A study at Kayunga Regional Referral Hospital in Uganda found that 42.1% of culture-confirmed urinary tract infection isolates showed antimicrobial resistance to at least one agent. The cross-sectional analysis covered January to June 2024 and points to a hospital setting where local resistance data had been limited.
Kayunga Regional Referral Hospital study
Researchers reviewed the KRRH Laboratory Microbiology Register, which listed 530 patients with presumptive urinary tract infections based on pyuria seen through microscopy and dipstick chemistry. From that pool, 240 patients were approached in random order, and 164 patients with culture-confirmed UTI were enrolled.
The team used Kirby-Bauer disk diffusion testing and interpreted zone diameters with Clinical and Laboratory Standards Institute M100, 33rd edition criteria. Drug and organism combinations without specific criteria, or involving intrinsic resistance, were not interpreted, and intermediate results were counted as not resistant.
Escherichia coli and Enterobacterales
Among the 164 isolates, 69 were resistant to at least one antimicrobial agent. Escherichia coli was the most frequent uropathogen, with 85 isolates, and 51 of those showed resistance to at least one agent.
Resistance also appeared in 7 of 34 Klebsiella spp. isolates and 6 of 18 Proteus spp. isolates. All 5 Enterococcus spp. isolates were resistant, while none of the 12 Pseudomonas spp. isolates and none of the 10 Staphylococcus spp. isolates were resistant to the agents with applicable criteria.
CLSI criteria and education
Among Enterobacterales isolates, resistance was highest to ampicillin at 32.0%. Ceftriaxone resistance was 23.4%, ceftazidime was 16.1%, and cotrimoxazole and meropenem were both 2.2%.
In multivariable analysis, tertiary education was associated with lower odds of antimicrobial resistance, with an adjusted odds ratio of 0.36, a 95% CI of 0.16 to 0.77, and p = 0.010. For patients at Kayunga Regional Referral Hospital, the finding gives a local resistance baseline that can be used when culture results arrive and treatment choices need to be narrowed quickly.
