Antibiotic resistance patterns of urinary pathogens in outpatients and inpatients: A report from Eastern Libya

Urinary tract infections (UTIs) are one of the most common infections and remain a public health problem worldwide. Incidence of UTI-causing pathogens and their antibiotic susceptibility are varied in different regions. To examine the frequency of UTIs among inpatients and outpatients at Tobruk Medical Centre, Eastern Libya to identify the UTIs most common causative agents, and to assess their resistance patterns to the commonly used antibiotics. A laboratory registry-based retrospective survey included 25 388 urine samples obtained from symptomatic UTIs cases that attended the Tobruk Medical Centre in the period from January 2006 to December 2018. Antimicrobial susceptibility testing and bacterial identification were done as per the microbiology lab's standard operating procedure. The frequency of UTIs and their resistance patterns were examined in inpatients and outpatients. Out of 25 388 urine samples tested, 6838 (26.9%) showed growth of pathogens indicative of positive UTI. Of these, 3827 samples (56%) belonged to the outpatient department (70.4% female, 29.6% male) and 3011 samples (44%) were from the inpatient departments (52.4% female, 47.6% male). The most prevalent uropathogen isolated from urine cultures in this study was Escherichia coli (47.8%) followed by Klebsiella spp. The frequency of E. coli and other pathogens varied among inpatients and outpatients and by patients' gender. The overall resistance rate of antibiotics ranged from 21% to 88% and was higher in inpatients compared with outpatients (p = 0.001). From the study, a higher incidence of UTIs was observed in outpatient samples but resistance rates of uropathogens to antimicrobials were observed to be higher for the urinary specimens obtained from inpatients. Continuous surveillance of antimicrobial resistance patterns and prudent use of antibiotics is an important measure for combating emerging antimicrobial resistance.