Occurrence of Carbapenem Resistance Producing Uropathogens Isolated From Refugees at the Nakivale Settlement in Isingiro District, Uganda: A Cross-Sectional Study

Abstract

Introduction: Carbapenem-resistant uropathogens are an emerging public health problem in sub-Saharan Africa. Such resistant pathogens are transferred easily from one community to another, given the rapid spread of mobile genetic elements containing carbapenemase genes. Uganda hosts refugees from several neighboring East African countries, many of whom are settled in the Nakivale Refugee Settlement. In our study, we analyze the extent of carbapenem-resistant uropathogens among refugees in one of the largest camps in Uganda. Methods: We recruited 308 consenting participants. Each participant was tested for bacteriological urinary tract infection (bUTI) using standard urine cultures. Significant bacteriuria was determined as growth ≥10 5 CFU/mL and conventional biochemical tests were used for the identification of uropathogens. Phenotypic screening for carbapenem resistance was achieved using the modified Hodges test. End-point polymerase chain reaction (PCR) using 1.5% agarose gel in electrophoresis was used for the detection of carbapenemase genes. Bivariate and multivariate logistic regression using Stata, version 14.0, was done to identify the factors associated with carbapenem-resistant uropathogens. Ethical clearance was obtained from the Institutional Review Board of the Mbarara University of Science and Technology (MUST). Results: The overall significant (≥10 5 CFU/mL) single bacterial growth was 29.0% (89/308). We detected phenotypic resistance in 55 (61.8%) out of 89 isolates and carbapenem resistance gene detected in 20 (22.5%) out of 89 isolates. Escherichia coli was the most common uropathogen, detected in 32 (36%) out of 89 isolates. The with carbapenem resistance were history of self-medication (odds ratio (OR)=5.09, 95% CI: 1.04-24.77, p=0.044), antibiotic use before laboratory diagnosis (OR=6.07, 95% CI: 1.77-20.81, p=0.004), and having spent more than five months on antibiotics (OR=8.52, 95% CI: 1.47-49.36, p=0.017). Conclusion: The prevalence of carbapenem-resistant uropathogens isolated from refugees at Nakivale settlement was high. Accurate antimicrobial stewardship program implementation in refugee settlements is urgently needed. Screening and identification of carbapenem-resistant Enterobacterial careers among refugees at entry point could be helpful in mitigating the spread in refugee settlement.