Multi-Drug-Resistant Enterobacteriaceae Causing Urinary Tract Infections At Al- Marj Teaching Hospital

Abstract

Urinary tract infections (UTIs) are one of the most common infections in hospitals. Studies on the causative agents of UTIs in Libya and their susceptibility to antimicrobials are few and were mainly carried out in the two main cities in Libya, Tripoli and Benghazi. The study aims to identify the Gram-negative bacteria that cause UTIs at Al-Marj Teaching Hospital as well as determine the antibiotic sensitivity (AST) of the isolated bacteria. Between March and September 2018, 163 urine samples were collected from the inpatients at the AL-Marj teaching hospital. The samples were inoculated onto CLED agar and incubated at 37^oC for 24 hours. The phoenix system was used for the identification of bacteria and AST. Of 163 samples, significant growth was seen in 50 samples (30.6%). Of them, 27 were Gram-positive and 23 were Gram-negative, which comprised Escherichia coli 16 (32 %), Klebsiella pneumoniae 6 (12%), and Citrobacter freundii 1 (2.0%). The percentage of extended spectrum beta lactamase (ESBL) producers in E. coli and K. pneumoniae was observed to be 68.7% and 50%, respectively. While carbapenamase producers were observed to be 6.2% for E. coli and 16.6% for K. pneumoniae. The highest resistance rates were against Ampicillin (86.9%), Cephalothin (82.6%), Cefuroxime (73.9%), Cefepime (69.5%), Ampicillin-Clavulanate, and Ceftriaxone (65.2%), respectively. In conclusion, E. coli and K. pneumoniae were the most common microorganisms causing UTIs. The increased prevalence of multi-drug-resistant organisms limits the available treatment options for infections caused by these organisms. Therefore, the identification and reporting of ESBL-producing organisms is crucial for clinical decision-making.