Multidrug resistance bacteria causing community acquired urinary tract infections among adult outpatients attending lower-level health facilities in Mwanza, Tanzania

BackgroundUrinary tract infections (UTIs) remain a common clinical condition requiring antibiotic prescription among adult outpatients in low- and middle-income countries (LMICs). Data regarding the prevalence, patterns of bacteria and their antibacterial susceptibility profile for community acquired UTI are limited. MethodsA hospital-based cross-sectional study was conducted from May to August 2024 at Igoma and Buzuruga Health Centres in Mwanza. Symptomatic adults patients, without recent hospitalization (within past 30 days) or urinary catheterization were enrolled. Clinical and demographic data were collected followed by standard mid-stream urine culture and disc diffusion susceptibility testing. Descriptive data analysis was performed using STATA version 15. ResultsA total of 1,005 adult patients with the median age of 32 [IQR: 23-49] years were recruited, of whom 727 (72.3%) were female. The majority (64.3%) reported a previous history of UTI (within six months), and the median symptom duration before presentation was 8 [5-15] days. Microbiological confirmation of UTI was found in 221 patients (22.0%, 95% CI 19.5%-24.7%). The most frequently isolated uropathogens were Escherichia coli (32.9%) and Staphylococcus aureus (24.7%). Escherichia coli isolates were [≥]50% resistant to ciprofloxacin, amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole, tetracycline, and ampicillin. About 20.3% of E. coli isolates showed positive extended-spectrum beta-lactamase (ESBL) phenotypes whereas 64.6% of S. aureus were resistant to cefoxitin, hence methicillin-resistant S. aureus (MRSA) strains. Conclusion and recommendationThis study revealed a significant burden of community-acquired urinary tract infections (CA-UTIs) among adult outpatients, with an overall prevalence of 22%. Escherichia coli and Staphylococcus aureus were the most frequently isolated pathogens, and alarmingly high levels of antimicrobial resistance, particularly multidrug resistance in E. coli. Improved diagnostic capacity and strengthened antibiotic stewardship are urgently needed to guide effective management of community-acquired UTIs to control the AMR development. HighlightO_LIA total of 1,005 symptomatic adult patients at primary healthcare facilities were assessed for community-acquired urinary tract infections (CA-UTIs). C_LIO_LICA-UTIs were identified in 22% of cases, with Escherichia coli and Staphylococcus aureus as the most common pathogens. C_LIO_LIE. coli demonstrated a notably high rate of multidrug resistance, with 82.8% of isolates resistant to multiple antibiotic classes. C_LIO_LIOver 70% of Gram-negative bacterial isolates were resistant to at least three classes of antibiotics, presenting major treatment difficulties. C_LIO_LIThese results highlight the urgent need for ongoing surveillance and updated empirical treatment policies for UTIs in outpatient clinics, especially in resource-limited settings. C_LI