the 7 years, resistance to most of the antibiotics showed an incremental pattern. Conclusion: Current empirical antibiotic therapy for UTI should be modified, and new guidelines should be established based on local resistance rates. This study comes up with precious regional data for evidence-based empirical antibiotic treatment, but a national sentinel surveillance system and regional antibiograms should be established to track the bacterial susceptibility profiles in Sudan.
Highlights
Bacterial infections of the urinary tract represent a major cause of outpatient visits as well as hospital-acquired infections
E.coli, S.aureus & candida spp were found to cause a higher proportion of infections in females, Proteus and coagulase-negative staphylococci (CNS) were equal in both genders while the other types of pathogens were more in males (Table 2)
Microbiological susceptibility of a total of 28 antibiotics was tested; for each urinary isolate, different sets of these antibiotics were used. 601(96%) of the bacteria were resistant to at least one antibiotic. 17 antibiotics were found to have a bacterial resistance rate of more than 50%, including all B lactams except Cefurixime, Nalidixic acid, Ciprofloxacin, Norfloxacin Clindamycin, Co-Trimoxazole, and Tetracyclines (Tetracycline& Doxycycline)
Summary
Bacterial infections of the urinary tract represent a major cause of outpatient visits as well as hospital-acquired infections. Urinary tract infection (UTI) is defined as the colonization of the urinary tract by microbial pathogens. UTIs could be categorized by various methods, anatomically into lower (cystitis), upper (pyelonephritis), or prostatitis. It can be symptomatic UTI or asymptomatic bacteriuria (ASB). [1 - 3] Bacterial pathogens are the major cause of UTI, accounting for 95% of cases [4]. Urine culture is the gold standard test but is not approved for managing uncomplicated lower UTI, such as cystitis. A urine culture and sensitivity test should be obtained for acute pyelonephritis and any type of complicated UTIs, before empiric therapy to optimize the subsequent definitive antibiotic regimen [5]
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