Research

Antimicrobial susceptibility of organisms causing community-acquired urinary tract infections in Gauteng Province, South Africa

David A Lewis, Lindy Y E Gumede, Louis A van der Hoven, Gloria N de Gita, Elsabe J E de Kock, Telsa de Lange, Venessa Maseko, Valentia Kekana, Francois P Smuts, Olga Perovic

Abstract


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.


Authors' affiliations

David A Lewis, Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa

Lindy Y E Gumede, Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa

Louis A van der Hoven, Merck, Johannesburg, South Africa

Gloria N de Gita, Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa

Elsabe J E de Kock, Retrasol Research and Training Solutions, Pretoria, South Africa

Telsa de Lange, DamaneX, Centurion, South Africa

Venessa Maseko, Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa

Valentia Kekana, Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa

Francois P Smuts, Merck, Johannesburg, South Africa

Olga Perovic, Centre for Opportunistic, Tropical and Hospital Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Keywords

Urinary tract infection; resistance; antibiotic; South Africa; primary healthcare

Cite this article

South African Medical Journal 2013;103(6):377-381. DOI:10.7196/SAMJ.6722

Article History

Date submitted: 2013-01-21
Date published: 2013-03-15

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