Antimicrobial resistant pattern and its associated factors in UTI causative pathogen among women of reproductive age (15-45 years) at Lira Regional Referral Hospital : a retrospective study

Abstract

Urinary tract infections (UTIs) are a major public health concern, with rising antimicrobial resistance (AMR) posing treatment challenges globally. This retrospective study assessed AMR patterns and associated factors among UTI-causing pathogens in women of reproductive age (15-45 years) attending Lira Regional Referral Hospital in Northern Uganda. We analyzed 481 patient records from 2021-2024, focusing on culture results, antibiotic susceptibility patterns, and clinical predictors of resistance. Escherichia coli emerged as the predominant pathogen (16.4%), while a striking 81% of isolates remained uncategorized, highlighting diagnostic limitations. Resistance was highest to erythromycin (11.1%), trimethoprim (8.3%), and ciprofloxacin (7.8%). Notably, nitrofurantoin demonstrated excellent efficacy (96.1% susceptibility), while E. coli showed complete resistance to nalidixic acid and 66.7% resistance to clindamycin. Prior antibiotic use within six months was a predictor of resistance (OR=11.98, 95% CI: 6.95-21.32), with 34.7% of cases involving self-medication. These findings underscore three critical concerns: (1) the predominance of non-E. coli pathogens requiring better diagnostic characterization, (2) the alarming resistance to commonly used antibiotics, and (3) the substantial impact of prior antibiotic exposure on resistance patterns. The study recommends, an enhanced diagnostic capacity, robust antibiotic stewardship programs, emphasize the need for decentralized AMR surveillance, tailored treatment guidelines that account for regional resistance patterns, and filling of the crucial knowledge gap for this underserved region, at Lira Regional Referral Hospital. Addressing these challenges will be essential for preserving antibiotic efficacy and improving UTI management in resource-limited settings.