Sexually transmitted infections and prior antibiotic use as important causes for negative urine cultures among adults presenting with urinary tract infection symptoms to primary care clinics in Zimbabwe: a cross-sectional study

Olaru, Ioana D; Chisenga, Mutsawashe; Yeung, Shunmay; Mabey, David; Marks, Michael; Chonzi, Prosper; Masunda, Kudzai PE; Machiha, Anna; Ferrand, Rashida A; Kranzer, Katharina

Sexually transmitted infections and prior antibiotic use as important causes for negative urine cultures among adults presenting with urinary tract infection symptoms to primary care clinics in Zimbabwe: a cross-sectional study

Files

bmjopen-2021-050407.pdf (385.28 KB)

Authors

Olaru, Ioana D

Chisenga, Mutsawashe

Yeung, Shunmay

Mabey, David

Marks, Michael

Chonzi, Prosper

Masunda, Kudzai PE

Machiha, Anna

Ferrand, Rashida A

Kranzer, Katharina

Issue Date

2021-08-11

Type

Article

Language

en_US

Keywords

Epidemiology , Primary Care , Sexual Medicine , Urinary Tract Infections

Abstract

Objective: Urinary tract infections (UTIs) are common in primary care. The yield of urine cultures in patients with UTI symptoms can be considerably different between high-income and low-income settings. This study aimed to explore possible causes of negative urine cultures in patients presenting with symptoms of UTI to primary health clinics in Harare. Design: Cross-sectional study. Setting: Nine primary health clinics in Harare, Zimbabwe. Participants: Adults presenting with symptoms of UTIs between March and July 2020. Primary outcome measures Urine samples underwent dipstick testing, microscopy, culture, and testing for sexually transmitted infections (STIs) using GeneXpert and for the presence of antibiotic residues using an antibiotic bioassay. The primary outcomes were the number and proportion of participants with evidence of STIs, prior antibiotic exposure, leucocyturia and UTIs. Results: The study included 425 participants with a median age of 37.3 years, of whom 275 (64.7%) were women. Leucocyturia was detected in 130 (30.6%, 95% CI 26.2% to 35.2%) participants, and 96 (22.6%, 95% CI 18.7% to 26.9%) had a positive urine culture for a uropathogen. Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis were detected in 43/425 (10.1%, 95% CI 7.4% to 13.4%), 37/425 (8.7%, 95% CI 6.2% to 11.8%) and 14/175 (8.0%, 95% CI 4.4% to 13.1%) participants, respectively. Overall, 89 (20.9%, 95% CI 17.2% to 25.1%) participants reported either having taken prior antibiotics or having had a positive urine bioassay. In 170 (40.0%, 95% CI 35.3% to 44.8%) participants, all of the tests that were performed were negative. Conclusions: This study found a high prevalence of STIs and evidence of prior antimicrobial use as possible explanations for the low proportion of positive urine cultures.

Citation

Olaru, I. D., Chisenga, M., Yeung, S., Mabey, D., Marks, M., Chonzi, P., Masunda, K. P., Machiha, A., Ferrand, R. A., & Kranzer, K. (2021). Sexually transmitted infections and prior antibiotic use as important causes for negative urine cultures among adults presenting with urinary tract infection symptoms to primary care clinics in Zimbabwe: a cross-sectional study. BMJ open, 11(8), e050407. https://doi.org/10.1136/bmjopen-2021-050407

Publisher

BMJ Open