title: Resistance of uropathogens in symptomatic urinary tract infections in León, Nicaragua.
abstract: Management of urinary tract infections (UTI) in Central America and especially Nicaragua, is complicated by the lack of knowledge about the antibiotic resistance of uropathogens. We conducted a prevalence study to gain more insight into the aetiology, bacterial resistance and risk factors for symptomatic UTI in the region of León, Nicaragua. In 2002, all consecutive patients with UTI symptoms and pyuria >/=10 WBC/hpf were admitted to the study. Positive cultures from midstream urine specimens were defined as >/=10(5) cfu/ml of a single uropathogen. Susceptibility tests were performed with disc diffusion tests using the Kirby-Bauer method and broth microdilution using National Committee for Clinical Laboratory Standards criteria both in León and a reference laboratory in Utrecht. A positive culture was present in 62 of 208 study subjects (30%). Escherichia coli (56%), Klebsiella spp. (18%) and Enterobacter spp. (11%) were the most frequent pathogens isolated. Presence of cystocele, incontinence and increasing age were risk factors for bacterial UTI. E. coli was least resistant to ceftriaxone, amikacin and nitrofurantoin (>90% susceptible). We observed high resistance rates in E. coli to amoxicillin (82%, MIC(90) 128 mg/l), trimethoprim-sulphamethoxazole (TMP-SMX) (64%, MIC(90) 32 mg/l), cephalothin (58%, MIC(90), 32 mg/l), ciprofloxacin (30%; MIC(90), 32 mg/l), amoxicillin/clavulanate (21%, MIC(90) 8 mg/l) and gentamicin (12%, MIC(90) 2 mg/l). Our results suggests that community acquired uropathogens in Nicaragua are highly resistant to many antimicrobial agents. The use of amoxicillin, trimethoprim-sulphamethoxazole and cephalothin against uropathogens needs to be reconsidered. High quinolone resistance rates among E. coli in Nicaragua gives cause for great concern.
authors.affiliation: Department of Medicine, University Hospital, UNAN, León (L), Nicaragua.
authors.forename: A J
authors.initials: AJ
authors.lastname: Matute
authors.forename: E
authors.initials: E
authors.lastname: Hak
authors.forename: C A M
authors.initials: CA
authors.lastname: Schurink
authors.forename: A
authors.initials: A
authors.lastname: McArthur
authors.forename: E
authors.initials: E
authors.lastname: Alonso
authors.forename: M
authors.initials: M
authors.lastname: Paniagua
authors.forename: E
authors.initials: E
authors.lastname: Van Asbeck
authors.forename: A M
authors.initials: AM
authors.lastname: Roskott
authors.forename: F
authors.initials: F
authors.lastname: Froeling
authors.forename: M
authors.initials: M
authors.lastname: Rozenberg-Arska
authors.forename: I M
authors.initials: IM
authors.lastname: Hoepelman
mesh_terms: D000328:Adult; D000658:Amoxicillin / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification*; D002512:Cephalothin / Q000494:pharmacology / Q000627:therapeutic use; D004338:Drug Combinations; D024881:Drug Resistance, Bacterial; D004754:Enterobacter / Q000187:drug effects / Q000302:isolation & purification; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007709:Klebsiella / Q000187:drug effects / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D009527:Nicaragua; D011776:Pyuria / Q000382:microbiology; D015363:Quinolones / Q000494:pharmacology / Q000627:therapeutic use; D012307:Risk Factors; D013419:Sulfamethizole / Q000494:pharmacology / Q000627:therapeutic use; D014295:Trimethoprim / Q000494:pharmacology / Q000627:therapeutic use; D001745:Urinary Bladder Diseases; D014549:Urinary Incontinence; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D014556:Urine / Q000382:microbiology; D000096926:Benzenesulfonamides
chemical_list: D000658:Amoxicillin; D000900:Anti-Bacterial Agents; D002512:Cephalothin; D004338:Drug Combinations; D015363:Quinolones; D013419:Sulfamethizole; D014295:Trimethoprim; C029078:trimethoprim sulfamethizole; D000096926:Benzenesulfonamides