The pathogens of urinary tract infections (UTI) isolated from hospital and community sources at the EWMSC were similar to those reported by others. E. coli, Klebsiella pneumoniae, Proteus mirabilis, Group В streptococci, Enterococci, Citrobacter and Enterobacter species were the etiologic agents in over 75% of UTI in patients from both hospital and community practices. The predominant isolate, E. coli, has been reported to account for 80 to 85% and 60 to 60% of infections. This is in contrast to the 30.4% prevalence rate observed in this study.
One significant observation in the isolated species was an increase in the prevalence of isolation of Citrobacter organisms. It also was noticed that the major increases in isolation of these organisms occurred around December 1997, the month when the pediatric hospital was transferred to the EWMSC. At the beginning of 1999, three new adult wards were opened in keeping with the Ministry of Health’s plan to upgrade and restructure the health services. That same year, the total number of Citrobacter species isolated from clinical sources increased significantly, and particularly so, from urine. Citrobacter organisms are members of the Enterobacteriaceae family and are ubiquitous in nature, inhabiting soil, water, sewage, food and occasionally, the intestines of humans and animals. They have been implicated in lung infections, superficial wound infections, osteomyelitis, meningitis, and urinary tract infections. Epidemiologically, neonates and immunocompromised or debilitated patients are two groups at highest risk for clinical disease due to Citrobacter organisms. eriacta 100 mg
In this study, Citrobacter was recovered primarily from patients < 10 years of age and those > 50 years of age. Despite the varied sources from which Citrobacter was isolated, sputum and urine were the principal sources from which they were recovered. In a report by Fields and co-workers, researchers found that 78% (43/55) of patients with acute pulmonary disease had Citrobacter species as the etiologic agents. From urine, they found that 56% (74/131) of isolates were Citrobacter species. Most of the patients older than 51 years of age had chronic indwelling urethral catheters, and from whom, Citrobacter species were isolated. These men had prostatic diseases that were either awaiting surgery, were unfit for surgery or who refused surgery. These organisms were occasionally recovered from mixed (polymicrobic) cultures. Although polymicrobic bacteriuria has been associated with fatal bacteremia, no instance of bacteremia was observed in patients with polymicrobic bacteriuria. Similar findings of Citrobacter UTI were reported by Altmann et al. and Mandgazo et al.
The extent to which bacterial strains are susceptible to antimicrobials may depend on the prescribing practices in the particular region and on the period of study. The choice of antimicrobial, the cost, patient compliance, frequency and route of administration and severity of side-effects also are important factors. Despite the urinary pathogens, most isolates from both hospital and community practices remain relatively susceptible to several agents, namely, gentamicin (Table 3). The reason for this may be low consumption of these drugs due to unreliability of supplies. The carriage of antibiotic resistant organisms in the healthy community should alert us to the fact that we should be conservative with the use of antimicrobial agents, not only in community practice, but in hospital practice, as well.