Resistance of uropathogens in symptomatic urinary tract infections in Leon, Nicaragua

Management of urinary tract infections (UTI) in Central America and especially Nicaragua, is complicated by the lack of knowledge about the antibiotic resistance of uropathogens. We conducted a prevalence study to gain more insight into the aetiology, bacterial resistance and risk factors for symptomatic UTI in the region of Leon, Nicaragua. In 2002, all consecutive patients with UTI symptoms and pyuria greater than or equal to 10 WBC/hpf were admitted to the study. Positive cultures from midstream urine specimens were defined as greater than or equal to 10(5) cfu/ml of a single uropathogen. Susceptibility tests were performed with disc diffusion tests using the Kirby-Bauer method and broth microdilution using National Committee for Clinical Laboratory Standards criteria both in Leon and a reference laboratory in Utrecht. A positive culture was present in 62 of 208 study subjects (30%). Escherichia coli (56%), Klebsiella spp. (18%) and Enterobacter spp. (11%) were the most frequent pathogens isolated. Presence of cystocele, incontinence and increasing age were risk factors for bacterial UTI. E. coli was least resistant to ceftriaxone, amikacin and nitrofurantoin (>90% susceptible). We observed high resistance rates in E. coli to amoxicillin (82%, MIC90 128 mg/l), trimethoprim-sulphamethoxazole (TMP-SMX) (64%, MIC90 32 mg/l), cephalothin (58%, MIC90, 32 mg/l), ciprofloxacin (30%; MIC90, 32 mg/l), amoxicillin/clavulanate (21%, MIC90 8 mg/l) and gentamicin (12%, MIC90 2 mg/l). Our results suggests that community acquired uropathogens in Nicaragua are highly resistant to many antimicrobial agents. The use of amoxicillin, trimethoprim-sulphamethoxazole and cephalothin against uropathogens needs to be reconsidered. High quinolone resistance rates among E. coli in Nicaragua gives cause for great concern. (C) 2004 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.