Background:
The Namibia Standard Treatment Guidelines (STGs) recommends empirical antibiotic treatment in patients with signs and symptoms of Urinary tract infections (UTIs). The goal of UTI treatment is to eliminate the bacteria from the urinary tract. Efficacy of empirical antimicrobial treatment of UTI depends on the sensitivity of common microorganisms, the level of the antimicrobial load in the urine and the duration of treatment. The objective of this study was to identify the common uropathogens that cause UTI, describe the sensitivity pattern of common isolates to antibiotics that are used in the treatment of UTI and recommend appropriate antibiotics for the empirical treatment of UTI in Namibia.
Methods:
This was a cross-sectional descriptive analysis of antibiotic susceptibility of isolates from urine using routinely collected data from the Namibia Institute of Pathology (NIP) database. Urine culture and sensitivity results from health facilities throughout Namibia from January 1, 2009 to June 30, 2013 were analysed. A total of 94, 682 urine samples were tested during the study period.
Results:
The most common pathogens isolated were Escherichia coli (n = 18668, 34.1 %), Proteus mirabilis (n = 3520, 6.8%), and Klebsiella pneumoniae (n = 3266, 6.4%). E. coli showed very high resistance rate to amoxicillin and co-trimoxazol (79.6%, 78.64%) respectively. About one third (28%) of E. coli were resistant to Cephalothin and Nalidixic Acid. However, E. coli remained highly sensitive to ceftriaxone, amikacin, cefuroxime, gentamycin, nitrofurantoin, ofloxacin, norfloxacin, ciprofloxacin, and amoxicillin/ clavulanic acid its resistance ranging from 2.2% -16.82%. Proteus was found to be highly resistant to amoxicillin (55.91%), co-trimoxazole (57.85%) and nitrofurantoin (77.37%). However, it is less resistant to cephalothin (15.51%) and nalidixic acid (11.14%). Klebsiella, on the other hand, was found to be more resistant to Amoxicillin (96.72%) but less resistant to nitrofurantoin ( 23.87). It also demonstrated resistance to co-trimoxazole (56.52%) and cephalothin (35.79%).
Conclusions:
E. coli isolated from urine showed high resistance to nalidixic acid which is the first line treatment for community acquired UTI. In addition, the second common isolate Proteus spp is naturally resistant to nitrofurantoin but highly sensitive to nalidixic acid. Klebsiella showed moderate resistance to nitrofurantoin but less resistance to nalidixic acid. We therefore recommend the substitution of nalidixic acid with fosfomycin as first line treatment of community acquired UTI.
Author(s): Assegid Mengistu, Norbert Forster, Johannes Gaeseb, Gilbert Habimana, Saren Kauhondamwa, Gottfried Uaaka, Christophine Ndjavera, Emanuel Ugbaro, Lazarus Indongo, and Evans Sagwa