Abstract
The global impact of antimicrobial resistance (AMR) includes increased morbidity and mortality rates and healthcare costs, particularly in low- and middle-income countries (LMICs), and it has dire economic and security implications. This study assessed the resistance of clinical isolates responsible for urinary tract infections (UTI) to antibacterial agents for treating UTIs in selected healthcare facilities in Tanzania. A total of 151 clinical isolates of E. coli and S. aureus isolated from urine samples in selected health facilities were analyzed for antimicrobial susceptibility to establish the presence of individual and multi-drug resistance (MDR). The results revealed that E. Coli displayed a significant difference in resistance (χ2 =12.808, p =0.002) across the selected antibiotics, in which E. coli showed the highest resistance to amoxicillin (AML) and the least resistance to meropenem (p <0.005). In contrast, S. aureus isolates showed a significant difference. (χ2=53.627, p-value<0.001) in resistance across the selected antibiotics, in which S. aureus showed the highest resistance to AML, peaking at more than 91%, and least resistant (4%) to nitrofurantoin (NIT) (4%). When p-value<0.005, both E. coli and S. aureus demonstrated MDR against selected antibiotics in all health facilities under study, in which Morogoro Regional Referral Hospital showed the highest (65.4%) for E. coli and Benjamin Mkapa Hospital showed the highest (83.3%) for S. aureus. Similarly, Maweni Regional Referral Hospital demonstrated the lowest MDR for E. coli (23%) and S. aureus (13%). Finding suggest that some antibiotics are still in used in clinical practice despite of the evidence of emerging resistance against them hence it call for effective regular AMR surveillance and antimicrobial stewardship implementation to optimize antibiotics use in clinical practice and exclude less efficacious ones.
Keywords
Antimicrobial Resistance, Clinical Isolates, Urinary Tract Infections, E. coli and S. aureus, Tanzania Healthcare Facilities
1. Introduction
Antibacterial agents are compounds that kill or immobilize bacteria and are used to treat and manage bacterial infections and perioperative procedures
[1] | Denyer, S P., Hodges NA, Gorman SP, Gilmore BF. Pharmaceutical Microbiology. 8th ed. New Delhi: Wiley Blackwell Publishing House; 2011. |
[1]
. These are further categorized based on their activity against different bacterial agents as either broad-spectrum, which acts on a wide range of gram-positive and gram-negative bacteria, or narrow-spectrum, which works on either gram-positive or gram-negative bacteria
.
Despite the importance of these antibiotics in treatment, there have been reports of a significant increase in unsuccessful treatments owing to emerging antimicrobial resistance (AMR)
[3] | Camara N, Moremi N, Mghamba J, Eliakimu E, Shumba E, Ondoa P, et al. Surveillance of antimicrobial resistance in human health in Tanzania: 2016–2021. Afr J Lab Med. 2023;12: 1–8. https://doi.org/10.4102/ajlm.v12i1.2053 |
[3]
. When AMR occurs, microorganisms persist or grow in the presence of antibiotics designed to inhibit or kill them
. Several related factors, including poor hygiene and sanitation, infection control, overprescription, lack of treatment completion, antibiotic overuse in farming, and lack of development of novel antibiotics, have been identified as drivers of emerging AMR
[5] | Knobler L, Lemon SM, Najafi M. The Resistance Phenomenon in Microbes and Infectious Disease Vectors. Washington, D.C.: National Academies Press; 2003. https://doi.org/10.17226/10651 |
[6] | Sangeda RZ, William SM, Masatu FC, Bitegeko A, Mwalwisi YH, Nkiligi EA, et al. Antibiotic Utilisation Patterns in Tanzania: A Retrospective Longitudinal Study Comparing Pre- and Post-COVID-19 Pandemic Using Tanzania Medicines and Medical Devices Authority Data. medRxiv. 2023. https://doi.org/10.1101/2023.11.27.23299060 |
[5, 6]
. Additionally, substandard medicines are another major factor driving the development of antimicrobial resistance. For instance, a 2020 report by the Tanzania Medicines and Medical Devices Authority (TMDA) recorded nine substandard and falsified medicines, including antibiotics, circulating in the market
.
The global effects of AMR include increased morbidity and mortality rates, increased healthcare costs, particularly in low- and middle-income countries (LMICs), and dire economic and security implications
. Numerous studies conducted in Tanzania over the past ten years reveal that AMR continues to rise despite various intervention efforts
[9] | Ngowi BN, Sunguya B, Herman A, Chacha A, Maro E, Rugarabamu LF, et al. Prevalence of Multidrug Resistant UTI Among People Living with HIV in Northern Tanzania. Infect Drug Resist. 2021; Volume 14: 1623–1633. https://doi.org/10.2147/IDR.S299776 |
[10] | Silago V, Moremi N, Mtebe M, Komba E, Masoud S, Mgaya FX, et al. Multidrug-Resistant Uropathogens Causing Community Acquired Urinary Tract Infections among Patients Attending Health Facilities in Mwanza and Dar es Salaam, Tanzania. Antibiotics. 2022; 11: 1718. https://doi.org/10.3390/antibiotics11121718 |
[9, 10]
. To combat AMR, the World Health Organization (WHO), by partnering with different countries, including Tanzania, initiated antimicrobial stewardship programs to promote the optimal use of antimicrobials at all levels of healthcare facilities
[11] | Antimicrobial Stewardship—a practical guide to implementation in hospitals. JAC-Antimicrobial Resist. 2019; 1. https://doi.org/10.1093/jacamr/dlz005 |
[12] | Sangeda RZ, Kibona J, Munishi C, Arabi F, Manyanga VP, Mwambete KD, et al. Assessment of Implementation of Antimicrobial Resistance Surveillance and Antimicrobial Stewardship Programs in Tanzanian Health Facilities a Year After Launch of the National Action Plan. Front Public Heal. 2020;8: 454. https://doi.org/10.3389/fpubh.2020.00454 |
[11, 12]
. Tanzania continues implementing its National Action Plan on Antimicrobial Resistance (NAP–AMR), the first release implemented for 2017-2022 and the second in 2023-2028. NAP-AMR intends to minimize AMR delinquency and contribute to AMR global data
.
The prevalence of urinary tract infections (UTI) in Tanzania has been reported to range from 16% in children to 38-41% in adults
[15] | Sangeda RZ, Paul F, Mtweve DM. Prevalence of urinary tract infections and antibiogram of uropathogens isolated from children under five attending Bagamoyo District Hospital in Tanzania: A cross-sectional study. F1000Research. 2021; 10: 449. https://doi.org/10.12688/f1000research.52652.1 |
[16] | Mlugu EM, Mohamedi JA, Sangeda RZ, Mwambete KD. Prevalence of urinary tract infection and antimicrobial resistance patterns of uropathogens with biofilm forming capacity among outpatients in morogoro, Tanzania: a cross-sectional study. BMC Infect Dis. 2023; 23: 660. https://doi.org/10.1186/s12879-023-08641-x |
[17] | Schmider J, Bühler N, Mkwatta H, Lechleiter A, Mlaganile T, Utzinger J, et al. Microbiological Characterisation of Community-Acquired Urinary Tract Infections in Bagamoyo, Tanzania: A Prospective Study. Trop Med Infect Dis. 2022; 7: 100. https://doi.org/10.3390/tropicalmed7060100 |
[15-17]
. Typical human body flora under favorable conditions can cause infections such as UTI, abscesses, furuncles, cellulitis, traveler's diarrhea, bacteremia, pneumonia, and neonatal meningitis
. The occurrence of infectious diseases in Tanzania may be due to poor water and hygiene sanitation (WASH) and antibiotic misuse
. Among the most frequently diagnosed bacterial infections in healthcare facilities at different levels are
E. coli and
Staphylococcus aureus [19] | Dasgupta C, Rafi MA, Salam MA. High prevalence of multidrug resistant uropathogens: A recent audit of antimicrobial susceptibility testing from a tertiary care hospital in Bangladesh. Pakistan J Med Sci. 2020; 36: 1–6. https://doi.org/10.12669/pjms.36.6.2943 |
[19]
. Emerging AMR among these bacteria can contribute to the spread of AMR and transmit it to other bacteria, including pathogenic ones. Thus, we selected representative microbial agents to determine changes in AMR or susceptibility patterns of clinical isolates due to ongoing interventions against AMR.
As a medicine regulator in Tanzania, TMDA has a direct role in ensuring the quality and safety of medicines by utilizing different strategies in registration, inspection, pharmacovigilance, and post-market surveillance to support the National Action Plan on Antimicrobial Resistance (NAP–AMR) together with the National Strategic Health Plan in line with Sustainable Development Goals (SDG) 2030
. Therefore, this study aimed to assess the susceptibility of
E. coli and
S. aureus clinical isolate
s to selected antibiotics according to standard treatment guidelines (STG) to establish the magnitude of their AMR in four major referral regional hospitals in Tanzania.
2. Methodology
2.1. Study Location
The study was conducted in three zones of the country involving four referral hospitals, namely Western Zone (Maweni Regional Referral Hospital), Central Zone (Benjamin Mkapa Hospital and Morogoro Regional Hospital), and Eastern Zone (Temeke Referral Hospital).
2.2. Study Design and Sampling Strategy
A cross-sectional study design and purposive sampling were used (Kothari 2004). Individual hospitals were selected based on their capacity to perform bacterial cultures, isolation, and identification. Bacterial isolates of E. coli and S. aureus responsible for UTI were collected from hospital laboratories in selected hospitals. Samples were cultured and identified to obtain isolates, which were used to assess the prevalence of antibiotic resistance recommended in Tanzania's Standard Treatment Guideline 2022.
2.3. Sample Size Determination
The sample size was computed using a calculator developed by Statistics Kingdom (https://www.statskingdom.com/sample_size_chi2.html). The sample size computation followed a 95% Confidence Interval (CI) and a marginal error of 5%. Based on this calculation, 174 isolates were expected to be collected from the selected health facilities.
2.4. Sample Collection, Inclusion and Exclusion Criteria
2.4.1. Sample Collection
Positive E. coli and S. aureus isolates responsible for UTIs were collected from respective health facility laboratories responsible for UTI cases between February and March 2023 for subsequent analyses.
2.4.2. Inclusion and Exclusion Criteria
All positive clinical isolates responsible for UTI in the healthcare facilities laboratory were included in this study.
2.5. Sample Isolation
Isolates responsible for UTI were collected and subcultured for colony identification of
S. aureus and
E. coli, Isolates were grown on cystine lactose electrolyte-deficient (CLED) (Oxoid) and MacConkey Agar (MCA) (Oxoid), respectively
[21] | Karah N, Rafei R, Elamin W, Ghazy A, Abbara A, Hamze M, et al. Guideline for Urine Culture and Biochemical Identification of Bacterial Urinary Pathogens in Low-Resource Settings. Diagnostics. 2020; 10: 832. https://doi.org/10.3390/diagnostics10100832 |
[21]
. Gram Staining was performed to identify gram-positive and gram-negative bacteria
. For
S. aureus, colonies with deep yellow colonies and gram-positive bacteria were selected and submitted to biochemical tests (Shields and Tsang, 2006)
. A total of hundred three (103) isolates of
E. coli were collected
from different regions based on the hospital's capacity to perform bacterial culture, isolation, and identification as follows 30 (29%) from Benjamin Mkapa Hospital, 12 (12%) from Temeke Regional Referral Hospital, 29 (28%) from Morogoro Regional Referral Hospital, and 32 (31%) from Maweni Regional Referral Hospital. A total of eighty four (84) isolates of
S. aureus were collected from the four regions. 31(37%) were recruited from Morogoro Referral Hospital, 32(38%) from Maweni Hospital, 8(10%) from Benjamin Mkapa Hospital, and 13(15%) from Temeke Hospital. All isolates were transported to the TMDA Microbiology Laboratory in double-strength tryptic soy broth (TSB) at room temperature to the TMDA Microbiology Laboratory.
2.6. Laboratory Analysis
2.6.1. Biochemical Identification of S. aureus
Colonies with a deep yellow color on Cystine, lactose, electrolyte-deficient (CLED) Agar and positive Gram staining were collected for biochemical identification of
S. aureus. Catalase and coagulase were used, as described by Ali et al. (2019)
.
2.6.2. Biochemical Identification of E. coli
Red colonies on MacConkey agar (Oxoid) with negative gram staining were selected and subjected to biochemical tests. Oxidase, Sulfur Indole Motility (SIM), triple sugar iron (TSI), and urease tests were performed according to the procedures described by Ali (2019 and Brink, 2010)
.
2.6.3. Recovery of Isolates from Transport Media (TSB)
Using the Streak method, 151 out of 187 isolates were recovered on selective media (mannitol salt agar and MacConkey Agar) after 24 h of incubation at 37°C. Fifty-five (55) isolates of S. aureus and 96 isolates of E. coli were recovered. Pure cultures were subcultured in their respective culture media and incubated at 37ºC for 18-24 hours and the pure colonies were used for subsequent experiments.
2.6.4. Antibiotics and Reference Microorganisms
The selection of antibiotics used in this study was based on the current recommendations of the Tanzania Standard Treatment Guide for treating all types of tract infections. Selected antibiotics are listed in
table 1.
Table 1. List and details of Antibiotic agents used.
Class | Antibiotic | Batch No. | Date of expire |
Penicillin | Amox/Clav (AMC 20/10 µg), Piperacillin – tazobactam (TZP 100/10µg), Amoxicillin (AML 10 µg) | 3294941 | 2024/05/30 |
Aminoglycosides | Gentamicin (CN 10) | 3261708 | 2024/03/17 |
Quinolones | Ciprofloxacin (CIP 5 µg) | 3552317 | 2025/09/21 |
Cephalosporins | Ceftriaxone + sulbactam (CSE30 µg) | | |
Ceftriaxone (CRO 30 µg) | 3545371 | 2025/09/4 |
Nitrofurans | Nitrofurantoin (NIT 300 µg) | 3538222 | 2025/08/18 |
Carbapenem | Meropenem (MEM 10µg) | 3524471 | 2023/07/19 |
2.6.5. Standard Control Microorganism
This study used two controls reference standard microorganisms as shown in
table 2.
Table 2. List of reference bacteria used.
No. | Microorganism | Ref Number | Batch | Expire date |
1 | E. coli | ATCC 25922 | Lot: 362251 | 28/03/2023 |
2 | S. aureus | ATCC 25923 | Lot: 421086 | 27/06/2023 |
2.6.6. Antimicrobial Susceptibility Test
Pure overnight
E. coli and
S. aureus colonie
s were tested for antibiotic susceptibility on Muller Hilton agar using the Kirby-Bauer method
[26] | Odoch T, Wasteson Y, L’Abée-Lund T, Muwonge A, Kankya C, Nyakarahuka L, et al. Prevalence, antimicrobial susceptibility and risk factors associated with non-typhoidal Salmonella on Ugandan layer hen farms. BMC Vet Res. 2017; 13: 365. https://doi.org/10.1186/s12917-017-1291-1 |
[26]
. The disk diffusion method was employed according to the Clinical and Laboratory Standard Institute (CLSI) guidelines (32
nd edition 2022). Fresh colonies of each isolate were cultured on Nutrient Agar (NA). They were standardized in phosphate-buffered saline (PBS) to make a suspension equivalent to 0.5 McFarland, approximately 1.0 × 10
8 CFU/mL. Suspensions were uniformly spread on Mueller-Hinton agar (MHA) using a sterile swab. Antibiotic discs (Oxoid) containing ceftriaxone, amoxicillin/clavulanic acid, amoxicillin, meropenem, gentamycin, nitrofurantoin, ciprofloxacin, piperacin/tazobactam, or ceftriaxone/sulbactam were used. Nine discs were used for each isolate, and no more than five discs were placed on a single MHA plate at a distance of 24 mm
. The plates were incubated aerobic at 35°C
and 2°C for 16–18 h. A calibrated Vernier caliper was used to measure the zone of inhibition, and the results were interpreted as resistance (R), intermediate (I), or susceptible (S) according to the CLSI guideline 2022.
Staphylococcus aureus ATCC 25923 and
Escherichia coli ATCC 25922 were the controls.
2.7. Data Analysis
Data were captured in Microsoft Excel and analyzed using the Statistical Package for Social Sciences (SPSS) for Windows version 23. Categorical variables were summarized as proportions, and comparisons between groups were estimated using Pearson's chi-square test. Fisher's exact test was used when the total score was less than 20 (n ≤ 20) or when the total score was less than five (5). Intermediate-sensitive isolates were considered fully sensitive during analysis. Odds ratios with their respective 95% confidence intervals (CI) were calculated to measure the strength of associations. A two-sided p-value of less than 0.05 was considered statistically significant.
3. Results
3.1. Sample Size and Response Rate
Determination of The sample size per hospital was determined by Mugenda and Mugenda (2003), who considered that a response rate of 50% is appropriate for analysis and reporting, a rate of 60% is reasonable, and a rate of 70% or more is excellent. A total of 151 clinical isolates were collected to register a response rate of 87.8% (
Table 3). Response rates were considered excellent and accurate for statistical analysis.
Table 3. Hospital facilities response rate.
Hospital facility | Target | Actual | Response Rate (%) |
BMH | 43 | 35 | 81.4 |
MRH | 43 | 53 | 123.3 |
MHK | 43 | 45 | 104.7 |
TRH | 43 | 18 | 41.9 |
Total | 172 | 151 | 87.8 |
3.2. Sample Collection
A total of 151 clinical isolates were collected from four health facilities. The isolates comprised 96 (63.6%)
E. coli and 55 (36.4%)
S. aureus. Morogoro Regional Referral Hospital showed the highest number of isolates (n = 53), while Temeke (n = 18) had the lowest number of isolates (
Figure 1) and (
Table 4).
Figure 1. Bacterial isolates from four health facilities (n= 151).
Table 4. Distribution of collected bacterial isolates in relation to health facilities.
Health Facility | Isolates for E. coli n (%) | Isolates for S. aureus n (%) | Total isolates collected n (%) |
BMH | 29 (30.2) | 6 (10.9) | 35 (100) |
MHK | 30 (31.2) | 15 (27.3) | 45 (100) |
MRH | 26 (27.1) | 27 (49.1) | 53 (100) |
TRH | 11 (11.5) | 7 (12.7) | 18 (100) |
Total | 96 (63.6) | 55 (36.4) | 151 (100) |
Key: BMH = Benjamin Mkapa Referral Hospital, MHK = Maweni Regional Referral Hospital, MRH = Morogoro Regional Referral Hospital, TRH = Temeke Regional Referral Hospital.
3.3. Isolation and Purification
The collected clinical isolates were identified and purified using biochemical tests; only pure isolates were used in subsequent studies.
3.4. Control Data for Standard Microorganism (Positive Control)
The results of quality control for susceptibility testing of reference microorganisms against selected antibiotics was performed using standard microorganism Escherichia coli ATCC 95222 and Staphyloccocus aureus ATCC 25923 against all antibiotics in this study indicated susceptibility of the control organism.
3.5. Prevalence of Antimicrobial Resistance
3.5.1. Prevalence of Antimicrobial Resistance Among E. coli Isolates
Findings revealed that
E. coli showed varying resistance levels to all antibiotics.
E. coli showed the highest resistance to amoxicillin (AML), peaking at 93%, whereas the lowest resistance, 1% was observed in meropenem (MEM), (
Figure 2) where antimicrobial resistance patterns of
E. coli isolates against the nine (9) antibiotics is illustrated.
Figure 2. Overall resistance pattern of E. coli against nine antimicrobial agents (n=96).
3.5.2. Antimicrobial Resistance Pattern of E. coli
This study found a significant difference (Χ
2=12.808: p-value=0.002) in resistance across the selected antibiotics observed in which
E. coli showed the highest resistance to amoxicillin (AML) and least resistance to meropenem where p-value<0.005 (
Table 5).
Table 5. Antimicrobial resistance pattern of E. coil isolates across nine antibiotics.
Antibiotic | Sensitive n (%) | Intermediate n (%) | Resistant n (%) | Χ2 | p-value |
Amoxicillin clavulanic acid | 49 (51.0) | 20 (10.8) | 27 (28.2) | | |
Amoxicillin | 6 (6.3) | 1 (1.0) | 89 (92.7) | | |
Piperacillin tazobactam | 45 (46.9) | 29 (30.2) | 22 (22.9) | | |
Gentamycin | 81 (84.4) | 0.(0) | 15 (15.6) | | |
Ciprofloxacin | 49 (51.0) | 20 (20.8) | 27 (28.2) | 12.808 | 0.002 |
Ceftriaxone sulbactam | 88 (91.7) | 6 (6.3) | 2 (2.1) | | |
Ceftriaxone | 36 (37.5) | 3 (3.1) | 57 (59.4) | | |
Nitrofurantoin | 93 (96.9) | 2 (2.1) | 1 (1.0) | | |
Meropenem | 95 (99.0) | 0 (0) | (1.0) | | |
3.5.3. Antimicrobial Resistance Among S. aureus Isolates
Resistance to
S. aureus was observed for all five (5) selected antibiotics.
S. aureus demonstrated the highest resistance against amoxicillin (AML), peaking at more than 91%, followed by ciprofloxacin (CIP) at 47.3%. Nitrofurantoin (NIT) demonstrated the highest efficacy, with least resistance (4%) (
Figure 3).
Figure 3. Overall susceptibility pattern of S. aureus against five antibiotics.
3.5.4. Antimicrobial Resistance Pattern of S. aureus
The analysis of the chi-square test indicated a significant difference (x
2=53.627, p <0.001) in resistance across the selected antibiotics, in which
S. aureus showed the highest resistance to amoxicillin (AML) and the least resistance to nitrofurantoin (NIT), where p <0.005 (
Table 6).
Table 6. Antimicrobial resistance pattern of S. aureus isolates across five antibiotics.
Antimicrobial agent | Sensitive n (%) | Intermediate n (%) | Resistant n (%) | x2 | p-value |
Amoxicillin | 5(9.1) | 0 | 50(90.9) | 53.627 | <0.001 |
Gentamycin | 27(49.1) | 5(9.1) | 23(41.8) |
Ciprofloxacin | 28(49.1) | 2(3.6) | 25(47.3) |
Ceftriaxone | 50(90.9) | 3(5.5) | 2(3.6) |
Nitrofurantoin | 53(96.4) | 2(3.6) | 0 |
3.6. Multi-drug Resistance Among Isolates
Findings from this study showed that both
E. coli and
S. aureus isolates demonstrated multi-drug resistance (MDR) against selected antibiotics in all health facilities under study, in which isolates from Morogoro Regional Referral Hospital showed the highest (65.4%) MDR for
E. coli and Benjamin Mkapa Hospital showed the highest (83.3%) for
S. aureus. Similarly, Maweni Regional Referral Hospital demonstrated the lowest multi-drug resistance for
E. coli (23%)
and
S. aureus (13%) (
Figure 4).
A chi-square (χ
2) test for independence was performed to determine whether there was any difference in MDR across the four health facilities. These findings demonstrate that the differences in MDR status across health facilities were statistically significant for
E. coli (χ
2 = 10.301; p = 0.016) and
S. aureus (χ
2 = 11.673; p = 0.006). Regarding MDR among
E. coli, isolates Morogoro Regional Referral Hospital showed the highest (65.4%) and, Maweni Regional Referral Hospital demonstrated the lowest multi-drug resistance (23%) and Benjamin Mkapa Hospital showed the highest MDR in
S. aureus (83.3%)
. Maweni Regional Referral Hospital demonstrated the lowest multi-drug resistance for
E. coli (23%)
and
S. aureus (13%) (
Table 7).
Figure 4. Prevalence of multi-drug resistance across selected health facilities.
Table 7. Multidrug-resistant patterns of isolated E. coli and S. aureus across health facilities.
Health facility | E. coli | P - value | S. aureus (%) | P- value |
MDR Status n (%) | X2 | MDR Status n (%) | X2 |
Yes | No | | Yes | No | |
Benjamin Mkapa Hospital | 13 (44.8) | 16 (55.2) | 10.301 | 0.016 | 5 (83.3) | 1 (16.7) | 11.673
| 0.006 |
Maweni | 7 (23.3) | 23 (76.7) | 2 (13.3) | 13 (86.7) |
Morogoro Regional Referral Hospital | 17 (65.4) | 9 (34.6) | 16 (59.3) | 11 (40.7) |
Temeke Regional Referral Hospital | 4 (36.4) | 7 (63.6) | 3 (42.9) | 4 (57.1) |
Total | 41 (42.7) | 55 (57.3) | | | 26 (47.3) | (52.7) | | |
4. Discussion
This study assessed AMR among
E. coli and
S. aureus isolates from the urine of patients in selected health facilities against nine recommended antibiotics for treating UTI, according to the Standard Treatment Guidelines in Tanzania. Of the isolates (n=151) obtained, 96 (63.6%) and 55 (36.4%) were
E. coli and
S. aureus. respectively. This agrees with observations from other studies conducted in this locality and Sub-Saharan Africa, where
E. coli was the predominant causative agent of UTIs
.
S. aureus is not a commonly known causative agent of UTI. However, these bacteria cause ascending UTIs in patients with indwelling catheters or urinary tract instrumentation or patients who have recently undergone diagnostic cystoscopy and may experience transient bacteremia
[29] | Mlynarczyk-Bonikowska B, Kowalewski C, Krolak-Ulinska A, Marusza W. Molecular Mechanisms of Drug Resistance in Staphylococcus aureus. Int J Mol Sci. 2022; 23: 8088. https://doi.org/10.3390/ijms23158088 |
[29]
.
Of the six (6) antibiotic classes tested, the carbapenem showed the highest efficacy against
E. coli (meropenem 99%), followed by nitrofuran (nitrofurantoin 96.9%) and cephalosporin (ceftriaxone sulbactam 91.7%) where p-value<0.005. These findings are consistent with those reported previously
[19] | Dasgupta C, Rafi MA, Salam MA. High prevalence of multidrug resistant uropathogens: A recent audit of antimicrobial susceptibility testing from a tertiary care hospital in Bangladesh. Pakistan J Med Sci. 2020; 36: 1–6. https://doi.org/10.12669/pjms.36.6.2943 |
[19]
.
In the cephalosporin class, ceftriaxone was shown to be less effective (37.5%) against E. coli compared to ceftriaxone sulbactam (91.7%), this difference in efficacy can be attributed to the action of sulbactam which prevents the β-lactamase activity of E. coli.
E. coli isolates showed the highest resistance to antibiotics belonging to the penicillin class (amoxicillin, 92.7%) and marked resistance to amoxicillin-clavulanic acid (28.2%). These findings are consistent with those of other studies
[30] | Fredrick F, Francis JM, Fataki M MS. Aetiology, antimicrobial susceptibility and predators of urinary tract infection among febrile under-fives. Afr J Microbiol Res. 2013; 7: 1029–1034. https://doi.org/10.5897/ajmr12.1866 |
[30]
. The difference in resistance between amoxicillin 92.7%) and amoxicillin-clavulanic acid 28.2%, the same phenomenon has been reported by others
[31] | Rozwadowski M, Gawel D. Molecular Factors and Mechanisms Driving Multidrug Resistance in Uropathogenic Escherichia coli—An Update. Genes (Basel). 2022; 13: 1397. https://doi.org/10.3390/genes13081397 |
[31]
, who attributed the increased efficacy of AMC against
E. coli to the inhibitory effect of clavulanic acid on β-lactamase in
E. coli.
All isolates were highly susceptible to nitrofurantoin (96.4%) followed by ceftriaxone (90.9%). The high efficacy of nitrofurantoin is attributed to its multiple drug target sites that evade antimicrobial resistance.
S. aureus showed high resistance to amoxicillin (90.9%). Followed by ciprofloxacin 47.2% and gentamycin 41.8%). Resistance to quinolone ciprofloxacin may be attributed to chromosome-mediated resistance from overprescribing quinolone antibiotics for treating bacterial infections
[32] | Shariati A, Arshadi M, Khosrojerdi MA, Abedinzadeh M, Ganjalishahi M, Maleki A, et al. The resistance mechanisms of bacteria against ciprofloxacin and new approaches for enhancing the efficacy of this antibiotic. Front Public Heal. 2022; 10. https://doi.org/10.3389/fpubh.2022.1025633 |
[32]
.
Overall, multi-drug resistance, i.e., resistance by one species to antibiotics from at least three classes of antibiotics, was observed,
E. coli (42.7%) and
S. aureus (47.3%), respectively. A similar pattern was reported previously
[9] | Ngowi BN, Sunguya B, Herman A, Chacha A, Maro E, Rugarabamu LF, et al. Prevalence of Multidrug Resistant UTI Among People Living with HIV in Northern Tanzania. Infect Drug Resist. 2021; Volume 14: 1623–1633. https://doi.org/10.2147/IDR.S299776 |
[9]
. Resistance in
S. aureus has been documented to be mediated by the synthesis of Beta-Lactamases, Penicillin Binding Proteins (PBP2A), and Mutation-Dependent Modification of PBP Proteins
[33] | Majumder MMI, Mahadi AR, Ahmed T, Ahmed M, Uddin MN, Alam MZ. Antibiotic resistance pattern of microorganisms causing urinary tract infection: a 10-year comparative analysis in a tertiary care hospital of Bangladesh. Antimicrob Resist Infect Control. 2022;11: 156. https://doi.org/10.1186/s13756-022-01197-6 |
[33]
.
Resistance in
E. coli is caused by bacterial influx pumps, beta-lactamase production, drug target modification, and antibiotic molecule modification
[31] | Rozwadowski M, Gawel D. Molecular Factors and Mechanisms Driving Multidrug Resistance in Uropathogenic Escherichia coli—An Update. Genes (Basel). 2022; 13: 1397. https://doi.org/10.3390/genes13081397 |
[31]
. The development of multi-drug antimicrobial resistance in both bacterial species may be driven by factors such as misuse of antibiotics in human health care due to improper prescription practices, as reported by
[34] | Mabilika RJ, Shirima G, Mpolya E. Prevalence and Predictors of Antibiotic Prescriptions at Primary Healthcare Facilities in the Dodoma Region, Central Tanzania: A Retrospective, Cross-Sectional Study. Antibiotics. 2022; 11: 1035. https://doi.org/10.3390/antibiotics11081035 |
[34]
self-medication mediated by a shorter perceived distance to drug outlets and higher medical consultation fees, as documented by
[34] | Mabilika RJ, Shirima G, Mpolya E. Prevalence and Predictors of Antibiotic Prescriptions at Primary Healthcare Facilities in the Dodoma Region, Central Tanzania: A Retrospective, Cross-Sectional Study. Antibiotics. 2022; 11: 1035. https://doi.org/10.3390/antibiotics11081035 |
[34]
.
This study revealed
E. coli as an MDR etiological agent for UTI, with a prevalence rate of n=41 (42.7%). Similar findings were reported
[35] | Subramanya SH, Bairy I, Metok Y, Baral BP, Gautam D, Nayak N. Detection and characterization of ESBL-producing Enterobacteriaceae from the gut of subsistence farmers, their livestock, and the surrounding environment in rural Nepal. Sci Rep. 2021; 11: 2091. https://doi.org/10.1038/s41598-021-81315-3 |
[35]
with a slight variation in the percentage prevalence. Antibiotic resistance in
E. coli is caused by the bacterial influx pump,
Beta-lactamase production, drug target modification, and antibiotic molecule modification
[31] | Rozwadowski M, Gawel D. Molecular Factors and Mechanisms Driving Multidrug Resistance in Uropathogenic Escherichia coli—An Update. Genes (Basel). 2022; 13: 1397. https://doi.org/10.3390/genes13081397 |
[31]
.
This study revealed
S. aureus as an MDR etiological agent for UTI, with a prevalence rate of n=26 (47.3%). This observation correlates with other findings from studies on the status of multi-drug resistance in
S. aureus conducted in different parts of the world, with slight differences in prevalence
[19] | Dasgupta C, Rafi MA, Salam MA. High prevalence of multidrug resistant uropathogens: A recent audit of antimicrobial susceptibility testing from a tertiary care hospital in Bangladesh. Pakistan J Med Sci. 2020; 36: 1–6. https://doi.org/10.12669/pjms.36.6.2943 |
[24] | Ali M. Prevalence of Staphylococcus Species from Clinical Samples Obtained from Some Hospitals on Kano Metropolis, Nigeria. Am J Biomed Sci Res. 2019; 5: 207–211. https://doi.org/10.34297/AJBSR.2019.05.000913 |
[25] | Brink B. Urease Test Protocol - Library. 2010; 1–7. |
[36] | Fredrick F, Francis JM, Fataki M, Maselle SY. Aetiology, antimicrobial susceptibility and predictors of urinary tract infection among febrile under-fives at Muhimbili National Hospital, Dar es Salaam-Tanzania. African J Microbiol Res. 2013; 7: 1029–1034. https://doi.org/10.5897/AJMR12.1866 |
[19, 24, 25, 36]
.
Escherichia coli isolates showed MDR to commonly used antibiotics among the selected, with Morogoro Regional referral hospital being the highest with 65.4%). In comparison, the least was Maweni Regional Referral Hospital, with 7% of all health facilities.
This study revealed that S aureus isolates showed MDR as a commonly used antibiotic. Benjamin Mkapa Hospital had the highest rate at 83.3% and the lowest at Maweni Regional Referral Hospital at 7% in all health facility studies. This result indicates that the multi-drug resistance is vivid. This finding is consistent with those of other studies that showed a similar behavior of S. aureus against different classes of antibiotics.
5. Conclusion
This study found the existence of resistant and MDR isolates of E. coli and S. aureus to some antibiotics recommended in the Tanzania Standard Treatment Guidelines. Our findings call for continuous surveillance of AMR and implementation of antimicrobial stewardship at all hospital levels to identify and optimize antibiotic use against less-efficacious antibiotics still used in clinical practice. It also recommends a broader study on antibiotics currently in use to identify microorganisms that are highly resistant to and recommend their exclusion from treatment.
Funding Statement
This work did not receive any funds from funding agents and that all authors have none to declare.
Ethical Compliance
All procedures performed in studies did not involve human or animals and thus for this kind of research work ethical clearance was not reuired.
Data Summary
Research data for this publication is available for any kind of use, all data used to draw conclusion are provided in the manuscript as required.
Author Contributions
Adelard Bartholomew Mtenga: Conceptualization, Formal Analysis, Investigation, Methodology, Supervision, Writing – original draft, Writing – review & editing
Adam Fimbo: Supervision, Writing – review & editing
Danstan Hipolite: Project administration, Writing – review & editing
Revocatus Makonope: Data curation, Investigation, Methodology
Saxon Mwambene: Data curation, Investigation, Methodology, Software
Yonah Hebron: Validation, Writing – review & editing
Kissa Mwamwitwa: Supervision, Validation, Writing – review & editing
Raphael Zozimus Sangeda: Supervision, Validation, Writing – review & editing
Transparency Declaration
As the lead author on behalf of all authors, I confirm that the manuscript was developed based on the research data obtained from a genuine research work conducted and all information provided in this manuscript is honest, sincere and transparent account of the research to the best of our knowledge. Authors take fully responsibility of the information presented in this publication. All authors have none to declare.
Abbreviations
CFU | Colony Forming Unit |
AMR | Antimicrobial Resistance |
LMICs | Low- and Middle-income Countries |
UTI | Urinary Tract Infections |
MDR | Multi-drug Resistance |
AML | Amoxicillin |
NIT | Nitrofurantoin |
CIP | Ciprofloxacin |
CN | Gentamicin |
CSE | Ceftriaxone + Sulbactam |
CRO | Ceftriaxone |
MEM | Meropenem |
TMDA | Tanzania Medicines and Medical Devices Authority |
WHO | World Health Organization |
NAP–AMR | National Action Plan on Antimicrobial Resistance |
WASH | Water and Hygiene Sanitation |
BMH | Benjamin Mkapa Hospital |
MHK | Maweni Regional Referral Hospital |
MRH | Morogoro Regional Referrel Hospital |
TRH | Temeke Regional Referral Hospital |
SDG | Sustainable Development Goals |
STG | Standard Treatment Guidelines |
CLED | Cystine Lactose Electrolyte-deficient |
MCA | MacConkey Agar |
TSB | Tryptic Soy Broth |
SIM | Sulfur Indole Motility |
NA | Nutrient Agar |
PBS | Phosphate-buffered Saline |
CLSI | Clinical and Laboratory Standard Institute |
ATCC | American Type Culture Collection |
Conflicts of Interest
The authors declare no conflicts of interest.
References
[1] |
Denyer, S P., Hodges NA, Gorman SP, Gilmore BF. Pharmaceutical Microbiology. 8th ed. New Delhi: Wiley Blackwell Publishing House; 2011.
|
[2] |
Ullah H, Ali S. Classification of Anti‐Bacterial Agents and Their Functions. Antibacterial Agents. InTech; 2017.
https://doi.org/10.5772/intechopen.68695
|
[3] |
Camara N, Moremi N, Mghamba J, Eliakimu E, Shumba E, Ondoa P, et al. Surveillance of antimicrobial resistance in human health in Tanzania: 2016–2021. Afr J Lab Med. 2023;12: 1–8.
https://doi.org/10.4102/ajlm.v12i1.2053
|
[4] |
Michael CA, Dominey-Howes D, Labbate M. The Antimicrobial Resistance Crisis: Causes, Consequences, and Management. Front Public Heal. 2014; 2.
https://doi.org/10.3389/fpubh.2014.00145
|
[5] |
Knobler L, Lemon SM, Najafi M. The Resistance Phenomenon in Microbes and Infectious Disease Vectors. Washington, D.C.: National Academies Press; 2003.
https://doi.org/10.17226/10651
|
[6] |
Sangeda RZ, William SM, Masatu FC, Bitegeko A, Mwalwisi YH, Nkiligi EA, et al. Antibiotic Utilisation Patterns in Tanzania: A Retrospective Longitudinal Study Comparing Pre- and Post-COVID-19 Pandemic Using Tanzania Medicines and Medical Devices Authority Data. medRxiv. 2023.
https://doi.org/10.1101/2023.11.27.23299060
|
[7] |
Tanzania Medicines and Medical Devices Authority (TMDA). Drug Safety Bulletin 2020 1. 2020 [cited 24 Jan 2024] pp. 1–16. Available at;
https://www.tmda.go.tz/uploads/publications/en1666874973-en1661782920-DRUG%20SAFETY%20A5%20.pdf
|
[8] |
Dadgostar P. Antimicrobial Resistance: Implications and Costs. Infect Drug Resist. 2019; Volume 12: 3903–3910.
https://doi.org/10.2147/IDR.S234610
|
[9] |
Ngowi BN, Sunguya B, Herman A, Chacha A, Maro E, Rugarabamu LF, et al. Prevalence of Multidrug Resistant UTI Among People Living with HIV in Northern Tanzania. Infect Drug Resist. 2021; Volume 14: 1623–1633.
https://doi.org/10.2147/IDR.S299776
|
[10] |
Silago V, Moremi N, Mtebe M, Komba E, Masoud S, Mgaya FX, et al. Multidrug-Resistant Uropathogens Causing Community Acquired Urinary Tract Infections among Patients Attending Health Facilities in Mwanza and Dar es Salaam, Tanzania. Antibiotics. 2022; 11: 1718.
https://doi.org/10.3390/antibiotics11121718
|
[11] |
Antimicrobial Stewardship—a practical guide to implementation in hospitals. JAC-Antimicrobial Resist. 2019; 1.
https://doi.org/10.1093/jacamr/dlz005
|
[12] |
Sangeda RZ, Kibona J, Munishi C, Arabi F, Manyanga VP, Mwambete KD, et al. Assessment of Implementation of Antimicrobial Resistance Surveillance and Antimicrobial Stewardship Programs in Tanzanian Health Facilities a Year After Launch of the National Action Plan. Front Public Heal. 2020;8: 454.
https://doi.org/10.3389/fpubh.2020.00454
|
[13] |
United Republic of Tanzania. The National Action Plan on Antimicrobial Resistance 2017 - 2022. 2017 [cited 6 Nov 2019]. Available:
https://www.afro.who.int/publications/national-action-plan-antimicrobial-resistance-2017-2022
|
[14] |
United Republic of Tanzania (URT). The national action plan on antimicrobial resistance 2023-2028. 2023. Available:
https://www.mifugouvuvi.go.tz/publications/37
|
[15] |
Sangeda RZ, Paul F, Mtweve DM. Prevalence of urinary tract infections and antibiogram of uropathogens isolated from children under five attending Bagamoyo District Hospital in Tanzania: A cross-sectional study. F1000Research. 2021; 10: 449.
https://doi.org/10.12688/f1000research.52652.1
|
[16] |
Mlugu EM, Mohamedi JA, Sangeda RZ, Mwambete KD. Prevalence of urinary tract infection and antimicrobial resistance patterns of uropathogens with biofilm forming capacity among outpatients in morogoro, Tanzania: a cross-sectional study. BMC Infect Dis. 2023; 23: 660.
https://doi.org/10.1186/s12879-023-08641-x
|
[17] |
Schmider J, Bühler N, Mkwatta H, Lechleiter A, Mlaganile T, Utzinger J, et al. Microbiological Characterisation of Community-Acquired Urinary Tract Infections in Bagamoyo, Tanzania: A Prospective Study. Trop Med Infect Dis. 2022; 7: 100.
https://doi.org/10.3390/tropicalmed7060100
|
[18] |
Davis CP. Normal Flora. In: Baron S editor. MM 4th edition. G (TX): U of TMB at G 1996. C 6. A from:
https://www.ncbi.nlm.nih.gov/books/NBK7617 Medical Microbiology. 4th edition.
|
[19] |
Dasgupta C, Rafi MA, Salam MA. High prevalence of multidrug resistant uropathogens: A recent audit of antimicrobial susceptibility testing from a tertiary care hospital in Bangladesh. Pakistan J Med Sci. 2020; 36: 1–6.
https://doi.org/10.12669/pjms.36.6.2943
|
[20] |
Tanzania Medicines and Medical Devices Authority (TMDA). Good egulatory practices for medical products. 2023 [cited 24 Jan 2024]. Available:
https://www.tmda.go.tz/uploads/publications/en1678801576-GOOD%20REGULATORY%20PRACTICE%20GUIDELINE_FINAL.pdf
|
[21] |
Karah N, Rafei R, Elamin W, Ghazy A, Abbara A, Hamze M, et al. Guideline for Urine Culture and Biochemical Identification of Bacterial Urinary Pathogens in Low-Resource Settings. Diagnostics. 2020; 10: 832.
https://doi.org/10.3390/diagnostics10100832
|
[22] |
Shah HN, Gharbia SE, Collins MD. The Gram stain. Rev Med Microbiol. 1997; 8: 103.
https://doi.org/10.1097/00013542-199704000-00006
|
[23] |
Shields P, Tsang AY. Mannitol Salt Agar Plates Protocols. In: American Society for Microbiology [Internet]. 2006 [cited 24 Jan 2024] pp. 3–5. Available:
https://asm.org/ASM/media/Protocol-Images/Mannitol-Salt-Agar-Plates-Protocols.pdf?ext=.pdf
|
[24] |
Ali M. Prevalence of Staphylococcus Species from Clinical Samples Obtained from Some Hospitals on Kano Metropolis, Nigeria. Am J Biomed Sci Res. 2019; 5: 207–211.
https://doi.org/10.34297/AJBSR.2019.05.000913
|
[25] |
Brink B. Urease Test Protocol - Library. 2010; 1–7.
|
[26] |
Odoch T, Wasteson Y, L’Abée-Lund T, Muwonge A, Kankya C, Nyakarahuka L, et al. Prevalence, antimicrobial susceptibility and risk factors associated with non-typhoidal Salmonella on Ugandan layer hen farms. BMC Vet Res. 2017; 13: 365.
https://doi.org/10.1186/s12917-017-1291-1
|
[27] |
Hudzicki J. Kirby-Bauer Disk Diffusion Susceptibility Test Protocol Author Information. In: American Society For Microbiology [Internet]. 2012 [cited 24 Jan 2024] pp. 1–13. Available:
https://asm.org/getattachment/2594ce26-bd44-47f6-8287-0657aa9185ad/Kirby-Bauer-Disk-Diffusion-Susceptibility-Test-Protocol-pdf.pdf
|
[28] |
Mwang’onde BJ, Mchami JI. The aetiology and prevalence of urinary tract infections in Sub-Saharan Africa: a Systematic Review. J Heal Biol Sci. 2022; 10: 1.
https://doi.org/10.12662/2317-3076jhbs.v10i1.4501.p1-7.2022
|
[29] |
Mlynarczyk-Bonikowska B, Kowalewski C, Krolak-Ulinska A, Marusza W. Molecular Mechanisms of Drug Resistance in Staphylococcus aureus. Int J Mol Sci. 2022; 23: 8088.
https://doi.org/10.3390/ijms23158088
|
[30] |
Fredrick F, Francis JM, Fataki M MS. Aetiology, antimicrobial susceptibility and predators of urinary tract infection among febrile under-fives. Afr J Microbiol Res. 2013; 7: 1029–1034.
https://doi.org/10.5897/ajmr12.1866
|
[31] |
Rozwadowski M, Gawel D. Molecular Factors and Mechanisms Driving Multidrug Resistance in Uropathogenic Escherichia coli—An Update. Genes (Basel). 2022; 13: 1397.
https://doi.org/10.3390/genes13081397
|
[32] |
Shariati A, Arshadi M, Khosrojerdi MA, Abedinzadeh M, Ganjalishahi M, Maleki A, et al. The resistance mechanisms of bacteria against ciprofloxacin and new approaches for enhancing the efficacy of this antibiotic. Front Public Heal. 2022; 10.
https://doi.org/10.3389/fpubh.2022.1025633
|
[33] |
Majumder MMI, Mahadi AR, Ahmed T, Ahmed M, Uddin MN, Alam MZ. Antibiotic resistance pattern of microorganisms causing urinary tract infection: a 10-year comparative analysis in a tertiary care hospital of Bangladesh. Antimicrob Resist Infect Control. 2022;11: 156.
https://doi.org/10.1186/s13756-022-01197-6
|
[34] |
Mabilika RJ, Shirima G, Mpolya E. Prevalence and Predictors of Antibiotic Prescriptions at Primary Healthcare Facilities in the Dodoma Region, Central Tanzania: A Retrospective, Cross-Sectional Study. Antibiotics. 2022; 11: 1035.
https://doi.org/10.3390/antibiotics11081035
|
[35] |
Subramanya SH, Bairy I, Metok Y, Baral BP, Gautam D, Nayak N. Detection and characterization of ESBL-producing Enterobacteriaceae from the gut of subsistence farmers, their livestock, and the surrounding environment in rural Nepal. Sci Rep. 2021; 11: 2091.
https://doi.org/10.1038/s41598-021-81315-3
|
[36] |
Fredrick F, Francis JM, Fataki M, Maselle SY. Aetiology, antimicrobial susceptibility and predictors of urinary tract infection among febrile under-fives at Muhimbili National Hospital, Dar es Salaam-Tanzania. African J Microbiol Res. 2013; 7: 1029–1034.
https://doi.org/10.5897/AJMR12.1866
|
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APA Style
Mtenga, A. B., Fimbo, A., Hipolite, D., Makonope, R., Mwambene, S., et al. (2024). Assessment of Antibiotics Resistance from Isolates Responsible for UTI in Four Regional Referral Hospitals in Tanzania. American Journal of Life Sciences, 12(6), 170-180. https://doi.org/10.11648/j.ajls.20241206.18
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Mtenga, A. B.; Fimbo, A.; Hipolite, D.; Makonope, R.; Mwambene, S., et al. Assessment of Antibiotics Resistance from Isolates Responsible for UTI in Four Regional Referral Hospitals in Tanzania. Am. J. Life Sci. 2024, 12(6), 170-180. doi: 10.11648/j.ajls.20241206.18
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Mtenga AB, Fimbo A, Hipolite D, Makonope R, Mwambene S, et al. Assessment of Antibiotics Resistance from Isolates Responsible for UTI in Four Regional Referral Hospitals in Tanzania. Am J Life Sci. 2024;12(6):170-180. doi: 10.11648/j.ajls.20241206.18
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@article{10.11648/j.ajls.20241206.18,
author = {Adelard Bartholomew Mtenga and Adam Fimbo and Danstan Hipolite and Revocatus Makonope and Saxon Mwambene and Yonah Hebron and Kissa Mwamwitwa and Raphael Zozimus Sangeda},
title = {Assessment of Antibiotics Resistance from Isolates Responsible for UTI in Four Regional Referral Hospitals in Tanzania
},
journal = {American Journal of Life Sciences},
volume = {12},
number = {6},
pages = {170-180},
doi = {10.11648/j.ajls.20241206.18},
url = {https://doi.org/10.11648/j.ajls.20241206.18},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajls.20241206.18},
abstract = {The global impact of antimicrobial resistance (AMR) includes increased morbidity and mortality rates and healthcare costs, particularly in low- and middle-income countries (LMICs), and it has dire economic and security implications. This study assessed the resistance of clinical isolates responsible for urinary tract infections (UTI) to antibacterial agents for treating UTIs in selected healthcare facilities in Tanzania. A total of 151 clinical isolates of E. coli and S. aureus isolated from urine samples in selected health facilities were analyzed for antimicrobial susceptibility to establish the presence of individual and multi-drug resistance (MDR). The results revealed that E. Coli displayed a significant difference in resistance (χ2 =12.808, p =0.002) across the selected antibiotics, in which E. coli showed the highest resistance to amoxicillin (AML) and the least resistance to meropenem (p S. aureus isolates showed a significant difference. (χ2=53.627, p-valueS. aureus showed the highest resistance to AML, peaking at more than 91%, and least resistant (4%) to nitrofurantoin (NIT) (4%). When p-valueE. coli and S. aureus demonstrated MDR against selected antibiotics in all health facilities under study, in which Morogoro Regional Referral Hospital showed the highest (65.4%) for E. coli and Benjamin Mkapa Hospital showed the highest (83.3%) for S. aureus. Similarly, Maweni Regional Referral Hospital demonstrated the lowest MDR for E. coli (23%) and S. aureus (13%). Finding suggest that some antibiotics are still in used in clinical practice despite of the evidence of emerging resistance against them hence it call for effective regular AMR surveillance and antimicrobial stewardship implementation to optimize antibiotics use in clinical practice and exclude less efficacious ones.
},
year = {2024}
}
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TY - JOUR
T1 - Assessment of Antibiotics Resistance from Isolates Responsible for UTI in Four Regional Referral Hospitals in Tanzania
AU - Adelard Bartholomew Mtenga
AU - Adam Fimbo
AU - Danstan Hipolite
AU - Revocatus Makonope
AU - Saxon Mwambene
AU - Yonah Hebron
AU - Kissa Mwamwitwa
AU - Raphael Zozimus Sangeda
Y1 - 2024/12/31
PY - 2024
N1 - https://doi.org/10.11648/j.ajls.20241206.18
DO - 10.11648/j.ajls.20241206.18
T2 - American Journal of Life Sciences
JF - American Journal of Life Sciences
JO - American Journal of Life Sciences
SP - 170
EP - 180
PB - Science Publishing Group
SN - 2328-5737
UR - https://doi.org/10.11648/j.ajls.20241206.18
AB - The global impact of antimicrobial resistance (AMR) includes increased morbidity and mortality rates and healthcare costs, particularly in low- and middle-income countries (LMICs), and it has dire economic and security implications. This study assessed the resistance of clinical isolates responsible for urinary tract infections (UTI) to antibacterial agents for treating UTIs in selected healthcare facilities in Tanzania. A total of 151 clinical isolates of E. coli and S. aureus isolated from urine samples in selected health facilities were analyzed for antimicrobial susceptibility to establish the presence of individual and multi-drug resistance (MDR). The results revealed that E. Coli displayed a significant difference in resistance (χ2 =12.808, p =0.002) across the selected antibiotics, in which E. coli showed the highest resistance to amoxicillin (AML) and the least resistance to meropenem (p S. aureus isolates showed a significant difference. (χ2=53.627, p-valueS. aureus showed the highest resistance to AML, peaking at more than 91%, and least resistant (4%) to nitrofurantoin (NIT) (4%). When p-valueE. coli and S. aureus demonstrated MDR against selected antibiotics in all health facilities under study, in which Morogoro Regional Referral Hospital showed the highest (65.4%) for E. coli and Benjamin Mkapa Hospital showed the highest (83.3%) for S. aureus. Similarly, Maweni Regional Referral Hospital demonstrated the lowest MDR for E. coli (23%) and S. aureus (13%). Finding suggest that some antibiotics are still in used in clinical practice despite of the evidence of emerging resistance against them hence it call for effective regular AMR surveillance and antimicrobial stewardship implementation to optimize antibiotics use in clinical practice and exclude less efficacious ones.
VL - 12
IS - 6
ER -
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