Antibiotic susceptibility of organisms causing urinary tract infection in patients presenting at Kenyatta National Hospital, Nairobi

  • HI Magale
  • IA Kassim
  • SA Odera
  • MJ Omolo
  • WG Jaoko
  • PE Jolly


Background: Changes in susceptibility patterns of bacterial pathogens isolated from urinary tract   infections emphasize the need for regional surveillance to generate information that can be used in  management of patients. Knowledge on the current status of antimicrobial resistance in uropathogens,  and the prevalence of expanding spectrum beta-lactamases (ESBLs) in the isolates will guide policy  formulations and encourage prudent use of antimicrobials.
Objectives: To identify bacterial pathogens causing UTI and determine the association between the pathogens isolated from patients attending KNH. Determine antimicrobial susceptibility patterns of the UTI pathogens and the prevalence of ESBL in the isolated pathogens.
Design: Laboratory-based study.
Setting: Department of Medical Microbiology University of Nairobi and Kenyatta National Hospital   microbiology laboratory, Nairobi, Kenya.
Subjects: Nine hundred and forty eight patients presenting directly to the Kenyatta National Hospital’s diagnostic laboratory. Patients were only classified as in-patients if at the time of specimen collection  they were being admitted to one of KNH wards.
Results: Out of the 948 urine samples processed, 189 in-patients and 37 out-patients samples had  significant bacterial growth. The uropathogens identified from inpatient specimens were Escherichia coli (56), Klebsiellapneumoniae (33), Enterococcus spp. (34) and Entrobacter (16) making up 30%, 18%,  18% and 9% respectively. ESBL isolates were found to be resistant to the locally administered   antibiotics; Augmentin (37%), Levofloxacin (37%), Cefoperazone (37%), Ampicillin (39%), Doxycyline (41%), Gentamicin (30%) and Nalidixic Acid (38%).
Conclusion: The increased prevalence of multidrug resistant ESBL pathogens poses challenges for  healthcare providers at KNH and signifies the need for new approach to treat UTI. It would be prudent for laboratories to include specialised tests for detection of ESBL producing pathogens from isolates obtained from in-patients. Further studies on the mechanisms and pathways utilised by these bacteria to cause UTI will highlight other avenues in patient management.

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