Alarming Quinolone and Fluoroquinolone Resistance in Uropathogenic E. Coli from Acute Prostatitis Cases in Niger: A Call for Urgent Empiric Treatment Re-Evaluation

Background: The management of acute prostatitis is increasingly complicated by the growing antibiotic resistance of causative pathogens. This study aimed to determine the resistance profiles of uropathogenic Escherichia coli isolates to quinolones and fluoroquinolones in patients with acute prostatitis in Niger. Methods: A prospective cross-sectional study was conducted from July 1 to October 15, 2018, at the Lamordé National Hospital in Niamey. Urine samples from patients clinically diagnosed with acute prostatitis underwent cytobacteriological examination and culture. Phenotypic identification of bacterial isolates and antibiotic susceptibility testing were performed using the Kirby-Bauer disk diffusion method, following CA-SFM/EUCAST 2017 guidelines. Results: Of 223 patients seen in the urology department during the study period, 73 (32.7%) were diagnosed with acute prostatitis. Among these, 65 (89%) had positive urine cultures. E. coli was the predominant pathogen, accounting for 33 (50.77%) of all isolates. Susceptibility testing revealed an extremely high resistance rate of E. coli to nalidixic acid (a quinolone) at 96.9%. Resistance to fluoroquinolones was also alarmingly high, with 60.6% of isolates resistant to ciprofloxacin and 48.5% to ofloxacin. Conclusion: The high prevalence of quinolone and fluoroquinolone resistance in E. coli causing acute prostatitis necessitates an urgent revision of empirical treatment guidelines in Niger. These findings underscore the critical need for routine antimicrobial surveillance to guide therapeutic choices. Further molecular studies are warranted to characterize the underlying resistance genes and mechanisms.