“ANTIMICROBIAL RESISTANCE PATTERNS OF UROPATHOGENS ASSOCIATED WITH BACTERIURIA AMONG PATIENTS PRESENTING WITH BLADDER OUTLET OBSTRUCTION AT THE KORLE-BU TEACHING HOSPITAL, ACCRA”

ABSTRACT

Background: Bladder outlet obstruction (BOO) is an important public health problem which affects the health and social wellbeing of mainly elderly men. Bladder outlet obstruction is a major risk factor for the development of bacteriuria and recurrent urinary tract infections. These infections are usually associated with multi-drug resistant uropathogens leading to significant morbidity and mortality. Successful empirical management of these infections is dependent on knowledge of antimicrobial susceptibility patterns of the causative agents. However, in Ghana little is known about the bacterial etiology among BOO patients and their antibiogram.

Aim: To investigate antibiotic resistance of uropathogens associated with bacteriuria among patients with BOO at the Korle-Bu Teaching Hospital.

Methodology: This was a cross-sectional study involving 188 study male patients presenting with bladder outlet obstruction at the Urology Unit, Korle-Bu Teaching Hospital (KBTH). Urine specimens were collected from study recruits for bacterial culture and identification. Antimicrobial susceptibility testing was carried out on the bacterial isolates using Kirby Bauer method. Demographic and clinical information were also collected from all the study participants. The data were analyzed with Graph Pad Prism version 6.

RESULTS: The overall prevalence of bacteriuria among BOO patients was 76.6%. The risk factors of bacteriuria found among the BOO patients included catheterization (p < 0.0001), pyuria (p < 0.0001) and haematuria (p < 0.0005). Nineteen bacterial isolates covering ten genera were identified in the urine specimens. Escherichia coli was the most common bacteria isolated (33.3%) followed by Klebsiella species (11.5%). Bacterial isolates were most resistant to augmentin (97.8%) followed by tetracycline (85.8%), nalidixic acid (82.8%) and ciprofloxacin (75%) whiles 93.6% were multi-drug resistant. The highest susceptibility was observed with amikacin (4.4% resistance). Forty six percent prevalence of extended-spectrum beta-lactamases was observed among selected enterobateriaceae isolates.

Conclusion: The prevalence of bacteriuria at KBTH Is high (76.6%) among BOO patients. Escherichia coli is the main cause of bacteriuria among these patients and the urinary tract infections could be managed with nitrofurantoin and amikacin. Ciprofloxacin which was the most commonly prescribed antibiotic for the BOO patients was less effective. The findings of this study further strengthen the need for a re-evaluation of the recommended antibiotics used in therapeutic management of urinary tract infection in Ghana especially among bladder outlet obstruction patients.