Diversity and antibiotic sensitivity of uropathogens from a regional hospital in Rwanda.

Background: Urinary tract infections are a common cause for antibiotic consumption. Empirical treatment is common for community-acquired infections owing to predictability of pathogens.

Objectives: Describe sensitivity profiles of uropathogens at a regional hospital in Rwanda.

Methods: Hospital-based cross-sectional study in which clean-catch urine samples were analyzed. A two-stage process involving dipstick urinalysis and urine culture was used to identify true infections. The Kirby-Bauer disc diffusion method was used for antibiotic sensitivity analysis as per EUCAST guidelines.

Results: Of 198 samples studied, 107 met criterion for UTI with 94 yielding significant growth. Klebsiella pneumoniae (35%), and Escherichia coli (32%) were the most common organisms isolated. Others included Staphylococcal species, Proteus spp, Enterobacter spp and Salmonella. Very high resistance frequencies (above 70%) were observed against amoxycillin, cotrimoxazole, trimethoprim, aztreonam and fosfomycin. Resistance to fluoroquinolones, aminoglycosides and cephalosporins varied between 40-60%. High levels of cross resistance were observed for drugs of the same class. Resistance to the potentiated penicillins, meropenem, cefoxitin and nitrofurantoin were less than 30%. Piperacillintazo bactum performed best with 91% sensitivity against all organisms tested.

Conclusion: High levels of resistance were observed for most antibiotics studied. For empirical treatment of community-acquired UTI in our setting, nitrofurantoin remains effective while ciprofloxacin is not.