Factors associated with community-acquired urinary tract infections among adults attending assessment centre, Mulago Hospital Uganda.

Deus Kabugo, Samuel Kizito, Dave Dhara Ashok, Kiwanuka Alexander Graham, Nabimba Ronald, Namunana Sandra1, Kabaka M Richard, Beatrice Achan, Florence C Najjuka
1. Makerere University College of health sciences, Kampala
2. School of veterinary medicine, Makerere University, Kampala
3. Department of Medical Microbiology, Makerere University, Kampala
4. Clinical Epidemiology Unit, Makerere University College of Health sciences
5. Uganda Tuberculosis Surveillance Projects, Makerere University College of Health Sciences

Abstract
Background: Urinary tract infections (UTI) are a common medical problem affecting the general population and thus commonly encountered in medical practice, with the global burden of UTIs at about 150 million people. Because uropathogens  largely originate from colonic flora, they are easy to predict, and this is the rationale for empirical treatment in Community Acquired-UTI (CA-UTIs). With the increasing prevalence of drug-resistant bacteria among adults with CA-UTI in Uganda, it is  no longer adequate to manage CA-UTIs on empiric regimen without revising the susceptibility patterns of common CA-UTI  causative agents. Thus in this study we set out to identify:

The factors associated with CA-UTIs, the common uropathogens and  the drug sensitivity patterns of the common uropathogens cultured.

Methodology:This was a cross-sectional study that was conducted in adults who presented with symptoms of a UTI at Mulago  Hospital, assessment center. There were 139 patients who consented to the study and were recruited, an interviewer administered questionnaire was used to collect information from the study participants as regards demographic, social and clinical characteristics and Mid Stream Urine (MSU) samples were collected for urinalysis, culture and antibiotic susceptibility testing using  the Kirby-Bauer disc diffusion technique was applied to the isolates.Numeric data were summarized using measures of central  tendency while the categorical data was summarized using proportions and percentages.

Results: Age, female sex and marital status were factors that were significantly associated with CA-UTIs. Fifty four (54) cultures
were positive for UTI with 26 giving pure growths. The commonest uropathogen isolated was Escherichia coli at 50%, this was  followed by Staphylococcus aureusat 15.4%. The sensitivity of Escherichia colito Ampicillin and Nitrofurantoin were78.6%, 64.3%  respectively, and the sensitivity of Staphylococcus aureusto ciprofloxacin, Nitrofurantoin and gentamycin were 100%, 66.7% and  66.7% respectively.

Conclusion:There are known factors associated with CA-UTIs such as age, female sex. There was generally high sensitivity  to nitrofurantoin and gentamycin by most of the uropathogens isolated, and high resistance to the common antibiotics such as  nalidixic acid and erythromycin thus a need for a bigger study that can be used to effect the change of the current recommendations in the Uganda Clinical Guidelines as regards empirical management of CA-UTIs.

Keywords: Community-acquired urinary tract infections, assessment centre, Mulago Hospital Uganda.