Antimicrobial Resistance in Outpatient Escherichia coli Urinary Isolates in Dakar; Senegal

ABSTRACT

Background: Data regarding the evolution of antimicrobial resistance are needed to suggest appropriate empirical treatment of urinary tract infections (UTI) in developing countries. To assess the antimicrobial susceptibility of Escherichia coli; the predominant pathogen in community-acquired UTI; a prospective multicenter study was carried out in Dakar; Senegal. Methodology: From February 2004 to October 2006; 1010 non-duplicate E. coli strains were collected from four centres. Antimicrobial susceptibility testing was performed using disk diffusion method according to the recommendations of the CA-SFM (2004). Results: Most of the isolates were resistant to amoxicillin (73.1); amoxicillin- clavulanic acid (67.5); cephalothin (55.8); and trimethoprim/sulfamethoxazole (68.1). Extended spectrum beta-lactamase was detected in 38 strains. The overall resistance rates to nalidixic acid; norfloxacin and ciprofloxacin were 23.9; 16.4and 15.5; respectively. Most of the strains were susceptible to gentamicin; nitrofurantoin and fosfomycin (respective susceptibility rates; 93.8; 89.9; and 99.3). During this period; a significant decrease in sensitivity was observed for cephalothin; fluoroquinolones and trimethoprim/sulfamethoxazole (p0.001). Conclusions: These data suggest that trimethoprim/sulfamethoxazole may no longer be used as empirical treatment for community- acquired UTI in Dakar. In order to preserve the activity of fluoroquinolones for future years; alternatives such as fosfomycin or nitrofurantoin should be considered