Molecular Epidemiology of Antibiotic Resistant Gram-Negative Bacterial Uropathogens among Patients Attending Hospitals in Bushenyi District, Uganda
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Date
2021-07
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Kampala International University
Abstract
Beta-lactam and fluoroquinolone antibiotics are frequently used in the treatment of urinary tract infections (UTIs). Still, the rise and spread of multidrug resistance among the frequently encountered bacterial uropathogens to these categories of drugs compromise treatment outcomes. This study was, therefore, designed to determine the molecular epidemiology of antibiotic resistant Gram-negative bacterial uropathogens among patients who attended hospitals in Bushenyi District, Uganda. In this cross-sectional study, a total of 267, clean-catch midstream urine samples were collected aseptically and analyzed using standard microbiological methods. Phenotypic and genotypic determinations of resistance were done using the Kirby Bauer disk diffusion method and polymerase chain reaction amplification (PCR), respectively. Data for the factors associated with UTIs and resistant UTIs were acquired using questionnaires. Data were analysed using descriptive statistics and logistic regression tools. This study revealed 86/267 (32.2%) UTI prevalence in Bushenyi District, Uganda. Gram-negative bacterial aetiologies isolated were in the order Escherichia coli 36/86 (41.9%) > Klebsiella pneumoniae 10/86 (11.6%) > Klebsiella oxytoca 6/86 (7.0%) > Proteus mirabilis 3/86 (3.5%) > Proteus vulgaris 1/86 (1.2%). Gram-negative bacterial uropathogens showed high resistance to co-trimoxazole 53/56 (94.6%), cefazolin 48/56 (85.7%) ampicillin 45/56 (80.4%) and nalidixic acid 34/56 (60.7%). Multiple logistic regression has shown that hospitalization, possession of indwelling urinary catheter, sexual intercourse, wrong prescription of antibiotics, earlier exposure to antimicrobials, fluoroquinolones‟ and cephalosporins‟ use within the last one year bear significant statistical relationships (p<0.05) with antibiotic resistant urinary tract infections. The extended spectrum beta-lactamase (ESBL) gene, blaCTX-M 19/56 (33.9%) and quinolone-resistant gene, qnrS 25/56 (44.6%) were the most prevalent genes studied and were more dominant in E. coli strains. The most common phylogenetic groups of the multidrug-resistant E. coli associated with UTIs were A 5/31 (16.1%) 5/31 (16.1%) 5/31 (16.1%)5/31 (16.1%) and B2 4/31 (12.9%). To halt the progress of bacterial uropathogens' resistance to fluoroquinolones and cephalosporins, there is an urgent need for local surveillance studies to generate susceptibility data to guide the policy and clinicians' choice of appropriate antibiotics.
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A thesis submitted to the directorate of postgraduate studies and research for the award of the Degree of Doctor of Philosophy of Kampala International University, Uganda