Study title: Antimicrobial Resistance in Gram-negative bacteria from Urinary Specimens: a study of prevalence, risk factors and molecular mechanisms of resistance

Lead Researcher(s):

Funder(s): Wellcome Trust

Partner(s): Harare City Health

Background:

Antimicrobial resistance (AMR) is a global problem affecting all countries irrespective of income and geographical location and has been highlighted by the World Health Organization as one of the three most important public health threats of the 21st century. Infections due to antimicrobial-resistant organisms are associated with increased mortality and risk of onward transmission, particularly in low-income settings where alternative antibiotics are not readily available and pose an immense burden on weak health systems.

Data from low-resource settings on the prevalence of resistance are scarce because of limited laboratory capacity and access to diagnostics. Further, some individuals, such as people living with HIV, might be at increased risk of infections with antimicrobial-resistant organisms. Urinary tract infections are the most common infections caused by Gram negative bacilli and resistance patterns among patients with urinary tract infections can reflect the community burden of resistance with the added advantage that samples are easy to obtain and process.

Study aim(s)

To determine the prevalence of AMR in key Gram-negative pathogens causing urinary tract infections, to assess other causes that lead to symptoms suggestive of urinary tract infections, and to evaluate simplified phenotypic laboratory methods.

Study design

We conducted a prospective cohort study to investigate the prevalence of AMR among adult outpatients presenting with symptoms of urinary tract infections to primary care clinics in Harare and their treatment outcomes.

In a nested cross-sectional sub-study we investigated the performance of simplified culturing methods (using InTray and Compact Dry) that may have the potential of expanding laboratory testing in limited-capacity settings. We also evaluated the prevalence of sexually transmitted infections among outpatients presenting with symptoms of urinary tract infection.

Additionally, we conducted a survey among health care workers from outpatient clinics to explore their knowledge, attitudes, and practices relating to AMR and antibiotic use.

Study dates

June 2019 - April 2022