Background:Urinary tract infections (UTIs) are the most common bacterial infections in adults that compels immediate treatment to avoid serious complications. However, selecting the appropriate antibiotic therapy is challenging because of the emerging antibiotic resistance. The purpose of this narrative literature review is to gain knowledge on the prevalence of UTIs, predominant etiological agents, common risk factors, resistance patterns, and current antimicrobial therapy in five Arabian Gulf countries.
Methods: A literature search was conducted for articles published from five Gulf countries (United Arab Emirates, Bahrain, Qatar, Oman, and Kuwait) between October 2011- September 2021 using “PubMed” and “Google Scholar” databases. Articles were eligible for inclusion if they were retrospective or prospective research studies conducted on adult patients or meta-analyses of such studies. The search was limited to English language.
Results: UTIs were found to be more common among women than men across the region. The mean age of UTI patients ranged between 39 and 55.6 years. Uncomplicated and complicated UTIs accounted for 78.70% and 6.40%, respectively. Renal transplant, diabetes and prolonged catheterization were common risk factors for UTIs. Among renal transplant recipients, 35.19% had symptomatic UTI and 86% had symptomatic and asymptomatic bacteriuria. The rate of UTIs among diabetic patients was reported as 35%, detected by urine analysis. Additionally, the overall rate of catheter associated UTI (CAUTI) varied from 0.4 to 9 per 1000 catheter days. Escherichia coli was noted to be the primary uropathogen (11.1% to 32.5% for hospital-acquired (HA-UTI) and 61% to 76.5% for community acquired (Ca-UTI)), followed by Klebsiella pneumoniae (6% to 40% for HA-UTI and 16.4% to 23.5% for Ca-UTI), Acinetobacter baumannii (16.7% to 37.5% for HA-UTI and 0.52% for Ca-UTI), Pseudomonas aeruginosa (2% to 17.5% for HA-UTI and 0.8% for Ca-UTI), and Staphylococcus aureus (around 3% for HA-UTI and 0.81% for Ca-UTI). Prevalence of methicillin-resistant S. aureus was found to be 9.09% among overall UTI patients. The major extended spectrum beta-lactamase (ESBL) producing organisms were E. coli (11.1% to 32.5% for HA-UTI, 23% to 27.4% for Ca-UTI and 38.4% in CAUTI) and K. pneumoniae (16.6% to 20% for Ca-UTI and 56.7% for CAUTI)
The prevalence of carbapenem-resistant E. coli and carbapenem-resistant K. pneumoniae in Ca-UTI was documented to be 0.12% to 0.34% and 0.89%, respectively. The most commonly prescribed antimicrobials included ciprofloxacin, ceftriaxone, and co-amoxiclav. E. coli and K. pneumoniae exhibited increased resistance against ampicillin (31% - 100%) and cotrimoxazole (42.7% - 100%), and low resistance to amikacin, piperacillin-tazobactam and meropenem.
Conclusion: Evolving antibiotic resistance is becoming a therapeutic challenge and proving to be an emerging public threat across the region. There is an evident need for reliable regional epidemiological studies to ascertain the burden of UTIs, and to assess appropriateness of empiric antibiotic therapy and the impact on patient outcomes in different UTI settings. Enhanced surveillance is recommended to monitor antimicrobial resistance in UTIs.
Keywords— Adults, Antibiotic resistance, Gulf countries, Urinary tract infections