Muhammad Asaduzzaman, MBBS, MPH, MPhil

GHES LMIC Fellow 2017-2018

Home Institution: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
U.S. Institution: University of California, Berkeley

Project Title: Genetic characterization and risk factors for multi-drug resistant uropathogens causing recurrent urinary tract infection in Bangladesh

Urinary tract infection(UTI) is the second most common cause of hospital visit around the world and constitute 25% of bacterial infections 1. It is a major public health concern due to its potential to affect all age groups, though females are more affected. E. coli is the major causative agent of UTI in Bangladesh accounting for 71% to 79% of total infection and the other important causative agents include Streptococcus spp., Pseudomonas aeruginosa, Staphylococcus aureus and Klebsiella pneumoniae. The alarming perspective is the recurrent episodes of urinary tract infections by these pathogens which constitute the more complex situation like multiple antibiotic resistance, treatment failure, and related complications and they are more common in young healthy females. Recurrent UTI is probably the most contributing cause of multidrug-resistant (MDR), community-acquired urinary infections with an increased susceptibility to vaginal colonization.

A recurrent urinary tract infection is a symptomatic UTI that follows clinical resolution of an earlier UTI generally, but not necessarily, after treatment. It is quantified as the occurrence of 3 or more urinary infections (following the complete clinical resolution of a previous UTI) in 12 months’ period.

In the proposed study, we will determine the prevalence of recurrent UTI in Bangladesh irrespective of the causative agents. There is no valid data on recurrent UTI in Bangladesh. We are also not aware of the causative agents that contribute more in recurrence and drug resistance. Even the risk factors including dietary factors are not well understood. Studies have identified the same genetic lineages between MDR uropathogenic E. coli (UPEC) and E. coli causing infection in food animals. Therefore, additional research is required to understand the contribution of food and food animals as reservoirs for uropathogens that causes recurrent UTI. It is also not known if the same E. coli is causing the recurrent episodes of UTI or not in the same patient and whether there are any particular dietary characteristics or health conditions associated with recurrent UTI caused by the same organism. We aim to address these knowledge gaps though this study.