Abstract

Abstract
Aim/ Background
Urinary tract infections (UTIs), inflammatory responses of the epithelium of the urinary tract to microbial invasions, are a common healthcare problem affecting millions of individuals worldwide. The emergence of antimicrobial resistance among microorganisms responsible for UTIs poses a significant challenge in the effective treatment and management of these infections. Data on this issue is quite scarce in Afghanistan. The aim of this study is to find out the most common bacterial causes of UTI in cultured cases and their antibiotic resistance pattern.
Methods
In this cross-sectional study, a census sampling method was employed, and data were collected from cultured urine samples of patients referred to the main branch of City Medical Laboratory in Kabul, Afghanistan, between 5/10/2021 – 5/10/2022. Bacterial cultures were performed using blood agar and MacConkey agar, with growth assessed after overnight incubation at 37°C. Identification involved Gram staining and biochemical tests, to identify the bacteria in the urine samples. Data were analysed by SPSS version 21.
Results
Out of the 151 urine samples included in the study, 101 (66.9%) were from female patients. The median of age was 50. The prevalent microorganisms were E.coli (47%) and Staphylococcus (21.1%). Highest resistance of E.coli was seen in Cefotaxime (90.1%), Augmentin (88.7%), Cotrimoxazole (85.9%), and even fluoroquinolones (Ciprofloxacin and Levofloxacin, 81.7% and 80.3% respectively), while it was found that E.coli were sensitive to Meropenem (88.7%), Tazobactam-Pipracillin (73.2%), Amikacin (71.8%), and Nitrofurantoin (66.2%). Staphylococcus was sensitive to Vancomycin (87.5%), Nitrofurantoin (87.5%), Imepenem (71.9%), and Amikacin (62.5%). Staphylococcus spp. were resistant to Azithromycin (100%), Ciprofloxacin (93.8%), Fosfomycin (87.5%) and tetracycline (87.5%).

Conclusion
This study of 151 urine samples identified E. coli (47%) and Staphylococcus (21.1%) as the predominant pathogens causing UTIs, with a notable prevalence among females (66.9%) and individuals aged 21–30 years. E. coli exhibited concerning resistance to first-line antibiotics like Cefotaxime (90.1%) and Amoxicillin-clavulanic acid (88.7%), contrasting with retained sensitivity to Meropenem (88.7%) and Tazobactam-Piperacillin (73.2%). These findings underscore the need for region-specific antibiotic stewardship programs, routine susceptibility testing, and evidence-based prescribing to curb AMR progression.

Key words: : Antimicrobial Resistance, Kabul, Urinary Tract Infections