n South African Medical Journal - Antimicrobial susceptibility of organisms causing community-acquired urinary tract infections in Gauteng Province, South Africa : research
|Article Title||Antimicrobial susceptibility of organisms causing community-acquired urinary tract infections in Gauteng Province, South Africa : research|
|© Publisher:||Health and Medical Publishing Group (HMPG)|
|Journal||South African Medical Journal|
|Affiliations||1 National Health Laboratory Service, 2 National Health Laboratory Service, 3 National Health Laboratory Service, 4 National Health Laboratory Service, 5 National Health Laboratory Service, 6 National Health Laboratory Service, 7 University of the Witwatersrand, 8 University of the Witwatersrand, 9 University of Cape Town, 10 Merck, 11 Merck, 12 Retrasol Research and Training Solutions and 13 DamaneX|
|Publication Date||Jun 2013|
|Pages||377 - 381|
Background. Patients with community-acquired urinary tract infections (UTIs) frequently present to healthcare facilities in South Africa (SA).
Aim. To provide information on UTI aetiology and antimicrobial susceptibility of pathogens.
Methods. We recruited women with UTI-related symptoms, who tested positive for ≥2 urine dipstick criteria (proteinuria, blood, leucocytes or nitrites) at 1 public and 5 private primary healthcare facilities in 2011. Demographic and clinical data were recorded and mid-stream urine (MSU) specimens were cultured. UTI pathogens were Gram-stained and identified to species level. Etest-based antimicrobial susceptibility testing was performed for amoxicillin/clavulanic acid, cefixime, cefuroxime, ciprofloxacin, fosfomycin, levofloxacin, nitrofurantoin, norfloxacin and trimethoprim/sulphamethoxazole.
Results. Of the 460 women recruited, 425 MSU samples were processed and 204 UTI pathogens were identified in 201 samples. Most pathogens were Gram-negative bacilli (GNB) (182; 89.2%) and 22 (10.8%) were Gram-positive cocci (GPC). Escherichia coli was the most frequent GNB (160; 79.6%), while Enterococcus faecalis was the predominant GPC (8; 4.0%). The UTI pathogens had similar susceptibility profiles for fosfomycin (95.5%; 95% confidence interval (CI) 92.6 - 98.4), the 3 fluoroquinolones (94.1%; 95% CI 90.8 - 97.4), nitrofurantoin (91.7%; 95% CI 87.8 - 95.6), cefuroxime (90.1%; 95% CI 86.0 - 94.3) and cefixime (88.2%; 95% CI 83.7 - 92.6). UTI pathogens were less susceptible to amoxicillin/clavulanic acid (82.8%; 95% CI 77.5 - 88.0) when compared with fluoroquinolones and fosfomycin. Trimethoprim/sulphamethoxazole was the least efficacious antimicrobial agent (44.3% susceptible; 95% CI 37.4 - 51.2).
Conclusion. This study provides relevant data for the empirical treatment of community-acquired UTIs in SA.
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