Multidrug resistance in bacteria causing community-acquired urinary tract infections among adult outpatients attending primary healthcare facilities in Mwanza, Tanzania
5 affiliations
- 1Weil Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- 2Pharmacy Department, Igoma Health Centre, Mwanza, Tanzania
- 3Department of Biochemistry and Molecular Biology Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- 4Department of Epidemiology, Biostatistics and Behavioural science, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- 5Department of Microbiology and immunology, Weil Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
Abstract
Urinary tract infections (UTIs) are a common indication for antibiotic use among adult outpatients in low- and middle-income countries, yet data on community-acquired UTIs (CA-UTIs) and antimicrobial resistance at primary healthcare facilities remain limited. A facility-based cross-sectional study was conducted from May to August 2024 at Igoma and Buzuruga Health Centres in Mwanza, Tanzania. Symptomatic adults without hospitalization within the preceding 30 days or urinary catheterization were enrolled. Clinical and demographic data were collected, and midstream urine specimens were cultured, followed by antimicrobial susceptibility testing using the disc diffusion method. Of 1,005 participants, the median age was 32 years [IQR: 23–49], 727 (72.3%) were female, and 64.3% reported to have been diagnosed with UTI within the previous six months. The median symptom duration before presentation was 8 days [IQR: 5–15]. Culture-confirmed UTI was detected in 221 participants (22.0%; 95% CI: 19.5–24.7), with Escherichia coli (32.9%) and Staphylococcus aureus (24.7%) being the most frequently isolated pathogens. Only 35.7% of culture-confirmed cases are presented with classic urinary symptoms of dysuria, frequency, or urgency. E. coli showed high resistance to ampicillin (93.4%), ciprofloxacin (62.3%), trimethoprim-sulfamethoxazole (60.7%), amoxicillin-clavulanic acid (57.4%), and tetracycline (55.7%); 82.8% were multidrug-resistant and 20.3% exhibited extended-spectrum beta-lactamase phenotypes. Among S. aureus isolates, 64.6% were cefoxitin-resistant, indicating methicillin resistance. CA-UTIs therefore constitutes a substantial burden among adult primary-care outpatients, accompanied by high antimicrobial resistance and frequent atypical clinical presentations. Improved access to UTI diagnostics, strengthened antimicrobial stewardship, and locally informed treatment guidelines are needed, particularly given the high resistance to commonly used empirical antibiotics.
Related
- Nutritional status, clinical burden, and healthcare utilization among pediatric outpatients with congenital heart disease: A retrospective cross-sectional study from Indonesia
- Bacteriophage therapy against multidrug resistant bacterial infections demonstrates clinical advances and engineering innovations between 2020–2026
- The distribution and association of parasitic infections among human blood group in selected health facilities in Amhara National Regional State, Ethiopia: cross-sectional study, 2025
- Modeling the impact of healthcare personnel compensation and benefits on the spread of COVID-19 in skilled nursing facilities
- Impact of Pharmacist-Involved Antimicrobial Stewardship Interventions on Clinical and Process Outcomes in Multidrug-Resistant Organism Infections: A Systematic Review and Meta-Analysis.
BibTeX
@article{emmanuel2026multidrug,
title = {{Multidrug resistance in bacteria causing community-acquired urinary tract infections among adult outpatients attending primary healthcare facilities in Mwanza, Tanzania}},
author = {Eunice G. Emmanuel and Ashura Khamis and Elikana Michael and Dorina Muhizi and James Thomas and Bernard Okamo and Farida I. Mkassy and Eveline T. Konje and Vitus Silago and Martha F. Mushi and Stephen E. Mshana},
journal = {PLOS Global Public Health},
year = {2026},
month = oct,
doi = {10.1371/journal.pgph.0005638},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005638},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Multidrug resistance in bacteria causing community-acquired urinary tract infections among adult outpatients attending primary healthcare facilities in Mwanza, Tanzania
AU - Eunice G. Emmanuel
AU - Ashura Khamis
AU - Elikana Michael
AU - Dorina Muhizi
AU - James Thomas
AU - Bernard Okamo
AU - Farida I. Mkassy
AU - Eveline T. Konje
AU - Vitus Silago
AU - Martha F. Mushi
AU - Stephen E. Mshana
PY - 2026
DA - 2026/10/08
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0005638
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005638
AB - Urinary tract infections (UTIs) are a common indication for antibiotic use among adult outpatients in low- and middle-income countries, yet data on community-acquired UTIs (CA-UTIs) and antimicrobial resistance at primary healthcare facilities remain limited. A facility-based cross-sectional study was conducted from May to August 2024 at Igoma and Buzuruga Health Centres in Mwanza, Tanzania. Symptomatic adults without hospitalization within the preceding 30 days or urinary catheterization were enrolled. Clinical and demographic data were collected, and midstream urine specimens were cultured, followed by antimicrobial susceptibility testing using the disc diffusion method. Of 1,005 participants, the median age was 32 years [IQR: 23–49], 727 (72.3%) were female, and 64.3% reported to have been diagnosed with UTI within the previous six months. The median symptom duration before presentation was 8 days [IQR: 5–15]. Culture-confirmed UTI was detected in 221 participants (22.0%; 95% CI: 19.5–24.7), with Escherichia coli (32.9%) and Staphylococcus aureus (24.7%) being the most frequently isolated pathogens. Only 35.7% of culture-confirmed cases are presented with classic urinary symptoms of dysuria, frequency, or urgency. E. coli showed high resistance to ampicillin (93.4%), ciprofloxacin (62.3%), trimethoprim-sulfamethoxazole (60.7%), amoxicillin-clavulanic acid (57.4%), and tetracycline (55.7%); 82.8% were multidrug-resistant and 20.3% exhibited extended-spectrum beta-lactamase phenotypes. Among S. aureus isolates, 64.6% were cefoxitin-resistant, indicating methicillin resistance. CA-UTIs therefore constitutes a substantial burden among adult primary-care outpatients, accompanied by high antimicrobial resistance and frequent atypical clinical presentations. Improved access to UTI diagnostics, strengthened antimicrobial stewardship, and locally informed treatment guidelines are needed, particularly given the high resistance to commonly used empirical antibiotics.
SN - 2767-3375
ER -