Surveillance of antibiotic resistance among uropathogens in Aljouf region northern Saudi Arabia

  • Ibrahim Taher Department of Pathology, College of Medicine, Jouf University, Sakaka, Saudi Arabia
  • Abdulrahman Almaeen Department of Pathology, College of Medicine, Jouf University, Sakaka, Saudi Arabia
  • Hassan Aljourfi Department of Medicine,College of Medicine, Jouf University, Sakaka, Saudi Arabia
  • Eyad Bohassan Department of Medicine,College of Medicine, Jouf University, Sakaka, Saudi Arabia
  • Ahmed Helmy Department of Tropical Medicine & Gastroenterology, Assiut University Hospitals, Assiut, Egypt
  • Eman El-Masry Department of Pathology, College of Medicine, Jouf University, Sakaka, Saudi Arabia
  • Baraka Saleh Department of Microbiology, Microbiology Laboratory, Prince Mutaib Hospital, Sakaka, Saudi Arabia
  • Nawaf Aljaber Department of Microbiology, Microbiology Laboratory, Prince Mutaib Hospital, Sakaka, Saudi Arabia
Keywords:
Urinary tract infection; Gram-negative bacteria; Gram-positive bacteria; Antimicrobial susceptibility

Abstract

Background and Objectives: Urinary tract infections are common health problem affecting millions worldwide. Antibiotic resistance among uropathogens (Ups) is prevalent in many countries. In the absence of any available data in the region, this hospital-based study investigated the pattern, frequency and susceptibility of Ups at Prince Mutaib Bin Abdulaziz Hospital, Aljouf Region, Saudi Arabia.
Materials and Methods: A retrospective assessment of UPs and their antibiotics susceptibility was conducted from January 2017 to December 2017 using the fully automated Vitek2 system (BioMérieux, France).
Results: Among the 415 uropathogens isolates, the most prevalent bacteria were Gram-negatives comprising 137 (51%) E. coli; 46 (17.2%) Klebsiella spp.; 30 (11.2%) Pseudomonas spp.; 25 (9.3%) Proteus spp.; 14 (5.2%) Acinetobacter baumanii and 16 (5.9%) others. On the other hand, Enterococcus spp. were predominant among Gram-positive isolates representing 54 (36.7%), 47 (32.0%) Staphylococcus spp., 22 (15.1%) Streptococcus spp., and 13 (8.8%) S. aureus, and 11 (7.5%) others. Gram-negative Ups showed multidrug resistance towards the majority of the tested antimicrobials (ampicillins, cephalosporins, fluoroquinolones, trimethoprim-sulfamethoxazole, fosfomycin, aztreonam, and nitrofurantoin). While high resistance patterns by Gram-positives was also seen against cephalosporins, penicillins, amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole, clindamycin, erythromycin and tetracycline.
Conclusion: The observed widespread multidrug resistance clearly warrant implementing stricter control measures, local guidelines of antimicrobials usage, and continuous epidemiological surveys at hospitals and communities.

References

1. Cunha MA, Assunção GL, Medeiros IM, Freitas MR. Antibiotic resistance patterns of urinary tract infections in a northeastern Brazilian capital. Rev Inst Med Trop Sao Paulo 2016; 58:2.
2. Akram M, Shahid M, Khan AU. The etiology and the antibiotic resistance patterns of community-acquired urinary tract infections in the JNMC Hospital Aligarh, India. Ann Clin Microbiol Antimicrob 2007;6:4.
3. Braoios A, Turatti TF, Meredija LCS, TRS Fields, Denadai FHM. Urinary tract infections in non hospitalized patients: etiology and antibiotic resistance patterns. J Bras Patol Med Lab 2009; 45:449-456.
4. Kiffer CR, Camargo EC, Shimakura SE, Ribeiro PJ Jr, Bailey TC, Pignatari AC, et al. A spatial approach for the epidemiology of antibiotic use and resistance in community-based studies: the emergence of urban clusters of Escherichia coli quinolone resistance in Sao Paulo, Brazil. Int J Health Geogr 2011; 10:17.
5. Rocha JL, Tuon FF, Johnson JR. Sex, drugs, bugs, and age: rational selection of empirical therapy for outpatient urinary tract infection in an era of extensive antimicrobial resistance. Braz J Infect Dis 2012; 16:115-121.
6. Habte TM, Dube S, Ismail N, Hoosen AA. Hospital and community isolates of uropathogens at a tertiary hospital in South Africa. S Afr Med J 2009; 99:584-587.
7. Sugianli AK, Ginting F, Kusumawati RL, Pranggono EH, Pasaribu AP, Gronthoud F, et al. Antimicrobial resistance in uropathogens and appropriateness of empirical treatment: a population-based surveillance study in Indonesia. J Antimicrob Chemother 2017; 72:1469-1477.
8. Magale A, Kassim SA, Odera MJ, Omolo H, Jaoko WG, Jolly PE. Antibiotic susceptibility of organisms causing urinary tract infection in patients presenting at Kenyatta national hospital, Nairobi. East Afr Med J 2015; 92:333-337.
9. Miragliotta G, Di Pierro MN, Miragliotta L, Mosca A. Antimicrobial resistance among uropathogens responsible for community-acquired urinary tract infections in an Italian community. J Chemother 2008; 20:721-727.
10. WHO. Antimicrobial Resistance: Global Report on Surveillance 2014. https://www.who.int/drugresistance/documents/surveillancereport/en/
11. Wagenlehner FME, Naber KG. Current challenges in the treatment of complicated urinary tract infections and prostatitis. Clin Microbiol Infect 2006; 12 Suppl 3:67-80.
12. Al-Tawfiq JA, Anani AA. Antimicrobial susceptibility pattern of bacterial pathogens causing urinary tract infections in a Saudi Arabian hospital. Chemotherapy 2009; 55:127-131.
13. Al Yousef SA. Surveillance of antibiotic-resistant bacteria in King Khalid Hospital, Hafr Al-Batin, Saudi Arabia, during 2013. Jundishapur J Microbiol 2016;9(9): e19552.
14. Al-Otaibi FE, Bukhari EE. Clinical and laboratory profiles of urinary tract infections caused by extended-spectrum beta-lactamase-producing Escherichia coli in a tertiary care center in central Saudi Arabia. Saudi Med J 2013; 34:171-176.
15. Al-Rubeaan KA, Moharram O, Al-Naqeb D, Hassan A, Rafiullah MR. Prevalence of urinary tract infection and risk factors among Saudi patients with diabetes. World J Urol 2013; 31:573-578.
16. Ekwealor PA, Ugwu MC, Ezeobi I, Amalukwe G, Ugwu BC, Okezie U, et al. Antimicrobial evaluation of bacterial isolates from urine specimen of patients with complaints of urinary tract infections in Awka, Nigeria. Int J Microbiol 2016; 2016:9740273.
17. Bitew A, Tamirat M, Meseret C. Species distribution and antibiotic susceptibility profile of bacterial uropathogens among patients complaining urinary tract infections. BMC Infect Dis 2017;17:654.
18. Oladeinde BH, Omoregie R, Olley M, Anunibe JA. Urinary tract infections in a rural community of Nigeria. N Am J Med Sci 2011; 3:75-77.
19. Mody L, Juthani-Mehta M. Urinary tract infections in older women: a clinical review. JAMA 2014; 311:844-854.
20. Kalal BS, Nagaraj S. Urinary tract infections: a retrospective, descriptive study of causative organisms and antimicrobial pattern of samples received for culture, from a tertiary care setting. Germs 2016; 6:132-138.
21. Manjunath GN, Prakash R, Annam V, Shetty K. Changing trends in the spectrum of antimicrobial drug resistance pattern of uropathogens isolated from hospitals and community patients with urinary tract infections in tumkur and bangalore. Int J Biol Med Res 2011; 2:504-507.
22. Barate DL, Ukesh CS. Bacterial profile and antibiotic resistance pattern of urinary tract infections. DAVIJS 2012; 1:21-24.
23. Nerurkar A, Solanky P, Naik SS. Bacterial pathogens in urinary tract infection and antibiotic susceptibility pattern. JPBS 2012; 21:1-3.
24. de Francesco MA, Giuseppe R, Laura P, Riccardo N, Nino M. Urinary tract infections in Brescia, Italy: Etiology of uropathogens and antimicrobial resistance of common uropathogens. Med Sci Monit 2007; 13:BR136-144.
25. Adeep M, Nima T, Kezang W, Tshokey T. A retrospective analysis of the etiologic agents and antibiotic susceptibility pattern of uropathogens isolated in the Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan. BMC Res Notes 2016;9:54.
26. Haller M, Brandis M, Berner R. Antibiotic resistance of urinary tract pathogens and rationale for empirical intravenous therapy. Pediatr Nephrol 2004; 19:982-986.
27. Prais D, Straussberg R, Avitzur Y, Nussinovitch M, Harel L, Amir J. Bacterial susceptibility to oral antibiotics in community-acquired urinary tract infection. Arch Dis Child 2003; 88:215-218.
28. Choe HS, Lee SJ, Cho YH, Çek M, Tandoğdu Z, Wagenlehner F, et al. Aspects of urinary tract infections and antimicrobial resistance in hospitalized urology patients in Asia: 10-Year results of the Global Prevalence Study of Infections in Urology (GPIU). J Infect Chemother 2018:24;278-283.
29. Narchi H, Al-Hamdan MA. Antibiotic resistance trends in paediatric community-acquired first urinary tract infections in the United Arab Emirates. East Mediterr Health J 2010; 16:45-50.
30. Dash N, Mansour ALZ, Al-Kous N, Al-Shehhi F, Al-Najjar J, Senok A, et al. Distribution and resistance trends of community-associated urinary tract pathogens in Sharjah, UAE. Microbiol Insights 2008;1:41-45.
31. Wagenlehner FM, Pilatz A, Naber KG, Weidner W. Therapeutic challenges of urosepsis. Eur J Clin Invest 2008;38 Suppl 2:45-49.
32. Bours PH, Polak R, Hoepelman AI, Delgado E, Jarquin A, Matute AJ. Increasing resistance in community-acquired urinary tract infections in Latin America, five years after the implementation of national therapeutic guidelines. Int J Infect Dis 2010; 14(9):e770-774.
33. McKinnell JA, Stollenwerk NS, Jung CW, Miller LG. Nitrofurantoin compares favorably to recommended agents as empirical treatment of uncomplicated urinary tract infections in a decision and cost analysis. Mayo Clin Proc 2011; 86:480-488.
34. Kader AA, Kumar A. Prevalence and antimicrobial susceptibility of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a general hospital. Ann Saudi Med 2005; 25:239-242.
35. Kehinde EO, Rotimi VO, Al-Hunayan A, Abdul-Halim H, Boland F, Al-Awadi KA. Bacteriology of urinary tract infection associated with indwelling ureteral J stent. J Endourol 2004; 18:891-896.
36. Hitzenbichler F, Simon M, Holzmann T, Iberer M, Zimmermann M, Salzberger B, et al. Antibiotic resistance in E. coli isolates from patients with urinary tract infections presenting to the emergency department. Infection 2018; 46:325-331.
37. Patel MH, Trivedi GR, Patel SM, Vegad MM. Antibiotic susceptibility pattern in urinary isolates of gram-negative bacilli with special reference to AmpC β-lactamase in a tertiary care hospital. Urol Ann 2010; 2:7-11.
38. Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. P T 2015; 40:277-283.
39. Bin Abdulhak AA, Altannir MA, Almansor MA, Almohaya MS, Onazi AS, Marei MA, et al. Non prescribed sale of antibiotics in Riyadh, Saudi Arabia: A Cross-Sectional Study. BMC Public Health 2011;11:538.
40. Yang B, Yang F, Wang S, Wang Q, Liu Z, Feng W, et al. Analysis of the spectrum and antibiotic resistance of uropathogens in outpatients at a tertiary hospital. J Chemother 2018; 30:145-149.
Published
2020-01-11
How to Cite
1.
Taher I, Almaeen A, Aljourfi H, Bohassan E, Helmy A, El-Masry E, Saleh B, Aljaber N. Surveillance of antibiotic resistance among uropathogens in Aljouf region northern Saudi Arabia. Iran J Microbiol. 11(6):468-477.
Section
Original Article(s)