Decreased Susceptibility to Commonly Used Antimicrobial Agents in Bacterial Pathogens Isolated from Urinary Tract Infections in Rwanda: Need for New Antimicrobial Guidelines

摘要

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-lactamace (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.