Antimicrobial resistance among bacteria isolated from urinary tract infections in females in Namibia, 2016–2017

Antimicrobial Resistance & Infection Control

Olli Vainio¹  Antti J. Hakanen²  Jaana Vuopio²  Jana Hamman³  Marius Hedimbi⁴  Erastus H. Haindongo⁵  Binta Funtua⁶  Boni Singu⁶  Francis Kalemeera⁶ 

[1] Faculty of Medicine, University of Turku, Turku, Finland;Institute of Biomedicine, University of Turku, Turku, Finland;Department of Clinical Microbiology, Laboratory Division, Turku University Hospital, Turku, Finland;Namibia Institute of Pathology, Windhoek, Namibia;School of Medicine, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia;School of Medicine, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia;Institute of Biomedicine, University of Turku, Turku, Finland;School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia;

关键词: Antimicrobial resistance;    Urinary tract infections;    Female;    Escherichia coli;    Uropathogens;    Namibia;   

DOI  :  10.1186/s13756-022-01066-2

来源: Springer

【 摘 要 】

BackgroundThe emergence of antimicrobial resistance (AMR) among bacterial pathogens demands a local understanding of the epidemiological situation. This information is needed both for clinical treatment decision-making purposes as well as for the revision of current care guidelines. Clinical AMR data from Namibia is sparse, whilst urinary tract infections remain not only widespread but they disproportionally affect females. This paper aims to describe the national antimicrobial resistance situation of major bacterial uropathogens in females within the 14 Namibian regions.MethodRetrospective countrywide information on clinical urine cultures performed in females in Namibia in 2016–2017 was obtained from the national public health laboratory, Namibia Institute of Pathology (NIP). The data set included both microbiological findings as well as antimicrobial susceptibility test (AST) results. The AST was done as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Resistance to 3rd generation cephalosporins was indicative of Extended Spectrum-ß-lactamase (ESBL) production. Data analysis was done with WHONET using expert interpretation rules.ResultsIn total, 22,259 urinary cultures were performed, of which 13,673 (61.4%) were culture positive. Gram-negative bacterial species accounted for 72.6% of the findings. The most common pathogens identified were Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis. Most of these were from young females, with a median age ranging from 28 to 32 years for the various pathogens. Resistance to ampicillin was 77.7% in E. coli and 84.9% in K. pneumoniae. In E. coli, resistance to 1st line empiric therapy antibiotic, nitrofurantoin, was below 13%, except for one region that showed 59.2% resistance. Resistance to third generation cephalosporin (3GC) was used as a proxy for ESBL production. By year 2017, 3GC resistance was 22%, 31.4% and 8.3% for E. coli, K. pneumoniae and P. mirabilis, respectively.ConclusionWe report high resistance to ampicillin, quinolones and sulfamethoxazole-trimethoprim amongst E. coli. Resistance rates to third-generation cephalosporins was also concerningly high at 22%. Resistance to carbapenems was low. However, superiority of nitrofurantoin was found, which provides rational support for the usefulness of nitrofurantoin as an empiric therapy regimen for the treatment of urinary tract infections in this setting.

【 授权许可】

CC BY