Prevalence of nitrofurantoin resistance in Escherichia Coli isolates from urinary samples analysed in Makerere Microbiology Laboratory from 2020 to 2023
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Date
2024Author
Byekwaso, Godrine Mayanja
Kanyesigye, Shadrack
Gonzaga, Matthew
Ami, Anilkumar Patel
Kavuma, Frank
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BACKGROUND: The prevalence of antibiotic resistance in urinary tract infections caused by Escherichia coli (E. coli) is a significant public health concern worldwide. Nitrofurantoin is commonly used as a first-line treatment for uncomplicated urinary tract infections, but the emergence of resistance to this antibiotic poses a challenge to effective management. We investigated the prevalence of nitrofurantoin-resistant E. coli isolated from urine samples collected at the Microbiology Laboratory of Makerere University College of Health Sciences (MAKCHS) from 2020 to 2023. We also investigated multi drug and extensive drug resistance to assess for any correlation with nitrofurantoin resistance. METHODOLOGY: A cross sectional observational retrospective research design was utilized to track changes in resistance patterns over the four-year period. The target population consisted of patients who submitted urine samples to the MAKCHS microbiology lab during the study period and antibiotic susceptibility testing subjected to them. Sampling strategies, such as stratified sampling, were employed to select a representative subset of urine samples for analysis. Data analysis included calculating the prevalence of nitrofurantoin-resistant E. coli, stratified by year and other relevant variables such as means, medians and modes. Ethical considerations, including patient confidentiality, were addressed to ensure compliance with ethical guidelines. Quality control measures were implemented to maintain the reliability and validity of the data. Limitations of the study, such as potential biases in sample selection, were acknowledged. RESULTS: In 2020, the prevalence of nitrofurantoin resistance among E. coli isolates was 25%. By 2021, it had decreased to 17.14%. However, in 2022, there was a significant increase to 20.51%, followed by a sudden decrease to 13.04% in 2023. The overall prevalence was found to be 18.42%. Additionally, 64.76% of E. coli isolates exhibited multidrug resistance, while 25.71% showed extensive drug resistance. CONCLUSION: This research underscores a significant threat to the efficacy of antibiotics in treating urinary tract infections (UTIs). Notably, there appears to be a correlation between nitrofurantoin resistance and extensive drug resistance, which is concerning. These findings emphasize the urgent need to review UTI treatment protocols, conduct broader surveillance of resistance trends, identify underlying resistance mechanisms, and develop innovative strategies to combat these resistant strains.