title: Antimicrobial susceptibility of organisms causing community-acquired urinary tract infections in Gauteng Province, South Africa.
abstract: BACKGROUND
  Patients with community-acquired urinary tract infections (UTIs) frequently present to healthcare facilities in South Africa (SA).
  
  
  OBJECTIVE
  To provide information on UTI aetiology and antimicrobial susceptibility of pathogens.
  
  
  METHODS
  We recruited women with UTI-related symptoms, who tested positive for ≥2 urine dipstick criteria (proteinuria, blood, leucocytes or nitrites) at 1 public and 5 private primary healthcare facilities in 2011. Demographic and clinical data were recorded and mid-stream urine (MSU) specimens were cultured. UTI pathogens were Gram-stained and identified to species level. Etest-based antimicrobial susceptibility testing was performed for amoxicillin/clavulanic acid, cefixime, cefuroxime, ciprofloxacin, fosfomycin, levofloxacin, nitrofurantoin, norfloxacin and trimethoprim/sulphamethoxazole.
  
  
  RESULTS
  Of the 460 women recruited, 425 MSU samples were processed and 204 UTI pathogens were identified in 201 samples. Most pathogens were Gram-negative bacilli (GNB) (182; 89.2%) and 22 (10.8%) were Gram-positive cocci (GPC). Escherichia coli was the most frequent GNB (160; 79.6%), while Enterococcus faecalis was the predominant GPC (8; 4.0%). The UTI pathogens had similar susceptibility profiles for fosfomycin (95.5%; 95% confidence interval (CI) 92.6 - 98.4), the 3 fluoroquinolones (94.1%; 95% CI 90.8 - 97.4), nitrofurantoin (91.7%; 95% CI 87.8 - 95.6), cefuroxime (90.1%; 95% CI 86.0 - 94.3) and cefixime (88.2%; 95% CI 83.7 - 92.6). UTI pathogens were less susceptible to amoxicillin/clavulanic acid (82.8%; 95% CI 77.5 - 88.0) when compared with fluoroquinolones and fosfomycin. Trimethoprim/ sulphamethoxazole was the least efficacious antimicrobial agent (44.3% susceptible; 95% CI 37.4 - 51.2).
  
  
  CONCLUSIONS
  This study provides relevant data for the empirical treatment of community-acquired UTIs in SA.
authors.affiliation: National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa. davidl@nicd.ac.za
authors.forename: David A
authors.initials: DA
authors.lastname: Lewis
authors.forename: Lindy Y E
authors.initials: LY
authors.lastname: Gumede
authors.forename: Louis A
authors.initials: LA
authors.lastname: van der Hoven
authors.forename: Gloria N
authors.initials: GN
authors.lastname: de Gita
authors.forename: Elsabe J E
authors.initials: EJ
authors.lastname: de Kock
authors.forename: Telsa
authors.initials: T
authors.lastname: de Lange
authors.forename: Venessa
authors.initials: V
authors.lastname: Maseko
authors.forename: Valentia
authors.initials: V
authors.lastname: Kekana
authors.forename: Francois P
authors.initials: FP
authors.lastname: Smuts
authors.forename: Olga
authors.initials: O
authors.lastname: Perovic
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D003430:Cross-Sectional Studies; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D008826:Microbial Sensitivity Tests; D013019:South Africa / Q000453:epidemiology; D016482:Urinalysis / Q000379:methods; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000890:Anti-Infective Agents