By Sharon Atieno
Though the bulk of antibiotics prescription in outpatient clinic is because of urinary tract infection (UTI), half of UTI patients are being given antibiotics unnecessarily, a research study has disclosed.
A hospital based laboratory surveillance carried out by the United States Army Medical Research Directorate- Africa (USAMRD-A) in five counties in Kenya on antimicrobial resistance (AMR) found that out of 581 urine samples that were tested for UTI, half of the urine samples which have met the criteria for suspects of bacterial infection are not really bacteria.
Though antibiotics have saved millions of lives, increased human life span and made safe surgeries possible, increased and improper use of antibiotics has led to bacteria becoming resistant to the drugs. According to the World Health Organization (WHO), AMR is one of the biggest threats to global health, food security and development today, this is because few alternate antibiotics are available and only a limited number of new antibiotics are being discovered.
“As you take the antibiotics, normal bacteria in the body are also being exposed to it,” explained Dr. Lilian Musila, a Principal scientist at the department of emerging infectious diseases USAMRD-A/KEMRI during an interview at the 9th KEMRI Annual Scientific and Health (KASH) conference. “They do not just kill the thing that is making you sick, it kills all the other bacteria in your body. It destroys your normal flora which creates an imbalance and actually leads to other infections because your protective bacteria are all gone.”
While recommending that a study should be conducted to find out what the other causes of UTI are other than candida, yeast and some bacteria, Dr.Musila also urged physicians to do more examination to ascertain that the patient is suffering from UTI.
“The symptoms associated with UTI are similar to other health problems, thus, might be an indication of an underlying problem such as kidney infection. We have to be careful, we cannot have half of patients who are being given antibiotics not require it,” she said.
The WHO has prioritized a group of 7 pathogens which are highly multi drug resistant, referred to as ESKAPEE they include: enterococcus faecium, staphylococcus aureus, klebsiella pneumonia, acinetobacter baumanii, pseudomonas aeruginosa, enterobacter spp and e.coli. The research on the urine samples from Kisumu, Kericho, Kilifi, Nairobi and Kisii counties indicated that UTI is caused by several organisms among them being ESKAPEE.
In a related study by Martin Georges-a researcher at USAMRD-A/KEMRI-in those five counties, acinetobacter baumanii and pseudomonas aeruginosa were found to be common in males while enterobacter species were common in females. The findings also indicated that a higher number of multidrug resistance is found in males than females despite there being a high number of females with UTI.
In addition, the study found that drug resistance varies from one bacteria species to another, and that there is high drug resistance in all classes of drugs meant for treatment of UTI including the last line, that is, cabarpenem.
“Treatment of UTIs with antibiotics should be limited as majority of UTIs are either non-bacterial or self-limiting in nature,” he said. “The choice of antibiotics should be rational as ESKAPEE pathogens which have high multidrug resistance rates are key causes of UTIs.”
According to WHO, many countries lack reliable data to track emerging microbial threats. Many countries globally are monitoring fewer than five antibiotic resistant bacteria-drug pairs including Kenya which is monitoring just one bacteria-drug pair.
In a bid to combat AMR in Kenya, a national action policy and plan were put in place in 2017. The plan outlines several strategies including strengthening surveillance and research yet, strategic national surveillance for multidrug resistance for most of the bacteria strains in a wide range of infections in Kenya is not in place. This leaves a wide gap in the fight against antimicrobial resistance in the country.