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

Vitus Silago; Katherine Keenan; Martha F. Mushi; Catherine Kansiime; Benon Asiimwe; Benjamin Sunday; Joel Bazira; Alison Sandeman; Wilber Sabiiti; Jeremiah Seni; Matthew T.G. Holden; Stephen E. Mshana; behalf of the HATUA and CARE Consortia

doi:10.1093/jacamr/dlaf038

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

Vitus Silago^*, Katherine Keenan, Martha F. Mushi, Catherine Kansiime, Benon Asiimwe, Benjamin Sunday, Joel Bazira, Alison Sandeman, Wilber Sabiiti, Jeremiah Seni, Matthew T.G. Holden, Stephen E. Mshana, behalf of the HATUA and CARE Consortia

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English
Article number	dlaf038
Pages (from-to)	1-4
Number of pages	4
Journal	JAC-Antimicrobial Resistance
Volume	7
Issue number	2
Early online date	14 Mar 2025
DOIs	https://doi.org/10.1093/jacamr/dlaf038
Publication status	Published - Apr 2025

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10.1093/jacamr/dlaf038Licence: CC BY

Silago-2025-Patterns-of-antibiotic-resistance-JAC-AR-7-dlaf038-CCBY
Copyright © The Author(s) 2025. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/ by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Final published version, 238 KBLicence: CC BY

CARE: COVID-19 and Antimicrobial Resista: CARE: COVID-19 and Antimicrobial Resistance in East Africa - Impact and Response
Holden, M. (PI), Sabiiti, W. (CoI) & Sloan, D. J. (CoI)
Medical Research Council
13/11/20 → 12/05/22
Project: Standard
CARE: COVID-19 and Antimicrobial Resista: CARE: COVID-19 and Antimicrobial Resistance in East-Africa - impact and response
Keenan, K. L. (PI) & Kesby, M. (CoI)
13/11/20 → 12/08/22
Project: Standard

Cite this

Silago, V., Keenan, K., Mushi, M. F., Kansiime, C., Asiimwe, B., Sunday, B., Bazira, J., Sandeman, A., Sabiiti, W., Seni, J., Holden, M. T. G., Mshana, S. E., & behalf of the HATUA and CARE Consortia (2025). Patterns of antibiotic resistance in urinary tract infections before and during the COVID-19 pandemic in Uganda and Tanzania. JAC-Antimicrobial Resistance, 7(2), 1-4. Article dlaf038. https://doi.org/10.1093/jacamr/dlaf038

@article{f79c61f320634147a3df10813d2fa7ee,

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

abstract = "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.",

author = "Vitus Silago and Katherine Keenan and Mushi, {Martha F.} and Catherine Kansiime and Benon Asiimwe and Benjamin Sunday and Joel Bazira and Alison Sandeman and Wilber Sabiiti and Jeremiah Seni and Holden, {Matthew T.G.} and Mshana, {Stephen E.} and {behalf of the HATUA and CARE Consortia} and David Aanensen and Annette Aduda and Alison Elliott and Fredricks, {Kathryn J.} and Gillespie, {Stephen H.} and Green, {Dominique L.} and Mike Kesby and Gibson Kibiki and John Kiiru and Lynch, {Andy G.} and John Maina and Mmbaga, {Blandina T.} and Mwanga, {Joseph R.} and Stella Neema and Sloan, {Derek J.} and Smith, {V. Anne} and John Stelling",

note = "Funding: This work was funded by the National Institute for Health and Care Research, UK [grant number MR/V036157/1] using UK aid from the UK Government to support Global Health Research.",

year = "2025",

month = apr,

doi = "10.1093/jacamr/dlaf038",

language = "English",

volume = "7",

pages = "1--4",

journal = "JAC-Antimicrobial Resistance",

issn = "2632-1823",

number = "2",

}

Silago, V, Keenan, K, Mushi, MF, Kansiime, C, Asiimwe, B, Sunday, B, Bazira, J, Sandeman, A , Sabiiti, W, Seni, J, Holden, MTG, Mshana, SE & behalf of the HATUA and CARE Consortia 2025, 'Patterns of antibiotic resistance in urinary tract infections before and during the COVID-19 pandemic in Uganda and Tanzania', JAC-Antimicrobial Resistance, vol. 7, no. 2, dlaf038, pp. 1-4. https://doi.org/10.1093/jacamr/dlaf038

TY - JOUR

T1 - Patterns of antibiotic resistance in urinary tract infections before and during the COVID-19 pandemic in Uganda and Tanzania

AU - Silago, Vitus

AU - Keenan, Katherine

AU - Mushi, Martha F.

AU - Kansiime, Catherine

AU - Asiimwe, Benon

AU - Sunday, Benjamin

AU - Bazira, Joel

AU - Sandeman, Alison

AU - Sabiiti, Wilber

AU - Seni, Jeremiah

AU - Holden, Matthew T.G.

AU - Mshana, Stephen E.

AU - behalf of the HATUA and CARE Consortia

AU - Aanensen, David

AU - Aduda, Annette

AU - Elliott, Alison

AU - Fredricks, Kathryn J.

AU - Gillespie, Stephen H.

AU - Green, Dominique L.

AU - Kesby, Mike

AU - Kibiki, Gibson

AU - Kiiru, John

AU - Lynch, Andy G.

AU - Maina, John

AU - Mmbaga, Blandina T.

AU - Mwanga, Joseph R.

AU - Neema, Stella

AU - Sloan, Derek J.

AU - Smith, V. Anne

AU - Stelling, John

N1 - Funding: This work was funded by the National Institute for Health and Care Research, UK [grant number MR/V036157/1] using UK aid from the UK Government to support Global Health Research.

PY - 2025/4

Y1 - 2025/4

N2 - 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.

AB - 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.

U2 - 10.1093/jacamr/dlaf038

DO - 10.1093/jacamr/dlaf038

M3 - Article

AN - SCOPUS:105000256153

SN - 2632-1823

VL - 7

SP - 1

EP - 4

JO - JAC-Antimicrobial Resistance

JF - JAC-Antimicrobial Resistance

IS - 2

M1 - dlaf038

ER -

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

Abstract

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Projects

CARE: COVID-19 and Antimicrobial Resista: CARE: COVID-19 and Antimicrobial Resistance in East Africa - Impact and Response

CARE: COVID-19 and Antimicrobial Resista: CARE: COVID-19 and Antimicrobial Resistance in East-Africa - impact and response

Cite this