A retrospective analysis of uropathogens isolated and antimicrobial susceptibility patterns at a regional hospital in North West province, South Africa.

BACKGROUND

Urinary tract infections are among the most common infections affecting the general population. Their high incidence, as well as frequent antimicrobial use, contribute significantly to the development of antimicrobial resistance (AMR).

OBJECTIVE

To determine the profile and prevalence of uropathogens isolated from urine specimens at a regional hospital and assess susceptibility patterns to commonly used antimicrobials recommended by the National Essential Medicines List (NEML).

METHODS

This was a retrospective evaluation of laboratory reports for all urine specimens submitted between 01 January 2020 and 31 December 2023.

RESULTS

The most frequently cultured organisms were Escherichia coli (n = 1481; 42%); Klebsiella pneumoniae (n = 568; 16%); Enterococcus faecalis (n = 249; 7%); Proteus mirabilis (n = 229; 7%), Enterobacter cloacae (n = 137; 4%), and Candida albicans (n = 119; 3%). Escherichia coli maintained high sensitivity to antimicrobials such as nitrofurantoin (92.2%) and gentamicin (90.6%), whilst K. pneumoniae had decreased sensitivities of 40% and 77%, respectively. Cumulative sensitivities of commonly used first-line antimicrobials showed low rates of susceptibility to ciprofloxacin (77%), nitrofurantoin (67%), and amoxicillin/clavulanate (68.7%).

CONCLUSION

Escherichia coli was the most commonly identified isolate and remains sensitive to nitrofurantoin. It was, however, resistant to ciprofloxacin, amoxicillin/clavulanate, and trimethoprim sulfamethoxazole, as were all the other Gram-negative organisms. These sensitivity patterns do not align with the antimicrobials recommended in the current NEML guidelines, and highlight the need for targeted therapy and interventions.

WHAT THIS STUDY ADDS: This retrospective analysis identifies predominant uropathogens' updated antimicrobial susceptibility profiles, some of which misalign with NEML guidelines. Insights will guide targeted antimicrobial stewardship, empiric therapy, and local surveillance to curb AMR.