Profiling Of Antibiotic Resistance Among Uropathogens Isolated From Patients Attending Kericho County Referral Hospital

Abstract

Antibiotic resistance among the causative agents of urinary tract infections (UTIs) presents a crisis that hinders efforts for effective management of the infections globally. Understanding the antimicrobial susceptibility profiles of bacteria to antibiotics at the local level is very important in empirical therapy. WHO in their report for early implementation to minimize the spread of antibiotic resistance emphasized on the importance of continuous surveillance of antimicrobial resistance in order to determine the current status. Although antibiotic resistance among uropathogens has been reported in some regions in Kenya, the profile of this antibiotic resistance has not been done in Kericho County. This research intended to find out the bacteria causative agents of UTI among patients attending Kericho County Referral Hospital (KCRH) and the current resistance to the available therapeutic agents. The research was conducted after obtaining authority from the Board of Graduate Studies of University of Kabianga, ethical committee of KCRH and the ethical approval by Institutional Research and Ethics Committee of Moi Teaching and Referral Hospital, Eldoret. The study design was hospital-based cross-sectional and the participants were all outpatients with manifestation of UTI as diagnosed by the clinician and consented to participate. Data collection was done using questionnaires and laboratory analysis. Three hundred urine samples from the eligible participants were inoculated onto the respective agar media and the bacteria growth identified using biochemical tests. Antibiotic sensitivity test was done using Kirby Bauer disk diffusion method. Statistical Package for Social Scientists version 21 software was used to analyse data using frequencies. Pearson correlation was used to test for association between categorical variables. Of the 300 samples received, 60 yielded bacteria isolates giving UTI prevalence of 20%. Urinary tract infection was common in females compared to males. Gram positive cocci were the major causative agents of UTI accounting for 75%. Among these, 41.7% were Staphylococcus aureus and Enterococci faecalis (33.3%). Gram negative rods accounted for 25% of whom 20.0% were Escherichia coli, 3.3% Proteus spp. and 1.7% Klebsiella pneumoniae. There was no statistically significant association between organisms causing UTI and gender (Pearson correlation=0.872). Antibiotic sensitivity tests were done for the sixty (60) bacteria isolates. The isolates showed various susceptibility levels to the therapeutic agents in the study. Although some bacteria were susceptible to the commonly used antibiotics, resistance was observed towards the antibiotics namely; ampicillin (84.3%) and azithromycin (71.9%). There was a higher resistance (75%) to augmentin by gram negative bacteria as compared to resistance (40%) by gram positive bacteria. Overall, bacteria were moderately resistant (30%) to norfloxacin and least resistant to cefoxitine (13.3%), gentamycin (11.7%) and ciprofloxacin (10%). While most bacteria showed multiple resistance to 3 drugs, some showed resistance to utmost 5 drugs tested in the study. This study found Staphylococcus aureus to be the predominant aetiological agent of UTI while Enterococci faecalis showed high level of multiple resistance to antibiotics. Significant resistance levels exist against augmentin, azithromycin and ampicillin. In conclusion, cefoxitine, gentamycin and ciprofloxacin are good therapeutic choices for recurrent UTI when culture results are unavailable. The study will support an empiric approach to the management of UTI hence preventing reoccurrence of infection and deterring further development of related complications.