title: ANTIBIOTIC SUSCEPTIBILITY OF ORGANISMS CAUSING URINARY TRACT INFECTION IN PATIENTS PRESENTING AT KENYATTA NATIONAL HOSPITAL, NAIROBI.
abstract: BACKGROUND
  Changes in susceptibility patterns of bacterial pathogens isolated from urinary tract infections emphasize the need for regional surveillance to generate information that can be used in management of patients. Knowledge on the current status of antimicrobial resistance in uropathogens, and the prevalence of expanding spectrum beta-lactamases (ESBLs) in the isolates will guide policy formulations and encourage prudent use of antimicrobials.
  
  
  OBJECTIVE
  Identify bacterial pathogens causing UTI and determine the association between the pathogens isolated from patients attending KNH. Determine antimicrobial susceptibility patterns of the UTI pathogens and the prevalence of ESBL in the isolated pathogens.
  
  
  METHODS
  Laboratory-based study.
  
  
  METHODS
  Department of Medical Microbiology University of Nairobi and Kenyatta National Hospital microbiology laboratory, Nairobi, Kenya.
  
  
  METHODS
  Nine hundred and forty eight patients presenting directly to the Kenyatta National Hospital's diagnostic lab. Patients were only classified as in-patients if at the time of specimen collection they were being admitted to one of KNH wards.
  
  
  RESULTS
  Out of the 948 urine samples processed, 189 in-patients and 37 out-patients samples had significant bacterial growth. The uropathogens identified from in-patient specimens were Escherichia coli (56), Klebsiellapneumoniae (33), Enterococcus spp. (34) and Entrobacter (16) making up 30%, 18%, 18% and 9% respectively. ESBL isolates were found to be resistant to the locally administered antibiotics; Augmentin (37%), Levofloxacin (37%), Cefoperazone (37%), Ampicillin (39%), Doxycyline (41%), Gentamicin (30%) and Nalidixic Acid (38%).
  
  
  CONCLUSIONS
  The increased prevalence of multidrug resistant ESBL pathogens poses challenges for health care providers at KNH and signifies the need for new approach to treat UTI. It would be prudent for laboratories to include specialized tests for detection of ESBL producing pathogens from isolates obtained from in-patients. Further studies on the mechanisms and pathways utilized by these bacteria to cause UTI will highlight other avenues in patient management.
authors.affiliation: The University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, Arizona, United States.
authors.forename: H I
authors.initials: HI
authors.lastname: Magale
authors.affiliation: The Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville, North Carolina, United States.
authors.forename: I A
authors.initials: IA
authors.lastname: Kassim
authors.affiliation: Department of Medical Microbiology, University of Nairobi, P. O. Box 19676-00202, Nairobi, Kenya.
authors.forename: S A
authors.initials: SA
authors.lastname: Odera
authors.affiliation: Department of Medical Microbiology, University Of Nairobi, P. O. Box 19676-00202, Nairobi, Kenya.
authors.forename: M J
authors.initials: MJ
authors.lastname: Omolo
authors.affiliation: Department of Medical Microbiology, University of Nairobi, P. O. Box 19676-00202, Nairobi, Kenya, Kenya AIDS Vaccine Initiative (KAVI), School of Medicine, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya.
authors.forename: W G
authors.initials: WG
authors.lastname: Jaoko
authors.affiliation: Department of Epidemiology, University of Alabama in Birmingham School of Public Health, 1665 University Blvd, Birmingham, Alabama, United States.
authors.forename: P E
authors.initials: PE
authors.lastname: Jolly
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / 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; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007630:Kenya; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D015995:Prevalence; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D001618:beta-Lactamases