Multidrug Resistance in Uropathogens Isolated from University Students with Bacteriuria in Enugu State, Nigeria

Abstract

Urinary tract infections (UTIs) among university students and increasing antimicrobial resistance are global public health concerns with its burden higher in developing countries of the world; resulting in high morbidity and mortality rate. Multidrug resistance (MDR) to virtually all available antibiotics has been observed among uropathogens and their susceptibility patterns differ per individual. This study was undertaken to determine MDR of bacteria uropathogens from 460 undergraduate students (209 males and 251 females) in a higher institution at Enugu State, Nigeria. This cross sectional study determined the susceptibility patterns of 160 bacteria isolates from the urine culture of 460 apparently healthy undergraduate students at Renaissance University, Enugu State, Nigeria; who were randomly selected, using Kirby Bauer disc diffusion method. Multiple Antibiotic Resistance (MAR) index was determined. Demographic data were collected using pre-designed questionnaire. Data was analyzed with SPSS version 22 (percentages, chi square test) and statistical significance was determined at ≤0.05. All Klebsiella species, Enterobacter hormaechei, Providencia alcalifaciens and Citrobacter freundii showed 100% resistance to cefotaxime, a third generation cephalosporins. Isolates showed highest sensitivity to fluoroquinolones such as ofloxacin (94.4%), levofloxacin (86.9%), followed by gentamicin (78.1%) and nitrofurantoin (70.6%). Conversely, high resistance was recorded for third-generation cephalosporins like cefotaxime (90.6%), and β-lactam combinations such as ceftriaxone-sulbactam (74.4%), followed by imipenem/cilastatin 118 (73.6%). The prevalence of MDR in this study was 152(95%) and the association between bacterial isolates and MDR is statistically significant (P= 0.000). The MAR indices obtained for all bacteria isolates were >0.2. One hundred and thirty nine (30.2%) students have been previously exposed to antimicrobial agents and 53(31.2%) were positive for UTI. There is a significant association between prevalence of UTI and previous exposure to antimicrobial agents (P= 0.013). Findings underscore the need for targeted surveillance, individualized antibiotic therapy, and antimicrobial stewardship programs within university communities.