Antibiotic availability and multiresistant coliforms in a rural Ugandan hospital

Twenty-seven strains of coliforms (Enterobacteriaceae) isolated at Kisiizi Hospital, Uganda, were tested for their sensitivity to antibiotics. Sixteen of the 18 patient strains were identified as Escherichia coli, but biochemical analysis, serotyping, plasmid profile and antibiogram showed them to be heterogeneous. Resistance was very common to the antibiotics available in the community (ampicillin, chloramphenicol, tetracycline and trimethoprim), but was much less frequent for the agents used only in the hospital (gentamicin, ciprofloxacin and nitrofurantoin). A correlation was noted between the presence of large plasmids (150 kb or larger) and resistance to amoxicillin in patient strains of E. coli. The nine strains of coliform from the water supply were more heterogeneous and less resistant. The availability of antibiotics in the community seems linked to the development of multiresistant coliforms, which in a Ugandan context are very difficult to treat, and even more difficult to prevent.