Journal of the Bahrain Medical Society
Year 2019, Volume 31, Issue 3, Pages 35-43
https://doi.org/10.26715/jbms.31_06052019Safaa Al Khawaja1*, Rawan Al Aagha2, Nermin K Saeed3, Nashwa Fawzy4
1Consultant and Head of Infectious Diseases Unit, Department of Internal Medicine and Head of Infection
Control Department, Salmaniya Medical Center, Ministry of Health, Bahrain
2Chief Resident, Infectious Diseases, Department of Internal Medicine, Salmaniya Medical Center, Ministry
of Health, Bahrain
3Medical Microbiologist, Department of Pathology, Salmaniya Medical Center, Ministry of Health, Bahrain
4Lecturer Microbiology, High Institute of Public Health, Alexandria University, Egypt.
*Corresponding author:
Safaa Al Khawaja, Consultant and Head of Infectious Diseases Unit, Department of Internal Medicine, Head of Infection Control Department, Salmaniya Medical Center, Ministry of Health, Bahrain; Email: skhawaja@health.gov.bh, safaaalkhawaja@gmail.com
Received date: May 06, 2019; Accepted date: September 20, 2019; Published date: October 03, 2019
Abstract
Background and objectives: Urinary tract infections (UTIs) are amongst the most common infectionsdescribed in outpatients setting. This study was conducted to study the uropathogenic Escherichiacoli isolated from patients with clinical diagnosis of community onset UTI. Such studies are crucialto assess the local antimicrobial resistance rates for the common uropathogens in our community andaccordingly to suggest the best empirical therapy of UTI relying on the predictability of the agentscausing UTI and knowledge of their antimicrobial susceptibility patterns.
Materials and Methods: Total of 829 consecutive non duplicate urine specimens with positive growthof significant E.coli collected from patients presenting to the primary health centers in the Kingdomof Bahrain with clinical suspicion of UTI during the year 2017 were included. Urine samples wereprocessed in the Microbiology laboratory. Bacterial isolates were identified using standard conventionalmethods and antimicrobial susceptibility testing was performed using disk diffusion technique followingKirby-Bauer method.
Results: There was relatively high rate of resistance to commonly prescribed oral agents for UTI suchas cotrimoxazole (42.7%), amoxicillin-clavulanic acid (34.6%), cefuroxime (32.21%), and norfloxacin(23.6%), which are the available first line options for treating UTI in primary health centers, but mostisolates retains their susceptibility to nitrofurantoin (resistance of 5.19%). MDR phenotype (defined asexhibiting resistance to at least one agent in ≥3 antimicrobial classes) was observed among 34.8% ofthe isolates, ESBL production was confirmed among 27.39% of tested E. coli isolates.
Conclusion: Resistant strains of E. coli are prevalent in the community acquired UTI, nitrofurantoin isthe only drug that showed an excellent sensitivity pattern and should be the preferred drug for empiricaltherapy of uncomplicated lower UTI as an outpatient.
Keywords: Escherichia coli, fever, outpatients, antimicrobial resistance, urinary tract infection.