Prevalence, Antimicrobial Susceptibility Profiles, Genotypic Characterization and Biofilm Formation of Bacterial Isolates Causing Urinary Tract Infections Among Adult Patients Attending Kiambu Level 5 Hospital, Kenya

Abstract

Urinary tract infections (UTIs) are among the most prevalent extra-intestinal diseases, with alarming prevalences reported globally. Bacterial pathogens, including uropathogens, use various evolving mechanisms, such as carriage of resistance genes and biofilm formation, to significantly reduce cidal activity of antimicrobial agents. This cross-sectional study aimed to isolate & determine the prevalence, selected risk associated factors, antimicrobial susceptibility profiles, carriage of desired extended spectrum β-lactamase (ESβLs) genes, and biofilm formation by bacteria causing urinary tract infections among adult seeking medicare at Kiambu Level 5 hospital, Kenya. The study used well-structured questionnaires to capture socio-demographic data among the 206 participants. The prevalence rate of UTIs was 57/206 (27.6%). Escherichia coli, Staphylococcus aureus, and Klebsiella pneumoniae were the most prevalent bacterial pathogens at 18/57(31.6%), 14/57(24.5%), and 13/57(22.8%), respectively. On risk-associated factors, women had a significantly higher prevalence rate of UTIs at 47/57 (82.4%). The antimicrobial sensitivity analysis revealed high resistance towards Sulfamethoxazole and Ampicillin at 50% - 85% and resistance patterns towards Cefotaxime, Ceftriaxone, and Ciprofloxacin below 40%. ESβLs blaTEM genes genotype was the most prevalent revealed at 10/100 (100%), followed by blaOXA and blaSHV genes at 4/10 (40%) and 3/10 (30%), respectively. The biofilm formation finding also disclosed that most of the study isolates were biofilm formers36/57 (63.2%), with Gram-negative isolates being the most formers of biofilms 25/36 (69.4%). E. coli 15/36 (41.7 %), Klebsiella sp. 7/36 (19.4%), and S. aureus 7/36 (19.4%) were the most common biofilm formers. In conclusion, the carriage of ESβLs and bacteria's ability to form a biofilm may be drivers of antimicrobial resistance. The study advocates mapping the distribution of ESβLs to aid in halting antimicrobial resistance and offer support to pharmaceutical industries with fewer new antibiotics in the pipeline.