Prevalence and antibiotic susceptibility patterns of cotrimoxazole resistant bacterial uropathogens from Hiv patients attending Maseno mission hospital, western kenya

Abstract

Urinary tract infections (UTI) are inflammatory disorders within the urinary system due to presence of pathogenic microorganisms. Taking advantage of lowered immunity in Human Immuno-deficiency Virus (HIV) patients, bacterial UTI globally contribute up to 60% of opportunistic infections (OI). Previous HIV related (OI) studies concentrated on malaria and sexually transmitted diseases ignoring UTI. Owing to its wide interceptive range, cotrimoxazole was recommended for prophylaxis by world health organization and has been standard against opportunistic infections. However, with prolonged use, bacterial resistance is being reported. Uncertainty of UTI management following rising reports of bacterial resistance to commonly used drugs in AIDS era is real. This hospital based descriptive study investigated prevalence and antibiotic susceptibility patterns of cotrimoxazole resistant bacterial uropathogens from HIV patients attending Maseno mission hospital in western Kenya where treatment is blindly based on chance and history during clinic visits without laboratory testing. Specifically described bacterial UTI prevalence, determined their response to cotrimoxazole and established antibiotic susceptibility patterns. At interval of six, 354 participants were systematically selected from population of 2000. Mid-stream urine was cultured on cysteine lactose electrolyte deficiency agar and samples obtaining >105 colony forming units determined by colony counters were biochemically characterized before being subjected to cotrimoxazole broth dilution sensitivity testing. Isolates not responding to cotrimoxazole were subjected to disc diffusion susceptibility testing in accordance with Clinical Laboratory Standards Institute’s guidelines. Tables, graphs and charts were used to present generated data which was analyzed alongside structured questionnaire captured demographic information. Prevalence of UTI among HIV patients was 117(33%) where 75.4% originated from females and 25.6% males with Escherichia coli (54.7%) being most encountered. Chi square analysis of bacterial responses to cotrimoxazole evaluated at 95 % confidence level was statistically significant at P<0.05 (x)2 (5)=14.3, p< 0.005 with an average susceptibility of 46.6%. Significantly, study results will serve as reference point for future researchers and medics, formed policy reevaluation for prophylaxis program and enhanced better OI management by establishing susceptibility patterns and suitable antibiograms. Study recommended for constant monitoring profile aetiological bacteria, periodic surveillance of for prophylactic drug and practicing scientifically determined treatment recommending most susceptible gentamicin (80.3%) empirical antibiotic for region with 53.4% resistance