TY - JOUR

T1 - Antibiotic Exposure in a Low-Income Country: Screening Urine Samples for Presence of Antibiotics and Antibiotic Resistance in Coagulase Negative Staphylococcal Contaminants

T2 - Screening Urine Samples for Presence of Antibiotics and Antibiotic Resistance in Coagulase Negative Staphylococcal Contaminants

AU - Lerbeck, Anne Mette

AU - Tersbøl, Britt Pinkowski

AU - Styrishave, Bjarne

PY - 2014/12/2

Y1 - 2014/12/2

N2 - Development of antimicrobial resistance has been assigned to excess and misuseof antimicrobial agents. Staphylococci are part of the normal flora but are alsopotential pathogens that have become essentially resistant to many knownantibiotics. Resistances in coagulase negative staphylococci (CoNS) aresuggested to evolve due to positive selective pressure following antibiotictreatment. This study investigated the presence of the nine most commonly usedantimicrobial agents in human urine from outpatients in two hospitals in Ghana inrelation to CoNS resistance. Urine and CoNS were sampled (n5246 and n596respectively) from patients in two hospitals in Ghana. CoNS were identified usingGram staining, coagulase test, and MALDI-TOF/MS, and the antimicrobialsusceptibility to 12 commonly used antimicrobials was determined by disk diffusion.Moreover an analytical method was developed for the determination of the ninemost commonly used antimicrobial agents in Ghana by using solid-phaseextraction in combination with HPLC-MS/MS using electron spray ionization. Thehighest frequency of resistance to CoNS was observed for penicillin V (98%),trimethoprim (67%), and tetracycline (63%). S. haemolyticus was the most commonisolate (75%), followed by S. epidermidis (13%) and S. hominis (6%). S. haemolyticus was also the species displaying the highest resistance prevalence(82%). 69% of the isolated CoNS were multiple drug resistant (§4 antibiotics) and45% of the CoNS were methicillin resistant. Antimicrobial agents were detected in64% of the analysed urine samples (n5121) where the most frequently detectedantimicrobials were ciprofloxacin (30%), trimethoprim (27%), and metronidazole(17%). The major findings of this study was that the prevalence of detectedantimicrobials in urine was more frequent than the use reported by the patients and the prevalence of resistant S. haemolyticus was more frequent than other resistant CoNS species when antimicrobial agents were detected in the urine.

AB - Development of antimicrobial resistance has been assigned to excess and misuseof antimicrobial agents. Staphylococci are part of the normal flora but are alsopotential pathogens that have become essentially resistant to many knownantibiotics. Resistances in coagulase negative staphylococci (CoNS) aresuggested to evolve due to positive selective pressure following antibiotictreatment. This study investigated the presence of the nine most commonly usedantimicrobial agents in human urine from outpatients in two hospitals in Ghana inrelation to CoNS resistance. Urine and CoNS were sampled (n5246 and n596respectively) from patients in two hospitals in Ghana. CoNS were identified usingGram staining, coagulase test, and MALDI-TOF/MS, and the antimicrobialsusceptibility to 12 commonly used antimicrobials was determined by disk diffusion.Moreover an analytical method was developed for the determination of the ninemost commonly used antimicrobial agents in Ghana by using solid-phaseextraction in combination with HPLC-MS/MS using electron spray ionization. Thehighest frequency of resistance to CoNS was observed for penicillin V (98%),trimethoprim (67%), and tetracycline (63%). S. haemolyticus was the most commonisolate (75%), followed by S. epidermidis (13%) and S. hominis (6%). S. haemolyticus was also the species displaying the highest resistance prevalence(82%). 69% of the isolated CoNS were multiple drug resistant (§4 antibiotics) and45% of the CoNS were methicillin resistant. Antimicrobial agents were detected in64% of the analysed urine samples (n5121) where the most frequently detectedantimicrobials were ciprofloxacin (30%), trimethoprim (27%), and metronidazole(17%). The major findings of this study was that the prevalence of detectedantimicrobials in urine was more frequent than the use reported by the patients and the prevalence of resistant S. haemolyticus was more frequent than other resistant CoNS species when antimicrobial agents were detected in the urine.

U2 - 10.1371/journal.pone.0113055

DO - 10.1371/journal.pone.0113055

M3 - Journal article

C2 - 25462162

VL - 9

SP - 1

EP - 18

JO - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

IS - 12

M1 - e113055

ER -