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

In 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 were Escherichia coli (37.0%), Staphylococcus spp. (26.3%), Klebsiella spp. (5.8%) and Enterococcus spp. (5.5%). E. coli contributed 982 of the isolates with an MDR proportion of 52.2%. Staphylococcus spp. 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement HATUA is a Global Context Consortia Award (MR/S004785/1) funded by the National Institute for Health Research, Medical Research Council, and the Department of Health and Social Care. This UK funded award is part of the EDCTP2 programme supported by the European Union. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The studies involving human participants were reviewed and approved by University of St Andrews, UK (number MD14548, 10/09/19); National Institute for Medical Research, Tanzania (number 2831, updated 26/07/19); Catholic University of Health and Allied Sciences Research and Bugando Medical Centre Joint Ethics and Review Committee, Tanzania (number CREC /266/2018, updated on 02/2019); Mbeya Medical Research and Ethics Committee, Tanzania (number SZEC-2439/R.A/V.1/303030); Kilimanjaro Christian Medical College, Tanzania (number 2293, updated 14/08/19); Uganda National Council for Science and Technology (number HS2406, 18/06/18); Makerere University, Uganda (number 514, 25/04/18); and Kenya Medical Research Institute (04/06/19, Scientific and Ethics Review Committee (SERU) number KEMRI/SERU/CMR/P00112/3865 V.1.2). The patients/participants provided their written informed consent to participate in this study. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript