Antibiograms from community-acquired uropathogens in Gulu, northern Uganda - a cross-sectional study

BMC Infectious Diseases

Pancras Odongo²  Kenneth Luryamamoi⁴  Denis A Anywar¹  Charles O Odongo³ 

[1] Department of Biochemistry and Molecular Biology, Faculty of Medicine, Gulu University, Gulu, Uganda;Department of Internal Medicine, Faculty of Medicine, Gulu University, Gulu, Uganda;Department of Pharmacology & Therapeutics, Faculty of Medicine, Gulu University, P.O. box 166, Gulu, Uganda;Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda

关键词: Uganda;    Empirical treatment;    Uropathogens;    Antibiotic resistance;    Antibiograms;   

Others  :  1148744
DOI  :  10.1186/1471-2334-13-193

 received in 2012-12-19, accepted in 2013-04-19,  发布年份 2013

【 摘 要 】

Background

Urinary tract infections (UTI) are common in clinical practice and empirical treatment is largely employed due to predictability of pathogens. However, variations in antibiotic sensitivity patterns do occur, and documentation is needed to inform local empirical therapy. The current edition of the Uganda Clinical Guidelines recommends amoxicillin or cotrimoxazole as choice drugs for empirical treatment of community-acquired UTI. From our clinical observations, we suspected that this recommendation was not effective in our setting. In order to examine validity, we sought to identify bacteria from community-acquired infections and determine their susceptibility against these antibiotics plus a range of potentially useful alternatives for treatment of UTI.

Methods

A cross-sectional study of mid-stream urine collected from 339 symptomatic patients over a three-month period at Gulu regional referral hospital. Qualitative culture and identification of bacteria and antibiotic sensitivity testing using the modified Kirby-Bauer disk diffusion method was done. Participants’ demographic and clinical characteristics were collected using a standard form. Results were analyzed by simple proportions among related variables and confidence intervals computed using binomial exact distribution.

Results

Eighty two cultures were positive for UTI. Staphylococcus spp (46.3%) and Escherichia coli (39%) were the most common pathogens. There was high resistance to cotrimoxazole (73.2%), nalidixic acid (52.4%) and amoxicillin (51.2%). The most favorable antibiograms were obtained with gentamicin, amoxicillin-clavulanate and levofloxacin where 85.4%, 72.0%, 67.1% of isolates respectively, were either sensitive or intermediate. Only 51% of isolates were sensitive to ciprofloxacin.

Conclusion

There was high resistance to most antibiotics tested in this study. The recommendations contained in the current edition of the Uganda Clinical Guidelines are not in tandem with antibiotic sensitivity pattern of uropathogens seen in our setting. Amoxicillin-clavulanate or gentamicin should be considered for replacement of amoxicillin and cotrimoxazole for empirical treatment of UTI in our setting.

【 授权许可】

   
2013 Odongo et al.; licensee BioMed Central Ltd.

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