An analysis of urinary tract infection (UTI) isolates from East African countries found that roughly half were multidrug-resistant (MDR), researchers reported last week in JAC-Antimicrobial Resistance.

For the study, researchers recruited children and adults with UTI-like symptoms from healthcare facilities in Tanzania, Kenya, and Uganda and collected urine samples for microbiologic analysis, including antimicrobial susceptibility testing. MDR bacteria were defined as isolates resistant to at least one agent in three or more classes of antibiotic agents.

Of the 7,583 patients with symptomatic UTIs (3,852 from Tanzania, 1,903 from Kenya, 1,828 from Uganda), 2,653 (35.0%) had a microbiologically confirmed UTI. The predominant bacteria were Escherichia coli (37.0%), Staphylococcus (26.3%), Klebsiella (5.8%), and Enterococcus (5.5%). Of the 2,266 isolates submitted for antimicrobial susceptibility testing, 1,153 (50.9%) were categorized as MDR.

Findings fill 'crucial data gap'

MDR rates were 60.9% in Tanzania, 57.5% in Uganda, and 36.9% in Kenya. By pathogen, Staphylococcus had the highest MDR rate (60.9%), followed by E coli (52.2%), Klebsiella (50.6%), Enterococcus (38.1%), and other Enterobacterales (31.2%). The rate of MDR bacteria was much higher in inpatients than outpatients. The analysis also found "severely high" levels of resistance across pathogens to first-line antibiotics for UTIs.

The study authors say the findings fill a crucial data gap and should be used to inform guidelines for empiric antibiotic treatment of UTIs in East Africa.

They concluded, "More broadly, we emphasize the need for urgent investment in routine AMR surveillance programmes, expansion of diagnostic laboratory capacities and diagnostic algorithms to facilitate antimicrobial stewardship and call for greater commitment from policymakers to counter the threat of AMR."

Saudi Arabia has reported four more MERS-CoV cases, all in people whose symptoms began in the latter months of 2023, the World Health Organization (WHO) said in a February 16 update.

The cases, two of which were fatal, were confirmed between October 10 and November 16. The patients are from three different regions: Riyadh, Eastern, and Qassim. Two were men, and two were women. All had underlying health conditions, and none were health workers.

Exposure unclear for two patients

One patient was a camel owner, while another had a history of indirect contact with camels. Exposure to the virus hasn't been determined for the other two patients, and none of the patients had consumed raw camel milk before their symptoms began. The WHO said there are no epidemiologic links between any of the patients, and no secondary cases were found.

The WHO said MERS-CoV cases have declined substantially since the start of the COVID-19 pandemic. It said reasons could include public health actions prioritizing COVID-19 case detections or COVID-19 mitigation actions such as masking and physical distancing, which could reduce human-to-human transmission.

Cross-protection from COVID infection or vaccination?

The group also said it's possible that cross-protection from COVID-19 infection or vaccination may be playing a role. However, the WHO added that the hypothesis requires further investigation.

The newly reported cases lift Saudi Arabia's number of Middle East respiratory syndrome coronavirus (MERS-CoV) to 2,200, which includes 858 deaths. The WHO said the cases don't change its risk assessment, which remains at moderate globally and regionally. It said more cases are expected from Saudi Arabia and other countries where the virus circulates in dromedary camels.

Florida health officials are investigating a measles outbreak at an elementary school in Broward County, with four cases reported so far, according to a report from Miami-based WSVN TV news, citing a statement from Broward County Public Schools.

Officials reported an initial case from a school in Weston on February 16, then on the following day, they reported three more measles infections from the same school.

At least 11 states have reported recent measles cases, according to the US Centers for Disease Control and Prevention (CDC), which in January urged health providers to be alert for cases amid an ongoing rise in global measles activity.