High rate of multi-drug resistant Escherichia coli isolated from patients with urinary tract infections in Ifakara-Tanzania: implications for empirical antibiotic treatment guidelines and stewardship programs.
Magreth Erick Macha, Philipp Kohler, Anja Bösch, Honorathy Msami Urassa, Weihong Qi, Salome N Seiffert, Sabine Haller, Erin West, Maja Weisser Rohacek, Baharak Babouee Flury
{"title":"High rate of multi-drug resistant Escherichia coli isolated from patients with urinary tract infections in Ifakara-Tanzania: implications for empirical antibiotic treatment guidelines and stewardship programs.","authors":"Magreth Erick Macha, Philipp Kohler, Anja Bösch, Honorathy Msami Urassa, Weihong Qi, Salome N Seiffert, Sabine Haller, Erin West, Maja Weisser Rohacek, Baharak Babouee Flury","doi":"10.1186/s13756-025-01557-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) in Sub-Saharan Africa is a significant health threat, with limited data guide treatment. This study investigates multi-drug resistant Escherichia coli in urinary tract infections (UTIs) in rural Tanzania to guide empirical treatment strategies.</p><p><strong>Methods: </strong>A cross-sectional prospective study of adults with UTIs was conducted at St. Francis Regional Referral Hospital in Ifakara, Tanzania, from September 2021 to August 2023. Urine culture isolates underwent routine diagnostics in Tanzania and E. coli isolates underwent whole-genome sequencing in Switzerland.</p><p><strong>Results: </strong>Of 1055 patients, 248 (23.5%) had positive urine cultures, with E. coli as predominant pathogen (n = 87; 55.7%). Extended-spectrum beta-lactamase-producing E. coli (ESBL-E) was identified in 20 (23.0%) isolates, primarily sequence type ST167 carrying CTX-M-27. All ESBL-E cases (20/20, 100.0%) and half of non-ESBL-E cases (29/58, 50.0%) received empiric antibiotics to which the isolates were documented as resistant. ESBL-E showed higher resistance to cotrimoxazole (100.0%) and ciprofloxacin (90.0%) latter recommended for complicated UTIs in Tanzania's Standard Treatment Guidelines (STG) compared to non-ESBL-E. All ESBL-E isolates were susceptible to nitrofurantoin, as recommended by STG for uncomplicated UTIs, and fosfomycin showed potential alternative for complicated cases.</p><p><strong>Conclusion: </strong>Nearly one-quarter of E. coli isolates causing UTIs were ESBL-E, predominantly ST167 harboring bla<sub>CTX-M-27</sub>. Notably, nitrofurantoin remained effective for uncomplicated UTIs, similarly, fosfomycin emerged as a viable alternative. However, ciprofloxacin, despite being recommended in local guidelines for complicated UTIs, showed no efficacy. The genetic similarity between human and environmental isolates underscores the critical need for a One Health approach to tackle antimicrobial resistance (AMR) in the region.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"41"},"PeriodicalIF":4.4000,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12046935/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Antimicrobial Resistance and Infection Control","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13756-025-01557-y","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Antimicrobial resistance (AMR) in Sub-Saharan Africa is a significant health threat, with limited data guide treatment. This study investigates multi-drug resistant Escherichia coli in urinary tract infections (UTIs) in rural Tanzania to guide empirical treatment strategies.
Methods: A cross-sectional prospective study of adults with UTIs was conducted at St. Francis Regional Referral Hospital in Ifakara, Tanzania, from September 2021 to August 2023. Urine culture isolates underwent routine diagnostics in Tanzania and E. coli isolates underwent whole-genome sequencing in Switzerland.
Results: Of 1055 patients, 248 (23.5%) had positive urine cultures, with E. coli as predominant pathogen (n = 87; 55.7%). Extended-spectrum beta-lactamase-producing E. coli (ESBL-E) was identified in 20 (23.0%) isolates, primarily sequence type ST167 carrying CTX-M-27. All ESBL-E cases (20/20, 100.0%) and half of non-ESBL-E cases (29/58, 50.0%) received empiric antibiotics to which the isolates were documented as resistant. ESBL-E showed higher resistance to cotrimoxazole (100.0%) and ciprofloxacin (90.0%) latter recommended for complicated UTIs in Tanzania's Standard Treatment Guidelines (STG) compared to non-ESBL-E. All ESBL-E isolates were susceptible to nitrofurantoin, as recommended by STG for uncomplicated UTIs, and fosfomycin showed potential alternative for complicated cases.
Conclusion: Nearly one-quarter of E. coli isolates causing UTIs were ESBL-E, predominantly ST167 harboring blaCTX-M-27. Notably, nitrofurantoin remained effective for uncomplicated UTIs, similarly, fosfomycin emerged as a viable alternative. However, ciprofloxacin, despite being recommended in local guidelines for complicated UTIs, showed no efficacy. The genetic similarity between human and environmental isolates underscores the critical need for a One Health approach to tackle antimicrobial resistance (AMR) in the region.
期刊介绍：
Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
