Bacterial Uropathogens and Antimicrobial Susceptibility Profiles in Female Patients with Uncomplicated Cystitis

International Journal of Medicine and Medical Sciences | Vol. 12, No. 6, June 2022 | pp. 41–48

DOI: 10.46882/2022/IJMMS/120041

Original Research Article

Bacterial Uropathogens and Antimicrobial Susceptibility Profiles in Female Patients with Uncomplicated Cystitis

Elizabeth A. Cole¹, Moses Z. Tarawallie², Victoria N. Okoye¹*

¹Department of Medical Microbiology, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.

²Department of Obstetrics and Gynaecology, Connaught Hospital, Freetown, Sierra Leone.

Abstract:

Uncomplicated acute cystitis is a frequent cause of antibiotic prescriptions in women, but empirical therapy is increasingly limited by rising antimicrobial resistance. This prospective cross-sectional study identified the predominant bacterial uropathogens and mapped their resistance profiles among non-pregnant female outpatients presenting with signs of uncomplicated cystitis. Mid-stream urine specimens from 350 women aged 18 to 45 years were cultured. Bacterial confirmation was achieved through standard automated methods, and susceptibility profiles were assessed using the disk diffusion technique. Significant bacteriuria (≥ 10⁵ CFU/mL) was confirmed in 44.3% (155/350) of the participants. Escherichia coli was the most common isolate (61.3%), followed by Klebsiella pneumoniae (15.5%) and Staphylococcus saprophyticus (11.6%). Antibiogram mapping revealed high resistance rates among Gram-negative isolates to cotrimoxazole (74.2%) and ampicillin (81.9%). Resistance to ciprofloxacin was also high at 28.4%. Conversely, excellent susceptibility rates were observed for nitrofurantoin (91.6%) and fosfomycin (94.8%). Phenotypic screening for Extended-Spectrum Beta-Lactamase (ESBL) production was positive in 12.6% of the E. coli strains. Logistic regression showed that a history of prior UTI within the past 12 months was strongly linked to an ESBL-producing strain (OR = 3.2, 95% CI = 1.5–6.8, p < 0.01). Due to extensive resistance to cotrimoxazole and fluoroquinolones, these agents should be avoided for empirical use. Nitrofurantoin and fosfomycin should be prioritized as first-line agents for uncomplicated acute cystitis in this outpatient setting.

Keywords: Acute Cystitis, Escherichia coli, Antimicrobial Resistance, Nitrofurantoin, Fosfomycin, Empirical Therapy

Manuscript Timeline: Received: March 11, 2022; Revised: April 19, 2022; Accepted: May 15, 2022; Published: June 15, 2022.

Citation: Cole EA, Tarawallie MZ, Okoye VN. Bacterial Uropathogens and Antimicrobial Susceptibility Profiles in Female Patients with Uncomplicated Cystitis. International Journal of Medicine and Medical Sciences, 2022, 12(6): 41–48. DOI: 10.46882/2022/IJMMS/120041

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