Evaluation of Antimicrobial Susceptibility of Enterobacteriaceae Causing Urinary Tract Infections in Africa

Abstract

ABSTRACTOur objective was to evaluate the antimicrobial susceptibility ofEnterobacteriaceaecausing urinary tract infections (UTIs) in adults in Africa. The PubMed database was systematically searched to identify relevant studies published after 2000. Google, World Health Organization, and African Field Epidemiology networks were also searched. Twenty-eight studies, accounting for 381,899 urine isolates from 14 African countries, met the inclusion criteria.Escherichia coli,Klebsiellaspp., andProteusspp. were the most commonly encountered uropathogens. Cefotaxime, imipenem, fosfomycin, and ciprofloxacin were the antibiotics with the highest activity againstE. coliisolates from outpatients, with susceptibility being 92 to 99, 100, 100, and 68 to 91%, respectively. The susceptibility amongKlebsiellaspp. isolates from outpatients varied from 80 to 100% for amikacin and from 53 to 100% for ciprofloxacin, while susceptibility was 74 to 78, 97, and 77% for ciprofloxacin, amikacin, and fosfomycin, respectively, amongKlebsiellaspecies isolates from inpatients or patients with hospital-acquired UTIs. With regard toProteusspp., the highest activity was observed among fluoroquinolones; 71 to 100% of theP. mirabilisisolates were susceptible to ciprofloxacin in four studies, and 74 to 100% of theP. vulgarisisolates were susceptible to ofloxacin in two studies. The currently available evidence suggests that the antimicrobial susceptibility patterns ofEnterobacteriaceaeuropathogens in African countries were similar to those in countries of southeast Europe. Further original studies are warranted from African countries for which there is limited published data.