Antibacterial resistance patterns found in urine samples obtained from the elderly in Gauteng

Abstract

Background: Elderly are frequent users of healthcare services and may have complex needs related to frailty and multimorbidity. Urinary tract infection (UTI) is often diagnosed in this cohort (often based on non-specific or atypical symptoms) leading to antimicrobial therapy, often chosen empirically. This presents a poorly understood risk of antimicrobial resistance. More accurate data on antimicrobial resistance (AMR) of urinary pathogens in older people, including LTCF residents, is needed. This study aims to determine if samples obtained from LTCF-dwelling individuals show different rates of in vitro AMR compared to samples obtained from community dwelling older people (aged 60 years). Methodology: The study used computerised microbiology laboratory records of urinary samples analysed by Ampath Laboratories in South Africa. 𝜒2 analyses were used to detect differences in resistance patterns between LTCF and community-dwelling individuals. Sub-group analyses and multivariable logistic regression were undertaken for gender, age, in-patient and out-patient samples, and year of collection. Results: Microbiological results from urine samples in Gauteng where analysed (n=50,704). Three cultured bacteria (Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis) showed significant differences in AMR between the two study cohorts. The adjusted odd ratios for Escherichia coli and Proteus mirabilis indicated increased AMR amongst LTCF residents. Conclusion: Urine samples from LTCF-dwelling people have higher rates of in vitro resistance to common antimicrobials used to treat UTI. Greater focus on antimicrobial stewardship in LTCFs is recommended extending to diagnostic approach, empirical antibiotic choice and bacteriological confirmation of antimicrobial choice.