Bacterial Profile of Community-Acquired Urinary Tract Infections among Adults in Abidjan, Côte d'Ivoire

Abstract

Background: Urinary tract infections (UTIs) represent a significant global public health issue, second only to respiratory infections, and are a leading cause of morbidity and mortality worldwide. Bacterial pathogens are the primary etiologic agents of UTIs, which can affect both the upper and lower urinary tracts, manifesting in symptoms like fever, dysuria, urgency, flank pain, burning sensations, suprapubic tenderness, and intermittent urine. Aim: This study aimed to describe the bacterial profile and resistance profile of community-acquired urinary tract infections in adults in the city of Abidjan (Côte d'Ivoire). Place and Duration of Study: Medical laboratories (Yopougon, North-Abidjan and Plateau, South-Abidjan) (Côte d'Ivoire), between September 2020-December 2022. Methodology: This retrospective study included adult patients with urinary tract infections. Following a macroscopic examination, a microscopic examination of a urine sample was carried out. Thus, one (1) µL of urine suspension was then inoculated onto various agar media and incubated for 24 hours. Bacterial identification was carried out using the API 20 E system or a rack of Le Minor. Subsequently, susceptibility testing for five classes of antibiotics (beta-lactams, aminoglycosides, cyclins, quinolones and phosphonic acids), manly on Gram-negative bacilli, was carried out using ATB G-EU or discs, and zones of inhibition were detected. Results: A total of 500 samples were recorded across the two laboratories. At the Plateau laboratory, out of a sample size of 273 patients, 12.82 % presented a positive ECBU, with an average age of 60 ± 2.62 years and a sex ratio (M/F) of 0.5. Four types of microorganisms were identified, including 88.15 % Gram-negative bacilli, predominantly Escherichia coli (60 %); 1.10 % Gram-positive cocci; 2.20 % yeasts (Candida albicans); and 1.10 % intracellular bacteria (Chlamydia trachomatis). As for the Yopougon’s laboratory, 24.67 % of positive cases (out of a total of 227), with an average age of 45 ± 2.20 years and a sex ratio (M/F) of 0.3. Only one type of pathogen was isolated. These were Gram-negative bacilli, predominantly E. coli (57.17%), followed by Klebsiella pneumoniae (23.21%) and Enterobacter cloacae (12.5%). Thus, overall 97.6 % of Gram-negative bacilli were found in both laboratories, with a predominance of E. coli (58.8 %) followed by Klebsiella pneumoniae (25.2 %) and Enterobacter cloacae (12.5%). Furthermore, the antibiogram carried out on Gram-negative Bacilli revealed a high overall resistance in E. coli with 47.17% for penicillins (amoxicillin); 39.62% for cephalosporins. Regarding fluoroquinolones, resistance to ciprofloxacin was 62.26% and 67.92% for ofloxacin. As for the aminoglycosides (amikacin), which was 96.88% (Yopougon laboratory). With regard to the other predominant isolated germs, Klebsiella pneumoniae and Enterobacter cloacae also exhibited high resistance to these different antibiotics at over 60%. Among the other isolates (P. aeruginosa, P. mirabilis, S. marcescens, E. aerogenes, Lerinea sp, K. oxytoca), the resistance observed are varies and is limited to only some of the antibiotics studied. Conclusion: This study showed that 97.6 % of the isolates were Gram-negative bacilli, a predominance of Escherichia coli and Klebsiella pneumoniae species in urinary tract infections both in the northern and southern areas of the city of Abidjan, and with resistance levels rising steadily (from 39.62% to 96.88%). This resistance is particularly high resistance to fluoroquinolones (ciprofloxacin; ofloxacin) (over 60%) and aminoglycosides (96.88%).