Patterns of antibiotic resistance in urinary tract infections before and during the COVID-19 pandemic in Uganda and Tanzania

Background: Increased antimicrobial use during the COVID-19 pandemic has driven antimicrobial resistance (AMR) globally, particularly in resource-limited settings. This study assessed AMR patterns in urinary tract infections (UTIs) in Uganda and Tanzania before and during the pandemic. Methods: A cross-sectional study was conducted among UTI patients at healthcare facilities in Mbarara (Uganda) and Mwanza (Tanzania) between March 2019-September 2020 and January-December 2021. Mid-stream urine samples were collected and analysed following standard procedures. AMR patterns were compared across the two periods. Results: A total of 5563 patients were enrolled from Mwanza (55.0%, n = 3061) and Mbarara (45.0%, n = 2502). The overall prevalence of microbiologically confirmed UTIs in Mwanza was 32.5% (999/3060; 95% CI: 30.9%-34.3%), raised from 30.1% (655/2180; 95% CI: 28.1%-32.0%) before to 39.1% (344/880; 95% CI: 35.8%-42.4%) during the pandemic. Whereby, the overall prevalence of microbiologically confirmed UTIs in Mbarara was 24.8% (620/2502; 95% CI: 23.1%-26.5%), decreasing from 27.5% (502/1824; 95% CI: 25.5%-29.6%) before to 17.4% (118/678; 95% CI: 14.6%-20.5%) during the pandemic. The proportion of multidrug-resistant Gram-negative bacteria (MDR-GNB) rose significantly (74% versus 83.4%, P = 0.01) while MDR Gram-positive bacteria (MDR-GPB) increased slightly (55.5% versus 56.7%, P = 0.45) in Mwanza. Conversely, MDR-GPB increased substantially (31.4% versus 51.6%, P = 0.09) while MDR-GNB decreased (67.3% versus 61.9%, P = 0.22) in Mbarara. Conclusions: This study provides critical insights into AMR trends in UTI pathogens in Tanzania and Uganda, emphasizing the need for stringent antimicrobial stewardship, requiring ongoing surveillance and targeted interventions.