title: Antimicrobial resistance in outpatient Escherichia coli urinary isolates in Dakar, Senegal.
abstract: BACKGROUND
  Data regarding the evolution of antimicrobial resistance are needed to suggest appropriate empirical treatment of urinary tract infections (UTI) in developing countries. To assess the antimicrobial susceptibility of Escherichia coli, the predominant pathogen in community-acquired UTI, a prospective multicenter study was carried out in Dakar, Senegal.
  
  
  METHODS
  From February 2004 to October 2006, 1010 non-duplicate E. coli strains were collected from four centres. Antimicrobial susceptibility testing was performed using disk diffusion method according to the recommendations of the CA-SFM (2004).
  
  
  RESULTS
  Most of the isolates were resistant to amoxicillin (73.1%), amoxicillin-clavulanic acid (67.5%), cephalothin (55.8%), and trimethoprim/sulfamethoxazole (68.1%). Extended spectrum beta-lactamase was detected in 38 strains. The overall resistance rates to nalidixic acid, norfloxacin and ciprofloxacin were 23.9%, 16.4% and 15.5%, respectively. Most of the strains were susceptible to gentamicin, nitrofurantoin and fosfomycin (respective susceptibility rates, 93.8%, 89.9%, and 99.3%). During this period, a significant decrease in sensitivity was observed for cephalothin, fluoroquinolones and trimethoprim/sulfamethoxazole (p<0.001).
  
  
  CONCLUSIONS
  These data suggest that trimethoprim/sulfamethoxazole may no longer be used as empirical treatment for community-acquired UTI in Dakar. In order to preserve the activity of fluoroquinolones for future years, alternatives such as fosfomycin or nitrofurantoin should be considered.
authors.affiliation: Laboratoire de Biologie Médicale, Institut Pasteur, Dakar, Senegal. sire@pasteur.sn
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Sire
authors.forename: Pierre
authors.initials: P
authors.lastname: Nabeth
authors.forename: Jean-David
authors.initials: JD
authors.lastname: Perrier-Gros-Claude
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Bahsoun
authors.forename: Tidiane
authors.initials: T
authors.lastname: Siby
authors.forename: Edgard Adam
authors.initials: EA
authors.lastname: Macondo
authors.forename: Aïssatou
authors.initials: A
authors.lastname: Gaye-Diallo
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Guyomard
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Seck
authors.forename: Sébastien
authors.initials: S
authors.lastname: Breurec
authors.forename: Benoit
authors.initials: B
authors.lastname: Garin
mesh_terms: D000293:Adolescent; D000328:Adult; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010045:Outpatients; D011247:Pregnancy; D011446:Prospective Studies; D012675:Senegal / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D055815:Young Adult