Antimicrobial Resistance and Extended-Spectrum â-Lactamase (ESBL) Producing Clinical Isolates from Urinary Tract Infection at two teaching hospitals in Rwanda

Abstract

The objective of this study was to obtain data on susceptibility patterns of pathogens responsible for UTIs. In addition, for the first time, the  prevalence and risk factors of ESBL-producing strains in Rwanda are described. Urinary isolates from symptomatic UTI patients’ cases attending to the University Teaching Hospital-Kigali and University teaching Hospital-Butare were identified by conventional methods. Antimicrobial susceptibility testing was performed by Kirby Bauer's disc diffusion method. Isolates resistant to third generation cephalosporin were tested for ESBL production by double disk synergy test method. Escherichia coli was the most common uropathogen, accounting for infections in 119 (60.7%) of the 196 cases; and occurred significantly more frequently in urines from outpatients (70.6%) than from inpatients (50%). Antimiocrobial agents commonly used for the treatment of UTI in Rwanda such as nalidixic acid,  nitrofurantoin and ciprofloxacin are far from effective except Fosfomycin-trometamol and imipinem. ESBLs were detected in 38.3 % (36/94) of the strains from inpatients (13.8% of E.coli) and 5.9% (6/102) of all strains from outpatients (1.9% of E.coli). The use of ciprofloxacin and third-generation cephalosporin in the preceding 6 months (OR: 3.05; 95% CI 1.42–6.58; P = 0.04 and OR: 9.78; 95% CI 2.71–35.25; P = 0.01 respectively); and being inpatient (OR: 2.27; 95% CI 1.79–2.89; P < 0.001) were independently associated with ESBL production. In conclusion, ESBL producers are, as in many countries, frequent in enterobacteriaceae in Rwanda. On the basis of our findings, we suggest that antimicrobial agent such as fosfomycin-trometamol could be alternative therapy for uncomplicated UTI, and should be introduced in the national guidelines.

Keywords: Urinary tract infection, antimicrobial resistance, ciprofloxacin, ESBL production, Rwanda