# Occurrence of Carbapenem Resistance Producing Uropathogens Isolated From Refugees at the Nakivale Settlement in Isingiro District, Uganda: A Cross-Sectional Study

## TL;DR

This study found a high rate of carbapenem-resistant urinary tract infections among refugees in Uganda's Nakivale settlement, highlighting the need for better antibiotic use and screening.

## Contribution

The study reports a high prevalence of carbapenem-resistant uropathogens in a refugee population in Uganda and identifies risk factors for resistance.

## Key findings

- 29% of participants had significant bacteriuria, with 61.8% of these isolates showing phenotypic carbapenem resistance.
- KPC was the most frequently detected carbapenemase gene among resistant isolates.
- Self-medication and prior antibiotic use were strongly associated with carbapenem resistance.

## Abstract

Introduction

Carbapenem-resistant uropathogens are an emerging public health problem in sub-Saharan Africa. Such resistant pathogens are transferred easily from one community to another, given the rapid spread of mobile genetic elements containing carbapenemase genes. Uganda hosts refugees from several neighboring East African countries, many of whom are settled in the Nakivale Refugee Settlement. In our study, we analyze the extent of carbapenem-resistant uropathogens among refugees in one of the largest camps in Uganda.

Methods

We recruited 308 consenting participants. Each participant was tested for bacteriological urinary tract infection (bUTI) using standard urine cultures. Significant bacteriuria was determined as growth ≥105 CFU/mL and conventional biochemical tests were used for the identification of uropathogens. Phenotypic screening for carbapenem resistance was achieved using the modified Hodges test. End-point polymerase chain reaction (PCR) using 1.5% agarose gel in electrophoresis was used for the detection of carbapenemase genes. Bivariate and multivariate logistic regression using Stata, version 14.0, was done to identify the factors associated with carbapenem-resistant uropathogens. Ethical clearance was obtained from the Institutional Review Board of the Mbarara University of Science and Technology (MUST).

Results

The overall significant (≥105 CFU/mL) single bacterial growth was 29.0% (89/308). We detected phenotypic resistance in 55 (61.8%) out of 89 isolates and carbapenem resistance gene detected in 20 (22.5%) out of 89 isolates. Escherichia coli was the most common uropathogen, detected in 32 (36%) out of 89 isolates. The most frequently detected carbapenemase gene was KPC in 11 (55%) out of 20 isolates. The factors associated with carbapenem resistance were history of self-medication (odds ratio (OR)=5.09, 95% CI: 1.04-24.77, p=0.044), antibiotic use before laboratory diagnosis (OR=6.07, 95% CI: 1.77-20.81, p=0.004), and having spent more than five months on antibiotics (OR=8.52, 95% CI: 1.47-49.36, p=0.017).

Conclusion

The prevalence of carbapenem-resistant uropathogens isolated from refugees at Nakivale settlement was high. Accurate antimicrobial stewardship program implementation in refugee settlements is urgently needed. Screening and identification of carbapenem-resistant Enterobacterial careers among refugees at entry point could be helpful in mitigating the spread in refugee settlement.