Volume 84, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



The aim of this study was to obtain data on susceptibility patterns of pathogens responsible for both community and hospital urinary tract infections (UTIs); and analyzed risk factors for infection caused by ciprofloxacin-resistant and extended-spectrum β-lactamace (ESBL)-producing strains in Rwanda. Of 1,012 urine cultures prospectively studied, a total of 196 (19.3%) yielded significant growth of a single organism. The most common isolate (60.7%) was . The antibiotics commonly used in UTIs are less effective except Fosfomycin-trometamol and imipinem. The use of ciprofloxacin in the previous 6 months (odds ratio [OR] = 7.59 [1.75–32.74]), use of other antibiotics in the previous 6 months (OR = 1.02 [1.02–2.34]), and production of ESBL (OR = 19.32 [2.62–142.16]) were found to be associated with ciprofloxacin resistance among the isolates. Risk factors for ESBL positivity were the use of ciprofloxacin and third-generation cephalosporin in the preceding 6 months (OR = 3.05 [1.42–6.58] and OR = 9.78 [2.71–35.25], respectively); and being an inpatient (OR = 2.27 [1.79–2.89]). Fosfomycin-trometamol could be included as a reasonable alternative for the therapy of uncomplicated UTI in Rwanda.


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  1. Smith RD, Coast J, , 2002. Antimicrobial resistance: a global response. Bull World Health Organ 80: 126133. [Google Scholar]
  2. Warren JW, Abrutyn E, Hebel JR, Johnson JR, Schaeffer AJ, Stamm WE, , 1999. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). Clin Infect Dis 29: 745758.[Crossref] [Google Scholar]
  3. Echols RM, Tosiello RL, Haverstock DC, Tice AD, , 1999. Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis. Clin Infect Dis 29: 113119.[Crossref] [Google Scholar]
  4. Kahlmeter G, Menday P, , 2003. Cross-resistance and associated resistance in 2478 Escherichia coli isolates from the Pan-European ECO.SENS Project surveying the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections. J Antimicrob Chemother 52: 128131.[Crossref] [Google Scholar]
  5. Zhanel GG, Hisanaga TL, Laing NM, DeCorby MR, Nichol KA, Weshnoweski B, Johnson J, Noreddin A, Low DE, Karlowsky JA, Hoban DJ, , 2006. Antibiotic resistance in Escherichia coli outpatient urinary isolates: final results from the North American Urinary Tract Infection Collaborative Alliance (NAUTICA). Int J Antimicrob Agents 27: 468475.[Crossref] [Google Scholar]
  6. Gupta K, Scholes D, Stamm WE, , 1999. Increasing prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in women. JAMA 281: 736738.[Crossref] [Google Scholar]
  7. Alos JI, Serrano MG, Gomez-Garces JL, Perianes J, , 2005. Antibiotic resistance of Escherichia coli from community-acquired urinary tract infections in relation to demographic and clinical data. Clin Microbiol Infect 11: 199203.[Crossref] [Google Scholar]
  8. Kahlmeter G, , 2003. An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project. J Antimicrob Chemother 51: 6976.[Crossref] [Google Scholar]
  9. Nicoletti J, Kuster SP, Sulser T, Zbinden R, Ruef C, Ledergerber B, Weber R, , 2010. Risk factors for urinary tract infections due to ciprofloxacin-resistant Escherichia coli in a tertiary care urology department in Switzerland. Swiss Med Wkly 140: w13059. [Google Scholar]
  10. Bush K, Jacoby GA, Medeiros AA, , 1995. A functional classification scheme for beta-lactamases and its correlation with molecular structure. Antimicrob Agents Chemother 39: 12111233.[Crossref] [Google Scholar]
  11. Jacoby GA, Munoz-Price LS, , 2005. The new beta-lactamases. N Engl J Med 352: 380391.[Crossref] [Google Scholar]
  12. Goossens H, Ferech M, Vander Stichele R, Elseviers M, , 2005. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 365: 579587.[Crossref] [Google Scholar]
  13. Dromigny JA, Nabeth P, Juergens-Behr A, Perrier-Gros-Claude JD, , 2005. Risk factors for antibiotic-resistant Escherichia coli isolated from community-acquired urinary tract infections in Dakar, Senegal. J Antimicrob Chemother 56: 236239.[Crossref] [Google Scholar]
  14. Clinical and Laboratory Standards Institute, 2008. Performance Standards for Antimicrobial Susceptibility Testing: Eighteenth Informational Supplement 100-S18. Wayne, PA: Clinical and Laboratory Standards Institute. [Google Scholar]
  15. Raka L, Mulliqi-Osmani G, Berisha L, Begolli L, Omeragiq S, Parsons L, Salfinger M, Jaka A, Kurti A, Jakupi X, , 2004. Etiology and susceptibility of urinary tract isolates in Kosova. Int J Antimicrob Agents 23 (Suppl 1): S2S5.[Crossref] [Google Scholar]
  16. Randrianirina F, Soares JL, Carod JF, Ratsima E, Thonnier V, Combe P, Grosjean P, Talarmin A, , 2007. Antimicrobial resistance among uropathogens that cause community-acquired urinary tract infections in Antananarivo, Madagascar. J Antimicrob Chemother 59: 309312.[Crossref] [Google Scholar]
  17. Akram M, Shahid M, Khan AU, , 2007. Etiology and antibiotic resistance patterns of community-acquired urinary tract infections in J N M C Hospital Aligarh, India. Ann Clin Microbiol Antimicrob 6: 4.[Crossref] [Google Scholar]
  18. Andrade SS, Sader HS, Jones RN, Pereira AS, Pignatari AC, Gales AC, , 2006. Increased resistance to first-line agents among bacterial pathogens isolated from urinary tract infections in Latin America: time for local guidelines? Mem Inst Oswaldo Cruz 101: 741748. [Google Scholar]
  19. Schaeffer AJ, Rajan N, Cao Q, Anderson BE, Pruden DL, Sensibar J, Duncan JL, , 2001. Host pathogenesis in urinary tract infections. Int J Antimicrob Agents 17: 245251.[Crossref] [Google Scholar]
  20. Hryniewicz K, Szczypa K, Sulikowska A, Jankowski K, Betlejewska K, Hryniewicz W, , 2001. Antibiotic susceptibility of bacterial strains isolated from urinary tract infections in Poland. J Antimicrob Chemother 47: 773780.[Crossref] [Google Scholar]
  21. Arslan H, Azap OK, Ergonul O, Timurkaynak F, , 2005. Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey. J Antimicrob Chemother 56: 914918.[Crossref] [Google Scholar]
  22. Karlowsky JA, Kelly LJ, Thornsberry C, Jones ME, Sahm DF, , 2002. Trends in antimicrobial resistance among urinary tract infection isolates of Escherichia coli from female outpatients in the United States. Antimicrob Agents Chemother 46: 25402545.[Crossref] [Google Scholar]
  23. Aboderin OA, Abdu AR, Odetoyin BW, Lamikanra A, , 2009. Antimicrobial resistance in Escherichia coli strains from urinary tract infections. J Natl Med Assoc 101: 12681273.[Crossref] [Google Scholar]
  24. Goettsch W, van Pelt W, Nagelkerke N, Hendrix MG, Buiting AG, Petit PL, Sabbe LJ, van Griethuysen AJ, de Neeling AJ, , 2000. Increasing resistance to fluoroquinolones in Escherichia coli from urinary tract infections in The Netherlands. J Antimicrob Chemother 46: 223228.[Crossref] [Google Scholar]
  25. Hooton TM, , 2003. Fluoroquinolones and resistance in the treatment of uncomplicated urinary tract infection. Int J Antimicrob Agents 22 (Suppl 2): 6572.[Crossref] [Google Scholar]
  26. Schito GC, , 2003. Why fosfomycin trometamol as first line therapy for uncomplicated UTI? Int J Antimicrob Agents 22 (Suppl 2): 7983.[Crossref] [Google Scholar]
  27. Ullah F, Malik SA, Ahmed J, , 2009. Antimicrobial susceptibility and ESBL prevalence in Pseudomonas aeruginosa isolated from burn patients in the north west of Pakistan. Burns 35: 10201025.[Crossref] [Google Scholar]
  28. Lobel B, , 2003. Short term therapy for uncomplicated urinary tract infection today. Clinical outcome upholds the theories. Int J Antimicrob Agents 22 (Suppl 2): 8587.[Crossref] [Google Scholar]
  29. Sire JM, Nabeth P, Perrier-Gros-Claude JD, Bahsoun I, Siby T, Macondo EA, Gaye-Diallo A, Guyomard S, Seck A, Breurec S, Garin B, , 2007. Antimicrobial resistance in outpatient Escherichia coli urinary isolates in Dakar, Senegal. J Infect Dev Ctries 1: 263268. [Google Scholar]
  30. Howard AJ, Magee JT, Fitzgerald KA, Dunstan FD, , 2001. Factors associated with antibiotic resistance in coliform organisms from community urinary tract infection in Wales. J Antimicrob Chemother 47: 305313.[Crossref] [Google Scholar]
  31. Paterson DL, Bonomo RA, , 2005. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev 18: 657686.[Crossref] [Google Scholar]
  32. Reinert RR, Low DE, Rossi F, Zhang X, Wattal C, Dowzicky MJ, , 2007. Antimicrobial susceptibility among organisms from the Asia/Pacific Rim, Europe and Latin and North America collected as part of TEST and the in vitro activity of tigecycline. J Antimicrob Chemother 60: 10181029.[Crossref] [Google Scholar]
  33. Mulvey MR, Bryce E, Boyd D, Ofner-Agostini M, Christianson S, Simor AE, Paton S, , 2004. Ambler class A extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp. in Canadian hospitals. Antimicrob Agents Chemother 48: 12041214.[Crossref] [Google Scholar]
  34. Nijssen S, Florijn A, Bonten MJ, Schmitz FJ, Verhoef J, Fluit AC, , 2004. Beta-lactam susceptibilities and prevalence of ESBL-producing isolates among more than 5000 European Enterobacteriaceae isolates. Int J Antimicrob Agents 24: 585591.[Crossref] [Google Scholar]
  35. Smaoui H, Mahjoubi F, Boutiba I, Jouaihia W, Thabet L, Znazen A, Kammoun A, Mezghanni S, Triki O, Hammami A, Ben Hassen A, Kechrid A, Ben Redjeb S, , 2003. Antibiotic resistance among E. coli isolates from urinary tract infections (1999–2000): a multicenter study. Tunis Med 81: 390394. [Google Scholar]
  36. Edelstein M, Pimkin M, Palagin I, Edelstein I, Stratchounski L, , 2003. Prevalence and molecular epidemiology of CTX-M extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Russian hospitals. Antimicrob Agents Chemother 47: 37243732.[Crossref] [Google Scholar]
  37. Gangoue-Pieboji J, Bedenic B, Koulla-Shiro S, Randegger C, Adiogo D, Ngassam P, Ndumbe P, Hachler H, , 2005. Extended-spectrum-beta-lactamase-producing Enterobacteriaceae in Yaounde, Cameroon. J Clin Microbiol 43: 32733277.[Crossref] [Google Scholar]
  38. Ryoo NH, Kim EC, Hong SG, Park YJ, Lee K, Bae IK, Song EH, Jeong SH, , 2005. Dissemination of SHV-12 and CTX-M-type extended-spectrum beta-lactamases among clinical isolates of Escherichia coli and Klebsiella pneumoniae and emergence of GES-3 in Korea. J Antimicrob Chemother 56: 698702.[Crossref] [Google Scholar]
  39. Skippen I, Shemko M, Turton J, Kaufmann ME, Palmer C, Shetty N, , 2006. Epidemiology of infections caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp.: a nested case-control study from a tertiary hospital in London. J Hosp Infect 64: 115123.[Crossref] [Google Scholar]
  40. Yilmaz E, Akalin H, Ozbey S, Kordan Y, Sinirtas M, Gurcuoglu E, Ozakin C, Heper Y, Mistik R, Helvaci S, , 2008. Risk factors in community-acquired/onset urinary tract infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae . J Chemother 20: 581585.[Crossref] [Google Scholar]

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  • Received : 28 Jan 2011
  • Accepted : 23 Feb 2011
  • Published online : 01 Jun 2011

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