, Leopold Mbous Nguimbus3, 4, 5, Frantz Guy Epoupa Ngalle6, Thérèse Nkoa1, Albert Legrand Same Ekobo11Department of Microbiology/Parasitology/Hematology and infectious diseases, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
2Laboratory of Bacteriology/Parasitology, Centre Pasteur of Cameroon, Yaounde, Cameroon
3Department of Immunology, Faculty of Medicine and Health Science, University of Sherbrooke, Sherbrooke, Canada
4Department of Immunology, Catholic University of Central Africa, School of Health Science, Yaounde, Cameroon
5Department of Biochemistry, Faculty of Sciences, University of Yaounde I, Yaounde, Cameroon
6Department of surgery and specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
Background: Urinary tract infections (UTIs), which are most often caused by Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae) and Candida species (Candida spp.), have until now been a health problem throughout the world, particularly in developing countries. Moreover, with the growing increase in antibiotic resistance in recent years, the treatment of these infections is becoming increasingly difficult. The aim of this study was to present the prevalence of E. coli, K. pneumoniae and Candida spp. in UTIs, investigate the association between the previous species responsible for these infections with age and sex, to present the patterns of antimicrobial resistance and the evolution of these resistances during the study period. Methods: This was a retrospective study that was conducted from January 04, 2010 to November 27, 2019 in Yaounde, capital of the Central region in the Centre Pasteur of Cameroon. Following collection of urine samples, the laboratory analyses included macroscopic examination, culture on cystine lactose electrolyte deficient (CLED) medium using the semi-quantitative technique, incubation in an oven at 37°C between 18 and 24 hours and antimicrobial sensitivity testing using the diffusion method and the Vitek 2-Compact device. Results: During the study period, 23,507 urine samples were analysed. The prevalence of infection caused by E. coli, K. pneumoniae and Candida spp. was 46.2%. The female sex was the most represented (25.1%) against 21% for the male sex. The mean age of participants with a clinical picture of a UTI was 35.5 years ± 29.2 SD with patients under 20 years of age being the most represented. The prevalence of infection caused by E. coli was 32.1% ; that of K. pneumoniae was 12.1% and the prevalence of Candida species was 1.9% with Candida albicans being more represented. In this study, a statistically significant association was found between the above germs with age group (p<0.001) and sex (p<0.001). Antimicrobial susceptibility testing showed that E. coli and K. pneumoniae were particularly resistant to antibiotics of the penicillin family, the cephalosporin family, the sulfamide family and the quinolone family. Candida species were highly sensitive to most of the antifungal agents tested. The profiles of the evolution of antibiotic sensitivity according to the study period showed that, from one family of drugs to another, resistance was generally greater than sensitivity, with lower rates in recent years (2017-2019). Conclusion: The treatment of UTIs caused by E. coli and K. pneumoniae remains a challenge due to the frequent use of highly resistant antibiotics. Continuous monitoring of multidrug resistance by the organisms concerned remains necessary in order to prevent situations of therapeutic failure and to find appropriate treatments for UTIs in our context.
| [1] | Ganesh R, Shrestha D, Bhattachan B, Rai G. Epidemiology of urinary tract infection and antimicrobial resistance in a pediatric hospital in Nepal. BMC Infect Dis. 2019; 19(1): 420.View Article PubMed |
| [2] | Luna-Pineda VM, Ochoa SA, Cruz-Córdova A, Cázares-Domínguez V, Reyes-Grajeda JP, Flores-Oropeza MA, et al. Features of urinary Escherichia coli isolated from children with complicated and uncomplicated urinary tract infections in Mexico. PloS One. 2018; 13(10): e0204934.View Article PubMed |
| [3] | Ramírez-Castillo FY, Moreno-Flores AC, Avelar-González FJ, Márquez-Díaz F, Harel J, Guerrero-Barrera AL. An evaluation of multidrug-resistant Escherichia coli isolates in urinary tract infections from Aguascalientes, Mexico: cross-sectional study. Ann Clin Microbiol Antimicrob. 2018; 17(1): 34.View Article PubMed |
| [4] | Kengne M, Dounia AT, Nwobegahay JM. Bacteriological profile and antimicrobial susceptibility patterns of urine culture isolates from patients in Ndjamena, Chad. Pan Afr Med J. 2017; 28: 258.View Article PubMed |
| [5] | Wnorowska U, Piktel E, Durnaś B, Fiedoruk K, Savage PB, Bucki R. Use of ceragenins as a potential treatment for urinary tract infections. BMC Infect Dis. 2019; 19(1): 369.View Article PubMed |
| [6] | Gessese YA, Damessa DL, Amare MM, Bahta YH, Shifera AD, Tasew FS, et al. Urinary pathogenic bacterial profile, antibiogram of isolates and associated risk factors among pregnant women in Ambo town, Central Ethiopia: a cross-sectional study. Antimicrob Resist Infect Control. 2017; 6: 132.View Article PubMed |
| [7] | Alanazi MQ, Alqahtani FY, Aleanizy FS. An evaluation of E. coli in urinary tract infection in emergency department at KAMC in Riyadh, Saudi Arabia: retrospective study. Ann Clin Microbiol Antimicrob. 2018; 17(1): 3.View Article PubMed |
| [8] | Milovanovic T, Dumic I, Veličkovic J, Lalosevic MS, Nikolic V, Palibrk I. Epidemiology and risk factors for multi-drug resistant hospital-acquired urinary tract infection in patients with liver cirrhosis: single center experience in Serbia. BMC Infect Dis. 2019; 19(1): 141.View Article PubMed |
| [9] | Albu S, Voidazan S, Bilca D, Badiu M, Truţă A, Ciorea M, et al. Bacteriuria and asymptomatic infection in chronic patients with indwelling urinary catheter: The incidence of ESBL bacteria. Medicine (Baltimore). 2018; 97(33): e11796.View Article PubMed |
| [10] | Mitiku E, Amsalu A, Tadesse BT. Pediatric Urinary Tract Infection as a Cause of Outpatient Clinic Visits in Southern Ethiopia: A Cross Sectional Study. Ethiop J Health Sci. 2018; 28(2): 187‑96.View Article PubMed |
| [11] | Seifu WD, Gebissa AD. Prevalence and antibiotic susceptibility of Uropathogens from cases of urinary tract infections (UTI) in Shashemene referral hospital, Ethiopia. BMC Infect Dis. 2018; 18(1): 30.View Article PubMed |
| [12] | Koksal E, Tulek N, Sonmezer MC, Temocin F, Bulut C, Hatipoglu C, et al. Investigation of risk factors for community-acquired urinary tract infections caused by extended-spectrum beta-lactamase Escherichia coli and Klebsiella species. Investig Clin Urol. 2019; 60(1): 46‑53.View Article PubMed |
| [13] | Malekzadegan Y, Khashei R, Sedigh Ebrahim-Saraie H, Jahanabadi Z. Distribution of virulence genes and their association with antimicrobial resistance among uropathogenic Escherichia coli isolates from Iranian patients. BMC Infect Dis. 2018; 18(1):572.View Article PubMed |
| [14] | Dehbanipour R, Khanahmad H, Sedighi M, Bialvaei AZ, Faghri J. High prevalence of fluoroquinolone-resistant Escherichia coli strains isolated from urine clinical samples. J Prev Med Hyg. 2019; 60(1): E25‑30. |
| [15] | Paniagua-Contreras GL, Monroy-Pérez E, Bautista A, Reyes R, Vicente A, Vaca-Paniagua F, et al. Multiple antibiotic resistances and virulence markers of uropathogenic Escherichia coli from Mexico. Pathog Glob Health. 2018; 112(8): 415‑20.View Article PubMed |
| [16] | Garrido D, Garrido S, Gutiérrez M, Calvopiña L, Harrison AS, Fuseau M, et al. Clinical characterization and antimicrobial resistance of Escherichia coli in pediatric patients with urinary tract infection at a third level hospital of Quito, Ecuador. Bol Med Hosp Infant Mex. 2017;74(4):265‑71.View Article PubMed |
| [17] | Toka Özer T, Durmaz S, Yula E. Antifungal susceptibilities of Candida species isolated from urine culture. J Infect Chemother Off J Jpn Soc Chemother. 2016; 22(9): 629‑32.View Article PubMed |
| [18] | Lima GME, Nunes M de O, Chang MR, Tsujisaki RA de S, Nunes J de O, Taira CL, et al. Identification and antifungal susceptibility of Candida species isolated from the urine of patients in a university hospital in Brazil. Rev Inst Med Trop Sao Paulo. 2017; 59: e75.View Article |
| [19] | Jain N, Kohli R, Cook E, Gialanella P, Chang T, Fries BC. Biofilm formation by and antifungal susceptibility of Candida isolates from urine. Appl Environ Microbiol. 2007; 73(6): 1697‑703.View Article PubMed |
| [20] | Ding CH, Wahab AA, Muttaqillah NAS, Tzar MN. Prevalence of albicans and non-albicans candiduria in a Malaysian medical centre. JPMA J Pak Med Assoc. 2014; 64(12): 1375‑9. |
| [21] | R Y, M P S, U A B, R R, K B A. Candiduria: prevalence and trends in antifungal susceptibility in a tertiary care hospital of mangalore. J Clin Diagn Res JCDR. 2013; 7(11): 2459‑61. |
| [22] | Zarei Mahmoudabadi A, Rezaei-Matehkolaei A, Ghanavati F. The susceptibility patterns of Candida species isolated from urine samples to posaconazole and caspofungin. Jundishapur J Microbiol. 2015; 8(3): e24298.View Article |
| [23] | Toner L, Papa N, Aliyu SH, Dev H, Lawrentschuk N, Al-Hayek S. Candida growth in urine cultures: a contemporary analysis of species and antifungal susceptibility profiles. QJM Mon J Assoc Physicians. 2016; 109(5): 325‑9.View Article PubMed |
| [24] | Nikolić E, Brandmajer T, Bokan V, Ulyashova M, Rubtsova M. Prevalence of Escherichia coli Resistant to Beta-Lactam Antibiotics among Patients with Chronic Obstructive Pulmonary Disease and Urinary Tract Infection. Tohoku J Exp Med. 2018; 244(4): 271‑7.View Article PubMed |
| [25] | Adamus-Białek W, Baraniak A, Wawszczak M, Głuszek S, Gad B, Wróbel K, et al. The genetic background of antibiotic resistance among clinical uropathogenic Escherichia coli strains. Mol Biol Rep. 2018; 45(5): 1055‑65.View Article PubMed |
| [26] | Cristea VC, Gheorghe I, Czobor Barbu I, Popa LI, Ispas B, Grigore GA, et al. Snapshot of Phylogenetic Groups, Virulence, and Resistance Markers in Escherichia coli Uropathogenic Strains Isolated from Outpatients with Urinary Tract Infections in Bucharest, Romania. BioMed Res Int. 2019; 2019: 5712371.View Article PubMed |
| [27] | Galindo-Méndez M. [Molecular characterization and antimicrobial susceptibility pattern of extended-spectrum β-lactamase-producing Escherichia coli as cause of community acquired urinary tract infection]. Rev Chil Infectologia Organo Of Soc Chil Infectologia. 2018; 35(1): 29‑35. |
| [28] | Panizo MM, Reviákina V, Dolande M, Selgrad S. Candida spp. in vitro susceptibility profile to four antifungal agents. Resistance surveillance study in Venezuelan strains. Med Mycol. 2009;47(2):137‑43.View Article PubMed |
| [29] | Coico R. Gram staining. Curr Protoc Microbiol. 2005; Appendix 3: Appendix 3C.View Article PubMed |
| [30] | Holmes B, Willcox WR, Lapage SP. Identification of Enterobacteriaceae by the API 20E system. J Clin Pathol. 1978; 31(1): 22‑30.View Article PubMed |
| [31] | Détermination de la sensibilité aux antibiotiques. In: CASFM/EUCAST: Société Française de Microbiologie. 2019. p. 6‑25. |
| [32] | CLSI. Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard-Tenth Edition. CLSI document M02-A10. Wayne, PA: Clinical and Laboratory Standards Institute. 2009. |
| [33] | Clinical and Laboratory Standards Institute (CSLI). Performance Standards for antimicrobial susceptibility testing; Twenty-Fifth international supplement. CLSI document M100-S25. CLSI Wayne, PA; 2015. |
| [34] | Joyanes P, del Carmen Conejo M, Martínez-Martínez L, Perea EJ. Evaluation of the VITEK 2 System for the Identification and Susceptibility Testing of Three Species of Nonfermenting Gram-Negative Rods Frequently Isolated from Clinical Samples. J Clin Microbiol. 2001; 39(9): 3247‑53.View Article PubMed |
| [35] | Ramani R, Gromadzki S, Pincus DH, Salkin IF, Chaturvedi V. Efficacy of API 20C and ID 32C Systems for Identification of Common and Rare Clinical Yeast Isolates. J Clin Microbiol. 1998;36(11):3396‑8.View Article PubMed |
| [36] | Bourgeois N, Dehandschoewercker L, Bertout S, Bousquet P, Rispail P, Lachaud. Antifungal susceptibility of 205 Candida species isolated primarily during invasive Candidiasis and comparison of the Vitek 2 system with the CLSI broth microdilution and E test methods. J Clin Microbiol. 2010; 48: 154‑61.View Article PubMed |
| [37] | Clinical and Laboratory Standard Institute. Reference methode for broth dilution antifungal susceptibility testing of yeasts; 4 th Informational Supplement. CSLI document M27-S4. Wayne: CSLI; 2012. |
| [38] | R. Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria, 2019. https://www.R-project.org/. |
| [39] | Harrison E, Drake T, Ots R, finalfit: Quickly Create Elegant Regression Results Tables and Plots when Modelling, 2019. https://CRAN.R-project.org/package=finalfit |
| [40] | Wickham H, ggplot2: Elegant Graphics for Data Analysis. New York: Springer-Verlag, 2016. https://ggplot2.tidyverse.orgView Article |
| [41] | Seitz M, Stief C, Waidelich R. Local epidemiology and resistance profiles in acute uncomplicated cystitis (AUC) in women: a prospective cohort study in an urban urological ambulatory setting. BMC Infect Dis. 2017; 17(1): 685.View Article PubMed |
| [42] | Ozhak-Baysan B, Ogunc D, Colak D, Ongut G, Donmez L, Vural T, et al. Distribution and antifungal susceptibility of Candida species causing nosocomial candiduria. Med Mycol. 2012; 50(5): 529‑32.View Article PubMed |
| [43] | Gajdács M, Dóczi I, Ábrók M, Lázár A, Burián K. Epidemiology of candiduria and Candida urinary tract infections in inpatients and outpatients: results from a 10-year retrospective survey. Cent Eur J Urol. 2019; 72(2): 209‑14. |
| [44] | Lagunas-Rangel FA. Antimicrobial susceptibility profiles of bacteria causing urinary tract infections in Mexico: Single-centre experience with 10 years of results. J Glob Antimicrob Resist. 2018; 14: 90‑4.View Article PubMed |
| [45] | Pérez Heras I, Sanchez-Gomez JC, Beneyto-Martin P, Ruano-de-Pablo L, Losada-Pinedo B. Community-onset extended-spectrum β-lactamase producing Escherichia coli in urinary tract infections in children from 2015 to 2016: Prevalence, risk factors, and resistances. Medicine (Baltimore). 2017; 96(50): e8571.View Article PubMed |
| [46] | Erb S, Frei R, Tschudin Sutter S, Egli A, Dangel M, Bonkat G, et al. Basic patient characteristics predict antimicrobial resistance in E. coli from urinary tract specimens: a retrospective cohort analysis of 5246 urine samples. Swiss Med Wkly. 2018; 148: w14660.View Article PubMed |
| [47] | Edward EA, Mohamed NM, Zakaria AS. Resensitization of Fluconazole-Resistant Urinary Candida spp. Isolates by Amikacin through Downregulation of Efflux Pump Genes. Pol J Microbiol. 2020; 69(1): 73‑84.View Article PubMed |
| [48] | Kaduma J, Seni J, Chuma C, Kirita R, Mujuni F, Mushi MF, et al. Urinary Tract Infections and Preeclampsia among Pregnant Women Attending Two Hospitals in Mwanza City, Tanzania: A 1:2 Matched Case-Control Study. BioMed Res Int. 2019; 2019: 3937812.View Article PubMed |
| [49] | Córdoba G, Holm A, Hansen F, Hammerum AM, Bjerrum L. Prevalence of antimicrobial resistant Escherichia coli from patients with suspected urinary tract infection in primary care, Denmark. BMC Infect Dis. 2017; 17(1): 670.View Article PubMed |
| [50] | Lee H, Yoon E-J, Kim D, Jeong SH, Won EJ, Shin JH, et al. Antimicrobial resistance of major clinical pathogens in South Korea, May 2016 to April 2017: first one-year report from Kor-GLASS. Euro Surveill Bull Eur Sur Mal Transm Eur Commun Dis Bull. 2018; 23(42).View Article |
| [51] | Klingeberg A, Noll I, Willrich N, Feig M, Emrich D, Zill E, et al. Antibiotic-Resistant E. coli in Uncomplicated Community-Acquired Urinary Tract Infection. Dtsch Arzteblatt Int. 2018;115(29‑30):494‑500.View Article PubMed |
| [52] | Yábar MN, Curi-Pesantes B, Torres CA, Calderón-Anyosa R, Riveros M, Ochoa TJ. [Multiresistance and factors associated with the presence of extended-spectrum beta-lactamases in Escherichia coli strains isolated from urine culture]. Rev Peru Med Exp Salud Publica. 2017;34(4):660‑5.View Article PubMed |
| [53] | Raeispour M, Ranjbar R. Antibiotic resistance, virulence factors and genotyping of Uropathogenic Escherichia coli strains. Antimicrob Resist Infect Control. 2018; 7: 118.View Article PubMed |
| [54] | Forson AO, Tsidi WB, Nana-Adjei D, Quarchie MN, Obeng-Nkrumah N. Escherichia coli bacteriuria in pregnant women in Ghana: antibiotic resistance patterns and virulence factors. BMC Res Notes. 2018; 11(1): 901.View Article PubMed |
| [55] | Dehshiri M, Khoramrooz SS, Zoladl M, Khosravani SA, Parhizgari N, Motazedian MH, et al. The frequency of Klebsiella pneumonia encoding genes for CTX-M, TEM-1 and SHV-1 extended-spectrum beta lactamases enzymes isolated from urinary tract infection. Ann Clin Microbiol Antimicrob. 2018; 17(1): 4.View Article PubMed |
| [56] | Ali I, Rafaque Z, Ahmed I, Tariq F, Graham SE, Salzman E, et al. Phylogeny, sequence-typing and virulence profile of uropathogenic Escherichia coli (UPEC) strains from Pakistan. BMC Infect Dis. 2019; 19(1): 620.View Article PubMed |
| [57] | Dybowski BA, Zapała P, Bres-Niewada E, Zapała Ł, Miązek-Zapała N, Poletajew S, et al. Catheter-associated bacterial flora in patients with benign prostatic hyperplasia: shift in antimicrobial susceptibility pattern. BMC Infect Dis. 2018; 18(1): 590.View Article PubMed |
| [58] | Shin H-R, Moon J, Lee HS, Ahn SJ, Kim T-J, Jun J-S, et al. Increasing prevalence of antimicrobial resistance in urinary tract infections of neurological patients, Seoul, South Korea, 2007-2016. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2019; 84: 109‑15.View Article PubMed |
| [59] | Sohail M, Khurshid M, Saleem HGM, Javed H, Khan AA. Characteristics and Antibiotic Resistance of Urinary Tract Pathogens Isolated from Punjab, Pakistan. Jundishapur J Microbiol. 2015; 8(7): e19272.View Article PubMed |
| [60] | Choi JK, Yoo JH. Increasing Antimicrobial Resistance of Escherichia coli Makes Antimicrobial Stewardship More Important. J Korean Med Sci. 2019; 34(34): e236.View Article PubMed |
| [61] | Osawa K, Shigemura K, Yoshida H, Fujisawa M, Arakawa S. Candida urinary tract infection and Candida species susceptibilities to antifungal agents. J Antibiot (Tokyo). 2013; 66(11): 651‑4.View Article PubMed |
| [62] | Onozawa K, Miyake N, Iwasaki N, Nishida R, Chong Y, Shimoda S, et al. A case of Candida albicans fungus balls in the urinary tract appeared during the course of antifungal treatment for Candida endophthalmitis. J Infect Chemother Off J Jpn Soc Chemother. 2015; 21(9): 687‑90.View Article PubMed |
| [63] | Zarei Mahmoudabadi A, Rezaei-Matehkolaei A, Navid M, Torabizadeh M, Mazdarani S. Colonization and antifungals susceptibility patterns of Candida species isolated from hospitalized patients in ICUs and NICUs. J Nephropathol. 2015; 4(3): 77‑84.View Article |
| [64] | de Freitas AR, Baeza LC, Faria MGI, Dota KFD, Godoy Martínez P, Svidzinski TIE. Yeasts isolated from nosocomial urinary infections: antifungal susceptibility and biofilm production. Rev Iberoam Micol. 2014; 31(2): 104‑8.View Article PubMed |
| [65] | Almeida AA de, Mesquita CSS, Svidzinski TIE, Oliveira KMP de. Antifungal susceptibility and distribution of Candida spp. isolates from the University Hospital in the municipality of Dourados, State of Mato Grosso do Sul, Brazil. Rev Soc Bras Med Trop. 2013; 46(3): 335‑9.View Article PubMed |
| [66] | Whaley SG, Berkow EL, Rybak JM, Nishimoto AT, Barker KS, Rogers PD. Azole Antifungal Resistance in Candida albicans and Emerging Non-albicans Candida Species. Front Microbiol. 2016; 7: 2173.View Article PubMed |
| [67] | Behzadi P, Behzadi E, Ranjbar R. Urinary tract infections and Candida albicans. Cent Eur J Urol. 2015; 68(1): 96‑101.View Article |
| [68] | Arendrup MC. Candida and candidaemia. Susceptibility and epidemiology. Dan Med J. 2013; 60(11): B4698. |
