Prevalence of resistant uropathogenic Escherichia coli in Bahrain : a community based study

Abstract EN

Background and objectives: Urinary tract infections (UTIs) are amongst the most common infections described in outpatients setting.

This study was conducted to study the uropathogenic Escherichia coli isolated from patients with clinical diagnosis of community onset UTI.

Such studies are crucial to assess the local antimicrobial resistance rates for the common uropathogens in our community and accordingly to suggest the best empirical therapy of UTI relying on the predictability of the agents causing UTI and knowledge of their antimicrobial susceptibility patterns.

Materials and Methods: Total of 829 consecutive non duplicate urine specimens with positive growth of significant E.coli collected from patients presenting to the primary health centers in the Kingdom of Bahrain with clinical suspicion of UTI during the year 2017 were included.

Urine samples were processed in the Microbiology laboratory.

Bacterial isolates were identified using standard conventional methods and antimicrobial susceptibility testing was performed using disk diffusion technique following Kirby-Bauer method.

Results: There was relatively high rate of resistance to commonly prescribed oral agents for UTI such as cotrimoxazole (42.7%), amoxicillin-clavulanic acid (34.6%), cefuroxime (32.21%), and norfloxacin (23.6%), which are the available first line options for treating UTI in primary health centers, but most isolates retains their susceptibility to nitrofurantoin (resistance of 5.19%).

MDR phenotype (defined as exhibiting resistance to at least one agent in ≥3 antimicrobial classes) was observed among 34.8% of the isolates, ESBL production was confirmed among 27.39% of tested E.

coli isolates.

Conclusion: Resistant strains of E.

coli are prevalent in the community acquired UTI, nitrofurantoin is the only drug that showed an excellent sensitivity pattern and should be the preferred drug for empirical therapy of uncomplicated lower UTI as an outpatient