Introduction

In recent years, bacterial resistance to antibiotics has reached dangerously high levels in all regions of the world. New mechanisms of resistance appear and spread, thus rendering the treatment of infectious diseases ineffective (WHO, 2014). For an increasing number of infections, such as urinary tract infections, pneumonia, tuberculosis and gonorrhea, treatment becomes more difficult or impossible because of the loss of antibiotic efficacy. The World Health Organization has regarded antibiotic resistance as a serious threat to human health and modern medicine, and it is a public health problem that is emerging exponentially in some countries, according to the same organization. Given the importance of the subject, we were led to undertake this study which aims to assess the frequency of community bacterial infection as well as establish a susceptibility profile of bacteria isolated antibiotics.

Materials and Methods

This is a prospective study, descriptive type. It was conducted in a non-hospital environment in a private laboratory for medical, biological analysis in Casablanca. This study was carried out on 1565 positive cytobacteriological samples taken from a population comprising all age categories and sex. It was spread over a 6-month period. The isolation of the different strains was carried out on the various samples: Urinary cytobacteriological examination (UCB), vaginal sampling (VS), pus, sputum, sperms, urethral swabs (US). The exclusion criteria concerned patients with negative examinations and other microorganisms (viruses, mycoses and parasites). Data collection was carried out using a sheet containing the following information (age, sex, nature of sampling, bacterial identification, results and antibiograms). An antibiogram is a test of resistance, prediction, growth and mandatory interpretation, and it is performed on the positive identifications according to the CA-SFM/EUCAST 2019 (Kahlmeter, Brown, & Goldstein, 2006). The data was exploited on Excel and statistical analysis on software SPSS V 10.

Results

From a total of 1565 samples, we isolated on all strains 1228 strains of gram-negative bacilli (BGN) with a frequency of 78.46%, 323 strains of Gram-positive cocci (CG +) or a frequency of 20, 64%, 14 strains of Gram-negative cocci (CG-) is a frequency of 0.9%. Figure 1.

The majority is represented by the female sex with a total of 1080 (69%) samples compared to the total sex male who was on the order of 485 (31%) levies. The sex ratio is 2.2. The distribution of isolates in relation to samples showed a predominance of UCBs which numbered 1076 (68.8%), vaginal specimens 195 (12.5%), urethral specimens 111 (7.1%), sputum 105 (6.7%), spermocultures 36 (2.3%), pus 28 (1.8%) and other various samples 14 (0.8%) Figure 2.

The distribution of isolated bacteria showed a prevalence of Enterobacteriaceae represented by Escherichia coli (E. coli) with a frequency of 986 (63.1%) followed by Klebsiella pneumoniae 235 (15.1%), Staphylococcus sp 106 (6.8%), Enterococcus sp 64 (4.1%), Streptococcus sp 59 (3.8%), Enterobacter sp 39 (2.5%), Pseudomonas sp 28 (1.7%), Proteus sp 25 (1.5%), Neisseria gonorrhoae 13 (0.8%), Citrobacter koseri 8 (0.5%) and finally Acinetobacter sp which was in the order of 2 (0.1%) Figure 3.

The sensitivity profile of enterobacteria to antibiotics is shown in Figure 4 with a frequency of amoxicillin + clavulanic acid (AMC) of 49.3 %, ceftriaxone (CRO) 97.1%, cefuroxime (CXM) 89%, cefotaxime (CTX) 100%, gentamicin (GM) 69.6%, ciprofloxacin (CIP) 75, 1%, sulfamethoxazole-trimethoprim (SXT) 41.1% and doxycycline (DO) 29.9%.

Discussion

In view of the results obtained, there is a strong female predominance with a sex ratio of 2.2. This predominance is justified by several studies showing that women have a high probability of contracting urinary tract infections. Several national studies attest to this, namely a study carried out in Rabat sex ratio, which was 2.33 (Bakili, 2016). Urine samples are the largest category of samples; they are the majority and therefore representative. Of all the isolated strains, BGNs are the majority of the isolates, and the main isolated bacteria are E. coli and Klebsiella sp. Studies at the national and international levels demonstrate this predominance of BGNs. In Rabat (Bakili, 2016), E.coli was found at the head of the wire with a frequency of 47.1%, followed by Klebsiella pneumoniae with 12.4%. At the international scale, in Algeria (Bentroki et al., 2012), the predominance of E. coli represents a frequency of 53.33%, followed by Proteus mirabilis 10% and Klebsiella pneumoniae 10%. In France (Flores-Mireles, Walker, Caparon, & Hultgren, 2015), bacteria are represented by E. coli in 74.0%, followed by Klebsiella sp 8.0%, Proteus sp 5.1%, and Citrobacter sp. 3.0%. From these studies carried out either nationally or internationally, it can be seen that E.coli remains the most predominant causative agent and responsible for bacterial infections, especially urinary infections (Hadeq, 2016). The results of susceptibility of E. coli to antibiotics shows that the bacterium has a high resistance to AMP with a frequency of 20.1% sensitivity (a resistance of 79.9%), a slight sensitivity with SXT (41.7%). This increases with the CIP (55.9%) and finally the CMA (60.1%). However, its sensitivity is important for cephalosporins and IMP (100%). The strong resistance of E.coli to the MPA is consistent with the different studies conducted nationally (Hadeq, 2016). However, an improvement in sensitivity to AMC is found in several cities (Bakili, 2016; Hadeq, 2016). Compared with cefotaxime, a study conducted in Algeria showed a higher sensitivity compared to our results (95%). No strains exhibited resistance to Imipenem. Our results are comparable to national and international ones (Bentroki et al., 2012). This good activity of the imipenema is due to its expensive price and its limited use in the hospital. Bacteria produce a variety of enzymes, beta-lactamases, which inhibit the activity of antibiotics, especially aminopenicillins. However, this enzymatic activity is broken with clavulanic acid, which blocks the activity of these beta-lactamases.

Conclusion

The emergence of resistance in an out-of-hospital setting has become a global concern and a major public health problem. Many antibiotics are becoming more and more ineffective. This resistance can delay, hinder treatment and lead to complications and even death. Studies have yielded alarming results on the antibiotic resistance rate of bacteria involved in mainly urinary community infections. Awareness-raising action against the misuse of antibiotics, the standardization of therapeutic regimes and the issuing of preventive and curative recommendations would be desirable to control the spread of this phenomenon, which considers itself one of the major challenges of the new millennium.

Conflict of Interest

The authors declare that they have no conflict of interest for this study.

Funding Support

The authors declare that they have no funding support for this study.