Predominance of multidrug-resistant (MDR) bacteria causing urinary tract infections (UTIs) among symptomatic patients in East Africa: a call for action

Abstract

AbstractIn low-and middle-income countries, antibiotics are often prescribed for patients with symptoms of urinary tract infections (UTIs) without microbiological confirmation. Inappropriate antibiotic use can contribute to antimicrobial resistance (AMR) and the selection of multi-drug resistant (MDR) bacteria. Data on antibiotic susceptibility patterns of cultured bacteria are important in drafting empirical treatment guidelines and monitoring resistance trends, which can prevent the spread of AMR. In East Africa, antibiotic susceptibility data are sparse. To fill the gap, this study reports common microorganisms and their susceptibility patterns isolated from patients with UTI-like symptoms in Kenya, Tanzania, and Uganda in 2019-2020. Microbiologically confirmed UTI was observed in 2,653 (35.0%) of the 7583 patients studied. The predominant bacteria wereEscherichia coli(37.0%),Staphylococcusspp. (26.3%),Klebsiellaspp. (5.8%) andEnterococcusspp. (5.5%).E. colicontributed 982 of the isolates with an MDR proportion of 52.2%.Staphylococcusspp. contributed 697 of the isolates with an MDR rate of 60.3%. The overall proportion of MDR bacteria (n=1,153) was 50.9%. MDR bacteria are common causes of UTI in patients attending healthcare centres in East African countries, which emphasizes the need for investment in laboratory culture capacities and diagnostic algorithms to improve accuracy of diagnosis that will lead to appropriate antibiotic uses to prevent and control AMR.