Prevalence of multi-drug resistant UTIs and antibiotic sensitivity profiles amongst male patients with bladder outlet obstruction: A cross-sectional study

Abstract

Background: Antimicrobial resistance (AMR) is a rapidly emerging global problem with multidrug resistant (MDR) urinary tract infections (UTIs) complicating treatment, particularly in low and middle-income countries (LMICs). Patients with bladder outlet obstruction (BOO) are at heightened risk of recurrent UTIs, contributing to irrational antibiotic use and resistance. The limited treatment options for MDR UTIs create significant challenges in patient management. Objective: To determine the prevalence of MDR UTIs and assess the antibiotic sensitivity profiles amongst patients with BOO at Mulago National Specialized Hospital from July to September 2024. Methodology: A cross-sectional study recruited 156 male BOO patients consecutively. Socio-demographic data was collected using quantitative tools, while urine samples underwent microbiological and antibiotic sensitivity testing. Data were analyzed using STATA (version 18). Ethical approval and informed consent were secured.

Utility: Findings may inform local treatment protocols to enhance patient management and combat antibiotic resistance.

Results: Microbiologically confirmed UTIs were found in 65 (41.03%) participants, with gram-negative rods / Enterobacteriaceae (88.06%) as the predominant cause. E. coli (35.82%) and Klebsiella (10.45%) were the most common isolates. MDR UTI prevalence was 39.10% (95% CI: 30.48–45.76), with ESBL-producing E. coli being the most resistant strain. Common uro-pathogens exhibited high resistance to ciprofloxacin, trimethoprim-sulfamethoxazole, cefuroxime, levofloxacin, and ceftriaxone but remained sensitive to amikacin, piperacillin-tazobactam, and meropenem. Having an indwelling catheter increases the odds of developing MDR UTIs by 4.63 compared to not having an indwelling catheter.

Conclusion: We observed a high proportion of MDR UTIs in symptomatic patients with BOO with high microbial resistance observed towards commonly used antibiotic options in our setting.