Region of acquisition of urinary tract infection (UTI) may be an important parameter while treating UTI cases

The study recently published on urinary tract infection (UTI) cases at Najran University Hospital, Najran region of Saudi Arabia (Alshabi et al., 2019), though small, only on 19 cases, have been concluded beautifully, “regional clinical data regarding the prevalence and efficacy of antibiotics should be taken into consideration along with the treatment guidelines”. The authors reported a study on only 19 cases of UTI, of which 14 patients (73.68%) were positive for Escherichia coli, two (10.52%) each for Staphylococcus aureus and Pseudomonas, and one for Staphylococcus haemolyticus. However, in a recently published study, on 217 confirmed human cases of UTI from Rohilkhand, Bareilly region of Northern India (Singh, 2019), the picture was much different, the most common cause of UTI, Escherichia coli, was associated with only 22.12% cases, S. aureus was a rare (0.98%) cause of UTI but S. haemolyticus and other staphylococci caused 5.53 and 13.36% cases of UTI, respectively. In the Bareilly study, pseudomonads caused only 2.76% cases while other less known bacteria were responsible for more than 55% of the cases of UTI in humans. In Ireland too, only 14.3 and 19.4% cases of UTI were associated with E. coli infection in male and female, respectively (Tandan et al., 2016). Although in Nepal (Pandey et al., 2017), E. coli caused 78.6% and in Iran (Fallah et al., 2018) it caused 69% cases of UTI, similar to the study in Saudi Arabia (Alshabi et al., 2019), level of drug resistance was quite high. In a study in Nigeria (Ekwealor et al., 2016), E. coli was associated with only 24.6% cases of UTI and among the other causes S. aureus dominated the scene causing 28% of the UTIs, followed by Staphylococcus saprophyticus (20%) and streptococci and enterococci caused a sizeable number of cases (7.4%). Though E. coli is one of the most common cause of UTIs (Pandey et al., 2017) emergence of new pathogens including Enterobacter, Enterococcus, Proteus, Klebsiella, Citrobacter, Raoultella, Streptococcus, etc., are complicating the therapeutics of UTIs (Ekwealor et al., 2016; Howell and Fakhoury, 2017; Abejew et al., 2014).