Antibiotics Susceptibility Pattern of Uropathogenic Bacterial Isolates from Community- and Hospital- Acquired Urinary Tract Infections in a Nigerian Tertiary Hospital

摘要

The study was designed to determine common bacterial aetiology of community and hospital –acquired urinary tract infection and their antibiotic sensitivity pattern. Reports of urine culture and sensitivity were retrospectively studied from September 2007 to September 2008 in the laboratory of Medical Microbiology and Parasitology Department of Aminu Kano Teaching Hospital, Kano. Results were analysed using SPSS 11.0 statistical software while p- values <0.05 were considered significant. A total of 3500 urine samples were processed .The overall prevalence of urinary tract infection was 26.0% (n=910); community –acquired urinary tract infection was 14.9%(n=520) and hospital-acquired urinary tract infection was 11.1%(n=390). p<.05. Escherichia coli predominated across the two groups (community- acquired =70.0%, hospital- acquired =25.6%) followed by Klebsiella species ( community –acquired =25.4%, hospital acquired =15.2%), Proteus mirabilis( community- acquired =4.0%, 17.9%). Staphylococcus aureus(community-acquired =1.9%, hospital- acquired =6.0%). The least was Pseudomonas aeruginosa(community –acquired=0.0%, hospital-acquired =6.2%). Most isolates were resistant to Cotrimoxazole, Tetracyclines, Ampicillin, Erythromycin, Nalidixic acid and Chloramphenicol while Ciprofloxacin, Ceftriaxone and Ceftazidime showed very high activity against most of the isolates. Floroquinolones and third generation cephalosporins should be recommended choice of first line drugs for treatment of urinary tract infection where susceptibility testing is unavailable. Introduction Urinary tract infection (UTI) is the most common health care -associated group of bacterial infection affecting humans in Africa 1. Most of them are as a result of urinary catheter induced infection, which comprises about 85% of nosocomial UTI 2. A prevalent study done in Nguru, northern Nigeria3, of microorganisms in community –acquired (CA) versus hospital –acquired (HA) UTIs was as follows , E.coli ( CA=19.9%, HA =11.5%), Klebsiella species (CA=12.8%, HA=8.9%), S.aureus (CA=4.7%, HA=2.7%), Streptococcus fecalis (CA=1.4%, HA=4.3%), Pseudomonas aeruginosa (CA=1.7%, HA=3.7%), Proteus mirabilis (CA=1.7%, HA=3.0%), Salmonella species(CA=2.4%, HA=0.0%). A similar study was carried out in India 4, which recorded a predominant rate (50.0%) of E.coli among CA UTI, resistant to Cotrimoxazole and Aminopenicillins. Another study done in Sagamu, western Nigeria among pregnant women and non pregnant women recorded 26.6% and 5.6% prevalence respectively of significant bacteriuria 5. Thus UTI is a disease too common to be ignored in modern day medical practice since it is encountered at virtually all levels of health care provision in Africa and beyond 6. The present study was therefore carried out to determine the spectrum of bacterial isolates and their antibiotic susceptibility in community versus hospital –acquired UTI in Aminu Kano Teaching Hospital, Kano. The findings underscore the impact of UTI in the locality and the choice of empirical treatment. Materials and Methods Study AreaThe study was carried out in Kano, an ancient city situated in north- western part of Nigeria. It is densely populated and known for commercial activities, with a historic background of ground -nut pyramid. The city hosts a teaching hospital named Aminu Kano Teaching Hospital(AKTH) which serves as a referral centre for the state and neigbouring states like Kaduna, Katsina, Jigawa, Yobe. ProcedureA retrospective study that reviewed the report of urine microscopy , culture and sensitivity from September 2007 to September 2008 was carried out in Microbiology and Parasitology laboratory of the Aminu Kano Teaching Hospital. The urine samples were collected from out-patient departments and from the wards in the hospital. The samples were grouped into two categories on the basis of community –acquired UTI and hospital acquired UTI. COMMUNITY –ACQUIRED UTI group, included the following; (1) Out –patients with UTI