title: Microbiology of urinary tract infections in Gaborone, Botswana.
abstract: OBJECTIVE
  The microbiology and epidemiology of UTI pathogens are largely unknown in Botswana, a high prevalence HIV setting. Using laboratory data from the largest referral hospital and a private hospital, we describe the major pathogens causing UTI and their antimicrobial resistance patterns.
  
  
  METHODS
  This retrospective study examined antimicrobial susceptibility data for urine samples collected at Princess Marina Hospital (PMH), Bokamoso Private Hospital (BPH), or one of their affiliated outpatient clinics. A urine sample was included in our dataset if it demonstrated pure growth of a single organism and accompanying antimicrobial susceptibility and subject demographic data were available.
  
  
  RESULTS
  A total of 744 samples were included. Greater than 10% resistance was observed for amoxicillin, co-trimoxazole, amoxicillin-clavulanate, and ciprofloxacin. Resistance of E. coli isolates to ampicillin and co-trimoxazole was greater than 60% in all settings. HIV status did not significantly impact the microbiology of UTIs, but did impact antimicrobial resistance to co-trimoxazole.
  
  
  CONCLUSIONS
  Data suggests that antimicrobial resistance has already emerged to most oral antibiotics, making empiric management of outpatient UTIs challenging. Ampicillin, co-trimoxazole, and ciprofloxacin should not be used as empiric treatment for UTI in this context. Nitrofurantoin could be used for simple cystitis; aminoglycosides for uncomplicated UTI in inpatients.
authors.affiliation: Botswana-UPenn Partnership, Gaborone, Botswana.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Renuart
authors.forename: David M
authors.initials: DM
authors.lastname: Goldfarb
authors.forename: Margaret
authors.initials: M
authors.lastname: Mokomane
authors.forename: Ephraim O
authors.initials: EO
authors.lastname: Tawanana
authors.forename: Mohan
authors.initials: M
authors.lastname: Narasimhamurthy
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Steenhoff
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Silverman
mesh_terms: D000328:Adult; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000494:pharmacology / Q000627:therapeutic use; D000667:Ampicillin / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001902:Botswana / Q000453:epidemiology; D002939:Ciprofloxacin / Q000494:pharmacology / Q000627:therapeutic use; D015897:Comorbidity; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000254:growth & development; D006094:Gram-Positive Bacteria / Q000187:drug effects* / Q000254:growth & development; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009582:Nitrofurantoin / Q000494:pharmacology / Q000627:therapeutic use; D012189:Retrospective Studies; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology / Q000627:therapeutic use; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D019980:Amoxicillin-Potassium Clavulanate Combination; D000667:Ampicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D009582:Nitrofurantoin