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Antimicrobial resistance among bacteria isolated from urinary tract infections in females in Namibia, 2016–2017

BACKGROUND: The emergence of antimicrobial resistance (AMR) among bacterial pathogens demands a local understanding of the epidemiological situation. This information is needed both for clinical treatment decision-making purposes as well as for the revision of current care guidelines. Clinical AMR d...

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Autores principales: Haindongo, Erastus H., Funtua, Binta, Singu, Boni, Hedimbi, Marius, Kalemeera, Francis, Hamman, Jana, Vainio, Olli, Hakanen, Antti J., Vuopio, Jaana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8840701/
https://www.ncbi.nlm.nih.gov/pubmed/35151360
http://dx.doi.org/10.1186/s13756-022-01066-2
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author Haindongo, Erastus H.
Funtua, Binta
Singu, Boni
Hedimbi, Marius
Kalemeera, Francis
Hamman, Jana
Vainio, Olli
Hakanen, Antti J.
Vuopio, Jaana
author_facet Haindongo, Erastus H.
Funtua, Binta
Singu, Boni
Hedimbi, Marius
Kalemeera, Francis
Hamman, Jana
Vainio, Olli
Hakanen, Antti J.
Vuopio, Jaana
author_sort Haindongo, Erastus H.
collection PubMed
description BACKGROUND: The emergence of antimicrobial resistance (AMR) among bacterial pathogens demands a local understanding of the epidemiological situation. This information is needed both for clinical treatment decision-making purposes as well as for the revision of current care guidelines. Clinical AMR data from Namibia is sparse, whilst urinary tract infections remain not only widespread but they disproportionally affect females. This paper aims to describe the national antimicrobial resistance situation of major bacterial uropathogens in females within the 14 Namibian regions. METHOD: Retrospective countrywide information on clinical urine cultures performed in females in Namibia in 2016–2017 was obtained from the national public health laboratory, Namibia Institute of Pathology (NIP). The data set included both microbiological findings as well as antimicrobial susceptibility test (AST) results. The AST was done as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Resistance to 3rd generation cephalosporins was indicative of Extended Spectrum-ß-lactamase (ESBL) production. Data analysis was done with WHONET using expert interpretation rules. RESULTS: In total, 22,259 urinary cultures were performed, of which 13,673 (61.4%) were culture positive. Gram-negative bacterial species accounted for 72.6% of the findings. The most common pathogens identified were Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis. Most of these were from young females, with a median age ranging from 28 to 32 years for the various pathogens. Resistance to ampicillin was 77.7% in E. coli and 84.9% in K. pneumoniae. In E. coli, resistance to 1(st) line empiric therapy antibiotic, nitrofurantoin, was below 13%, except for one region that showed 59.2% resistance. Resistance to third generation cephalosporin (3GC) was used as a proxy for ESBL production. By year 2017, 3GC resistance was 22%, 31.4% and 8.3% for E. coli, K. pneumoniae and P. mirabilis, respectively. CONCLUSION: We report high resistance to ampicillin, quinolones and sulfamethoxazole-trimethoprim amongst E. coli. Resistance rates to third-generation cephalosporins was also concerningly high at 22%. Resistance to carbapenems was low. However, superiority of nitrofurantoin was found, which provides rational support for the usefulness of nitrofurantoin as an empiric therapy regimen for the treatment of urinary tract infections in this setting. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13756-022-01066-2.
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spelling pubmed-88407012022-02-16 Antimicrobial resistance among bacteria isolated from urinary tract infections in females in Namibia, 2016–2017 Haindongo, Erastus H. Funtua, Binta Singu, Boni Hedimbi, Marius Kalemeera, Francis Hamman, Jana Vainio, Olli Hakanen, Antti J. Vuopio, Jaana Antimicrob Resist Infect Control Research BACKGROUND: The emergence of antimicrobial resistance (AMR) among bacterial pathogens demands a local understanding of the epidemiological situation. This information is needed both for clinical treatment decision-making purposes as well as for the revision of current care guidelines. Clinical AMR data from Namibia is sparse, whilst urinary tract infections remain not only widespread but they disproportionally affect females. This paper aims to describe the national antimicrobial resistance situation of major bacterial uropathogens in females within the 14 Namibian regions. METHOD: Retrospective countrywide information on clinical urine cultures performed in females in Namibia in 2016–2017 was obtained from the national public health laboratory, Namibia Institute of Pathology (NIP). The data set included both microbiological findings as well as antimicrobial susceptibility test (AST) results. The AST was done as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Resistance to 3rd generation cephalosporins was indicative of Extended Spectrum-ß-lactamase (ESBL) production. Data analysis was done with WHONET using expert interpretation rules. RESULTS: In total, 22,259 urinary cultures were performed, of which 13,673 (61.4%) were culture positive. Gram-negative bacterial species accounted for 72.6% of the findings. The most common pathogens identified were Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis. Most of these were from young females, with a median age ranging from 28 to 32 years for the various pathogens. Resistance to ampicillin was 77.7% in E. coli and 84.9% in K. pneumoniae. In E. coli, resistance to 1(st) line empiric therapy antibiotic, nitrofurantoin, was below 13%, except for one region that showed 59.2% resistance. Resistance to third generation cephalosporin (3GC) was used as a proxy for ESBL production. By year 2017, 3GC resistance was 22%, 31.4% and 8.3% for E. coli, K. pneumoniae and P. mirabilis, respectively. CONCLUSION: We report high resistance to ampicillin, quinolones and sulfamethoxazole-trimethoprim amongst E. coli. Resistance rates to third-generation cephalosporins was also concerningly high at 22%. Resistance to carbapenems was low. However, superiority of nitrofurantoin was found, which provides rational support for the usefulness of nitrofurantoin as an empiric therapy regimen for the treatment of urinary tract infections in this setting. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13756-022-01066-2. BioMed Central 2022-02-12 /pmc/articles/PMC8840701/ /pubmed/35151360 http://dx.doi.org/10.1186/s13756-022-01066-2 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Haindongo, Erastus H.
Funtua, Binta
Singu, Boni
Hedimbi, Marius
Kalemeera, Francis
Hamman, Jana
Vainio, Olli
Hakanen, Antti J.
Vuopio, Jaana
Antimicrobial resistance among bacteria isolated from urinary tract infections in females in Namibia, 2016–2017
title Antimicrobial resistance among bacteria isolated from urinary tract infections in females in Namibia, 2016–2017
title_full Antimicrobial resistance among bacteria isolated from urinary tract infections in females in Namibia, 2016–2017
title_fullStr Antimicrobial resistance among bacteria isolated from urinary tract infections in females in Namibia, 2016–2017
title_full_unstemmed Antimicrobial resistance among bacteria isolated from urinary tract infections in females in Namibia, 2016–2017
title_short Antimicrobial resistance among bacteria isolated from urinary tract infections in females in Namibia, 2016–2017
title_sort antimicrobial resistance among bacteria isolated from urinary tract infections in females in namibia, 2016–2017
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8840701/
https://www.ncbi.nlm.nih.gov/pubmed/35151360
http://dx.doi.org/10.1186/s13756-022-01066-2
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