1risk factors for community acquired urinary tract infections by extended spectrum beta-lactamase producing bacteria, Harare 2019.

Abstract

Drug resistance is a major public health concern responsible for morbidity and mortality globally. In Harare 3rd generation cephalosporin resistant E. coli in urines increased from 28% to 38% from 2012-2017. These organisms known as extended spectrum beta-lactamases(ESBL)are multi-drug resistant and resist the 1stand 2ndline treatment for UTI. The associated risk factors for ESBL and the treatment outcomes in Harare remain undefined. The study was conducted to determine the factors associated with community acquired UTI by ESBL positive bacteria.

Methods: A 1:1 unmatched case control study was conducted among patients being attended at two major hospitals in Harare between April and August 2019. A case was a patient with community acquired UTI and a urine culture positive for ESBL-producing bacteria while a control was a patient with same diagnosis but a urine culture negative for ESBL-producing bacteria. Participants were randomly selected from laboratory registers and were interviewed using structured questionnaires to collect data on demographic characteristics, co-morbidity factors, behaviour factors, health related factors and knowledge on UTI. Data were analysed using Epi-Info 7TM (CDC, USA)to generate frequencies, means and proportions. Bivariate, stratified analysis and logistic regression were done.

Results: Eighty-one cases-control pairs were recruited. UTI within past 6months (OR 4.13 CI 1.28-13.35), antibiotic use within the previous 12 months (OR 2.93 CI 1.14-7.49) and in males, having prostate enlargement(OR 8.93 CI 1.88-42.47)were the independent risk factors for community acquired UTI by ESBL producing organisms. Sixty-two percent of cases(50/81)compared to17%(14/81)controls had ciprofloxacin resistant urinary tract infections. Thirty-two percent(26/81)cases compared to11%(9/81)controls had gentamicin resistant UTI. Two percent(4/162)of participants had carbapenem resistant infections. The cases were70% less likely to fully recover within 7 days than the controls.

Conclusion: Patients with recurrent UTI, previous antibiotic use and men with prostate diseases are at high risk of ESBL infection. The empirical use of beta-lactam and ciprofloxacin in high risk patients is inappropriate and should be discouraged. We recommend the use of laboratory results to guide treatment to arrest antibiotic resistance that is driven by empirical drug use. We also recommend revision of treatment guidelines for UTI in patients with risk factors for ESBL infections