Prevalence of extended spectrum beta-lactamase producing bacteria (ESBL) in patients presenting with urinary tract infections (UTIs) at a peri-Urban hospital, Uganda

Abstract

Introduction Urinary tract infections remain one of the infections that are commonly diagnosed in Uganda with Enterobacteriaceae reported as the commonest uropathogens. Extended Spectrum Beta Lactamase producing Enterobacteriaceae have emerged as signifi cant pathogens responsible for most of these urinary tract infections throughout the world. This resistance often leads to therapeutic failures from multidrug resistant bacteria. This study was carried out to determine the prevalence of Extended Spectrum Beta-Lactamase producing bacteria (ESBLs) in patients presenting with Urinary Tract Infections (UTIs) at Mbarara Municipal Council Health Center IV, an urban hospital in Mbarara district, south western Uganda. Methods This was a Cross sectional study in which a total of 158 non repetitive midstream urine samples were obtained from 158 participants during months of June to August, 2018. Samples were cultured on conventional media (MacConkey agar and Cysteine Lysine Electrolyte Deficient agar) using a standard wire loop of capacity 0.05ml, incubated at 37 0 C for 24hrs. Only samples that showed signifi cant growth (growth of pure colonies ≥105 cfu/ml) on primary culture were considered for further testing. The isolates were identifi ed basing on the colony appearance, Gram stain and different conventional biochemical tests. Phenotypic expression of ESBLs production was detected using the double disc synergy test using Amoxicillin, Ceftazidime, Amoxicillin-Clavulanic acid and Ceftazidime-Clavulanic acid. Results The results show that 23% of the 158 participants had Urinary Tract infection. The most common uropathogens isolated were Staphylococcus aureus (64%) and Escherichia coli (17%). Phenotypic ESBLs was seen in 27.8% (10/36) of the uropathogens and was commonly seen among Escherichia coli , 60% (6/10) isolates. Others included; Pseudomonas species (8%), Enterobacteraerogenes (1.3%), Citrobacterfruendii (0.6%) and coagulase negative staphylococcus (0.6%). Conclusion This study revealed a fairly high prevalence of ESBL producing organisms in Mbarara Municipal Council Health Center IV and high levels of resistance to third generation cephalosporins.