Diversity and antibiotic sensitivity of uropathogens from a regional hospital in Rwanda

Urinary tract infections are a common cause for antibiotic consumption. Empirical treatment is common for community-acquired infections owing to predictability of pathogens.

Describe sensitivity profiles of uropathogens at a regional hospital in Rwanda.

Hospital-based cross-sectional study in which clean-catch urine samples were analyzed. A two-stage process involving dipstick urinalysis and urine culture was used to identify true infections. The Kirby-Bauer disc diffusion method was used for antibiotic sensitivity analysis as per EUCAST guidelines.

Of 198 samples studied, 107 met criterion for UTI with 94 yielding significant growth. Klebsiella pneumoniae (35%), and Escherichia coli (32%) were the most common organisms isolated. Others included Staphylococcal species, Proteus spp, Enterobacter spp and Salmonella. Very high resistance frequencies (above 70%) were observed against amoxycillin, cotrimoxazole, trimethoprim, aztreonam and fosfomycin. Resistance to fluoroquinolones, aminoglycosides and cephalosporins varied between 40-60%. High levels of cross resistance were observed for drugs of the same class. Resistance to the potentiated penicillins, meropenem, cefoxitin and nitrofurantoin were less than 30%. Piperacillintazo bactum performed best with 91% sensitivity against all organisms tested.

High levels of resistance were observed for most antibiotics studied. For empirical treatment of community-acquired UTI in our setting, nitrofurantoin remains effective while ciprofloxacin is not.