Assessment of antimicrobial prescribing appropriateness for adult urinary tract infections in Moyo general hospital, Northwestern Uganda: A stewardship perspective.

Abstract

Antimicrobial resistance is a growing global challenge, often driven by inappropriate antibiotic use. In Northern Uganda, the extent of guideline adherence and the alignment of empirical therapy with bacterial susceptibility patterns in urinary tract infections (UTIs) remain poorly understood. This study evaluated the appropriateness of antibacterial prescriptions for adult UTIs at Moyo General Hospital by identifying commonly used antibacterials and assessing their alignment with the Uganda Clinical Guidelines (UCG) and in vitro susceptibility patterns.This cross-sectional study assessed antibacterial prescribing for adult UTIs at Moyo General Hospital, evaluating adherence to UCG and concordance with in vitro susceptibility results. Using systematic random sampling, 404 patients were recruited from 958 eligible prescriptions. Data on demographics, clinical features, prescriptions, and laboratory results were collected, with urine cultures analysed at Yumbe Regional Referral Hospital. Descriptive and inferential statistics, including chi-square tests and logistic regression, were used to evaluate prescribing appropriateness. Ethical approval was obtained, and findings were disseminated through a dissertation, peer-reviewed publication, and presentations to local health teams.Escherichia coli (49.5%) and Staphylococcus aureus (31.6%) were the most frequently isolated pathogens. High in vitro susceptibility was observed for cefixime (93.9%), ceftriaxone (84.1%), and levofloxacin (82.4%), whereas nitrofurantoin and ciprofloxacin showed moderate activity (66.7% and 69.4%, respectively). Resistance was high for trimethoprim/sulfamethoxazole (82.3%) and ampicillin (73.8%). Only 40.7% of prescriptions were aligned with susceptibility results, and 39.5% adhered to UCG recommendations. Agreement between guideline-based and susceptibility-driven prescribing was slight (κ = 0.1435).These findings reveal substantial gaps in empirical prescribing, guideline adherence, and microbiological alignment for adult UTIs at Moyo General Hospital (MGH). To optimize UTI management and curb antimicrobial resistance in Northern Uganda, there is an urgent need to strengthen antimicrobial stewardship, improve access to diagnostic testing, update national guidelines using local resistance data, and enhance prescriber training.