title: Decreased susceptibility to commonly used antimicrobial agents in bacterial pathogens isolated from urinary tract infections in Rwanda: need for new antimicrobial guidelines.
abstract: The aim of this study was to obtain data on susceptibility patterns of pathogens responsible for both community and hospital urinary tract infections (UTIs); and analyzed risk factors for infection caused by ciprofloxacin-resistant Escherichia coli and extended-spectrum β-lactamase (ESBL)-producing strains in Rwanda. Of 1,012 urine cultures prospectively studied, a total of 196 (19.3%) yielded significant growth of a single organism. The most common isolate (60.7%) was Escherichia coli. The antibiotics commonly used in UTIs are less effective except Fosfomycin-trometamol and imipinem. The use of ciprofloxacin in the previous 6 months (odds ratio [OR] = 7.59 [1.75-32.74]), use of other antibiotics in the previous 6 months (OR = 1.02 [1.02-2.34]), and production of ESBL (OR = 19.32 [2.62-142.16]) were found to be associated with ciprofloxacin resistance among the E. coli isolates. Risk factors for ESBL positivity were the use of ciprofloxacin and third-generation cephalosporin in the preceding 6 months (OR = 3.05 [1.42-6.58] and OR = 9.78 [2.71-35.25], respectively); and being an inpatient (OR = 2.27 [1.79-2.89]). Fosfomycin-trometamol could be included as a reasonable alternative for the therapy of uncomplicated UTI in Rwanda.
authors.affiliation: Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium. cmuvunyi@nur.ac.rw
authors.forename: Claude Mambo
authors.initials: CM
authors.lastname: Muvunyi
authors.forename: Florence
authors.initials: F
authors.lastname: Masaisa
authors.forename: Claude
authors.initials: C
authors.lastname: Bayingana
authors.forename: Léon
authors.initials: L
authors.lastname: Mutesa
authors.forename: André
authors.initials: A
authors.lastname: Musemakweri
authors.forename: Grégoire
authors.initials: G
authors.lastname: Muhirwa
authors.forename: Geert W
authors.initials: GW
authors.lastname: Claeys
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification* / Q000472:pathogenicity; D004927:Escherichia coli Infections / Q000188:drug therapy; D005260:Female; D005578:Fosfomycin / Q000627:therapeutic use; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D010045:Outpatients; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D012432:Rwanda; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology*; D055815:Young Adult; D001618:beta-Lactamases / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D005578:Fosfomycin; D002939:Ciprofloxacin; D001618:beta-Lactamases