title: Hospital and community isolates of uropathogens at a tertiary hospital in South Africa.
abstract: OBJECTIVE
  To investigate the profile of common uropathogens isolated from urine specimens submitted to the diagnostic microbiology laboratory at a tertiary teaching hospital and assess their antimicrobial susceptibility patterns to commonly used antimicrobial agents.
  
  
  METHODS
  We conducted a retrospective analysis of laboratory reports for all urine specimens submitted for investigations over a 1-year period. Isolates were tested by means of the Kirby-Bauer disc diffusion method for susceptibility to amoxicillin, ciprofloxacin, gentamicin, co-trimoxazole and nitrofurantoin, and for extended-spectrum beta-lactamase (ESBL) production.
  
  
  RESULTS
  Out of the total specimens (N=2,203) received over the 1-year study period, 51.1% (1,126) of the urine samples were culture-positive, the majority (65.4%) having come from females. The most common isolate was Escherichia coli (39.0%) followed by Klebsiella species (20.8%) and Enterococcus faecalis (8.2%). The Gram-negative isolates displayed a very high level of resistance to amoxicillin (range 43 - 100%) and co-trimoxazole (range 29 - 90%), whereas resistance to gentamicin (range 0 - 50%) and ciprofloxacin (range 0 - 33%) was lower. E. coli isolates were susceptible to nitrofurantoin (94%), and ESBL production was significantly higher (p=0.01) in the hospital isolates, compared with those from the community referral sites.
  
  
  CONCLUSIONS
  The culture-positive rate for uropathogens was high, with a greater incidence among females. E. coli was the most common aetiological agent identified, and remained susceptible to nitrofurantoin. Resistance levels to amoxicillin and co-trimoxazole were very high for all Gram-negative isolates, and it is recommended that these antibiotics should not be used for the empiric treatment of urinary tract infections.
authors.affiliation: Department of Microbiological Pathology, University of Limpopo, Medunsa Campus, Pretoria.
authors.forename: T M
authors.initials: TM
authors.lastname: Habte
authors.forename: S
authors.initials: S
authors.lastname: Dube
authors.forename: N
authors.initials: N
authors.lastname: Ismail
authors.forename: A A
authors.initials: AA
authors.lastname: Hoosen
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001437:Bacteriuria / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D013293:Enterococcus faecalis / Q000187:drug effects / Q000302:isolation & purification; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007709:Klebsiella / Q000187:drug effects / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D011511:Proteus / Q000187:drug effects / Q000302:isolation & purification; D012189:Retrospective Studies; D013019:South Africa; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology*; D014556:Urine / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents