Increasing Prevalence of Antimicrobial Resistance among Enterobacteriaceae Uropathogens in Bangui; Central African Republic

RESUMO

Background: Because of the previous high prevalence of resistance to usual antibiotics among uropathogens in Bangui; Central African Republic (CAR); a survey focused on Enterobacteriaceae; the most prevalent group responsible for urinary tract infections (UTIs); was conducted. The aim was to help health authorities revise antibiotic policies.Methodology: We performed a retrospective analysis of all cases of confirmed UTIs due to Enterobacteriaceae in outpatients attending the Institut Pasteur de Bangui (IPB); CAR; between 2004 and 2006. Results: During the study period; 560 (10.9of urine submissions) UTIs were confirmed and 443 Enterobacteriaceae strains were isolated; representing 79of the causative agents for UTIs. Among these 560 strains; E. coli was the most common; representing 64of the isolates; followed by K. pneumoniae (10) and other Enterobacteriaceae (5). Extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae significantly increased from five (3.7) to thirty-three (19.3) between 2004 and 2006. A significantly increased resistance rate to nalidixic acid; ciprofloxacin and gentamicin was observed in ESBL-nonproducing Enterobacteriaceae over the study period. Conclusions: Empiric treatment for UTIs in Bangui should be reconsidered and prudent use of antibiotics; particularly ciprofloxacin; is highly recommended. The recent spread of ESBL-producing Enterobacteriaceae in central African outpatients is striking and underlines the need for further studies