Increasing prevalence of antimicrobial resistance among Enterobacteriaceae uropathogens in Bangui, Central African Republic

Because of the previous high prevalence of resistance to usual antibiotics among uropathogens in Bangui, Central African Republic (CAR), a survey focused on Enterobacteriaceae, the most prevalent group responsible for urinary tract infections (UTIs), was conducted. The aim was to help health authorities revise antibiotic policies. We performed a retrospective analysis of all cases of confirmed UTIs due to Enterobacteriaceae in outpatients attending the Institut Pasteur de Bangui (IPB), CAR, between 2004 and 2006. During the study period, 560 (10.9% of urine submissions) UTIs were confirmed and 443 Enterobacteriaceae strains were isolated, representing 79% of the causative agents for UTIs. Among these 560 strains, E. coli was the most common, representing 64% of the isolates, followed by K. pneumoniae (10%) and other Enterobacteriaceae (5%). Extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae significantly increased from five (3.7%) to thirty-three (19.3%) between 2004 and 2006. A significantly increased resistance rate to nalidixic acid, ciprofloxacin and gentamicin was observed in ESBL-nonproducing Enterobacteriaceae over the study period. Empiric treatment for UTIs in Bangui should be reconsidered and prudent use of antibiotics, particularly ciprofloxacin, is highly recommended. The recent spread of ESBL-producing Enterobacteriaceae in central African outpatients is striking and underlines the need for further studies.