An analysis of urinary tract infection (UTI) isolates from East African countries found that roughly half were multidrug-resistant (MDR), researchers reported last week in JAC-Antimicrobial Resistance.

For the study, researchers recruited children and adults with UTI-like symptoms from healthcare facilities in Tanzania, Kenya, and Uganda and collected urine samples for microbiologic analysis, including antimicrobial susceptibility testing. MDR bacteria were defined as isolates resistant to at least one agent in three or more classes of antibiotic agents.

Of the 7,583 patients with symptomatic UTIs (3,852 from Tanzania, 1,903 from Kenya, 1,828 from Uganda), 2,653 (35.0%) had a microbiologically confirmed UTI. The predominant bacteria were Escherichia coli (37.0%), Staphylococcus (26.3%), Klebsiella (5.8%), and Enterococcus (5.5%). Of the 2,266 isolates submitted for antimicrobial susceptibility testing, 1,153 (50.9%) were categorized as MDR.

Findings fill 'crucial data gap'

MDR rates were 60.9% in Tanzania, 57.5% in Uganda, and 36.9% in Kenya. By pathogen, Staphylococcus had the highest MDR rate (60.9%), followed by E coli (52.2%), Klebsiella (50.6%), Enterococcus (38.1%), and other Enterobacterales (31.2%). The rate of MDR bacteria was much higher in inpatients than outpatients. The analysis also found "severely high" levels of resistance across pathogens to first-line antibiotics for UTIs.

The study authors say the findings fill a crucial data gap and should be used to inform guidelines for empiric antibiotic treatment of UTIs in East Africa.

They concluded, "More broadly, we emphasize the need for urgent investment in routine AMR surveillance programmes, expansion of diagnostic laboratory capacities and diagnostic algorithms to facilitate antimicrobial stewardship and call for greater commitment from policymakers to counter the threat of AMR."

Saudi Arabia has reported four more MERS-CoV cases, all in people whose symptoms began in the latter months of 2023, the World Health Organization (WHO) said in a February 16 update.

The cases, two of which were fatal, were confirmed between October 10 and November 16. The patients are from three different regions: Riyadh, Eastern, and Qassim. Two were men, and two were women. All had underlying health conditions, and none were health workers.

Exposure unclear for two patients

One patient was a camel owner, while another had a history of indirect contact with camels. Exposure to the virus hasn't been determined for the other two patients, and none of the patients had consumed raw camel milk before their symptoms began. The WHO said there are no epidemiologic links between any of the patients, and no secondary cases were found.

The WHO said MERS-CoV cases have declined substantially since the start of the COVID-19 pandemic. It said reasons could include public health actions prioritizing COVID-19 case detections or COVID-19 mitigation actions such as masking and physical distancing, which could reduce human-to-human transmission.

Cross-protection from COVID infection or vaccination?

The group also said it's possible that cross-protection from COVID-19 infection or vaccination may be playing a role. However, the WHO added that the hypothesis requires further investigation.

The newly reported cases lift Saudi Arabia's number of Middle East respiratory syndrome coronavirus (MERS-CoV) to 2,200, which includes 858 deaths. The WHO said the cases don't change its risk assessment, which remains at moderate globally and regionally. It said more cases are expected from Saudi Arabia and other countries where the virus circulates in dromedary camels.

More than half of sequenced samples of Mycoplasma genitalium (MG) in Belgium were resistant to macrolides, researchers reported last week in Eurosurveillance.

From July to November 2022, a team led by researchers with the National Reference Centre of Sexually Transmitted Infections Belgium analyzed a collection of frozen MG-positive samples from 21 Belgian laboratories. MG is a sexually transmitted bacterium that can cause symptomatic and asymptomatic urethritis in men and has been associated with cervicitis in women. Although MG infections are commonly treated with macrolides (azithromycin) or fluoroquinolones (moxifloxacin), the rising levels of resistance reported elsewhere in Europe is a growing concern, and researchers wanted to get a better picture of MG resistance in Belgium.

Of the 244 MG-positive samples received, 232 were able to be sequenced for macrolide and fluoroquinolone resistance-associated mutations (RAMs). Over half (55.2%) were resistant to macrolides, including all samples (24 of 24) from men who have sex with men (MSM). Macrolide resistance was also higher in men who have sex with women (18/30, 60%) than in women (64/143, 44.8%). Fluoroquinolone RAMs were found in 25.9% of samples, with little variation in resistance between sexes.

Concerns about multidrug resistance

The study authors say macrolide resistance testing for MG-positive samples should be implemented for all patient groups other than MSM to limit the use of fluoroquinolones and avoid the emergence of multidrug-resistant MG.

"Our findings highlight the requirement for updated Belgian MG testing and treatment guidelines, including comprehensive training for both laboratory specialists and healthcare practitioners," they wrote. "These measures are imperative in preventing testing practices that may inadvertently contribute to the further emergence of multidrug-resistant MG."