Prevalence, etiology, and factors associated with urinary tract infections among adult females at Nyamagana District Hospital in Mwanza city, Tanzania

Abstract

ABSTRACT Background: Urinary Tract Infections (UTIs) are public health problems affecting about 150 million people globally each year, mostly among females, representing the top 3 outpatient diagnoses in Nyamagana District in Mwanza region, Tanzania. Bacteria causing UTIs in females are diverse and incorrect treatment of UTIs could lead to antimicrobial resistance and potential complications such as kidney damage and renal failure. Several factors can increase the risk of UTIs including sexual practices, poor hygiene, low water intake, catheterization and history of UTIs. Aim: The aim of the study was to determine the prevalence, etiology, antimicrobial susceptibility patterns, and factors associated with UTIs among adult females at Nyamagana District Hospital in Mwanza City, Tanzania. Materials and Methods: A cross-sectional study was conducted among adult females (≥18 years) attending as outpatients at Nyamagana District Hospital between April and May 2024. A systematic random sampling procedure was used to recruit 392 participants. Data on sociodemographic, clinical, and behavioral factors associated with UTIs were collected using structured interview questionnaire and on etiology and antimicrobial susceptibility for UTIs were obtained through urine culture and sensitivity tests. Descriptive statistics and modified Poisson regression analysis (bivariate and multivariable analysis) were performed using STATA (version 15.1) where the association between UTIs and the independent variables was interpreted using adjusted prevalence ratios with significance level set at p-value< 0.05. Results: Among 392 participants with a Median age of 30 years and Interquartile Range (IQR) of 23 – 42 years, UTIs were found in 32.1% (95% CI: 27.5-36.8, n=126) adult females. The UTI was significantly associated with younger age, unsafe sexual activity, low drinking water intake, history of catheterization and knowledge on UTI prevention. Of the 126 isolated pathogens, gram-negative bacteria included Escherichia coli (31.7%, n=40), Klebsiella spp. (18.3%, n=23) and Enterobacter spp. (8.7%, n=11) and gram-positive bacteria included Staphylococcus aureus (21.4%, n=27) and Staphylococcus saprophyticus (5.6%, n=7). Escherichia coli, Staphylococcus aureus and Klebsiella spp., the predominant causative bacteria isolated had high antimicrobial susceptibility (≥80.0%) against antibiotics like Ciprofloxacin (E. coli – 87.5%, S. aureus – 85.2%, K. spp. – 87.0%), Gentamycin (E. coli – 100.0%, S. aureus – 88.9%, K. spp. – 95.7%), Ceftriaxone (E. coli – 85.0%) and Meropenem (E. coli – 92.5%, K. spp. – 95.7%). Low antimicrobial susceptibility rates ranged from 0.0% to 47.5% against Penicillin G, Trimethoprim-sulfamethoxazole, Erythromycin, Tetracycline, Clindamycin and Imipenem. Conclusion and Recommendations: The prevalence of UTIs is high among adult females at Nyamagana District Hospital with several socio-demographic, clinical and behavioral factors showing significant association with the disease. Escherichia coli, Staphylococcus aureus and Klebsiella spp. are the predominant causative bacteria, all of which have shown high antimicrobial susceptibility (≥80.0%) against antibiotics like Ciprofloxacin, Gentamycin, Ceftriaxone and Meropenem which are among the UTI treatment options as per Tanzania Mainland’s Standard Treatment Guideline (STG). Other treatment options in the guideline like Nitrofurantoin and Amoxicillin + Clavulanic acid showed considerably lower antimicrobial susceptibility (< 80%). Low antimicrobial susceptibility rates have been observed against other antibiotics which are not UTI treatment options (but could happen to be used) like Penicillin G, Erythromycin, Tetracycline, Trimethoprim-sulfamethoxazole, Clindamycin and Imipenem. There is a need to explore the effectiveness of existing UTI prevention and control interventions along with evaluating the utilization of the existing STG as possibility of UTI treatment contrary to recommended UTI treatment options may exist leading to antimicrobial resistance.