Prevalence of antimicrobial resistance and associated factors among patients diagnosed with urinary tract infections at Kayunga Regional Referral Hospital, Uganda

Antimicrobial resistance (AMR) threatens healthcare delivery globally, with low- and middle-income countries being disproportionately affected. In Uganda, resistance rates among pathogens associated with urinary tract infection (UTI) have increased. However, facility-level data from district and regional hospitals remain limited. To determine the prevalence of AMR, describe resistance patterns, and identify associated factors among patients with culture-confirmed UTI at Kayunga Regional Referral Hospital (KRRH), Uganda. A cross-sectional study was conducted from January to June 2024. Of 530 patients with presumptive UTI (pyuria on microscopy and dipstick chemistry) recorded in the KRRH Laboratory Microbiology Register, 240 were approached in random order, and 164 with culture-confirmed UTI were enrolled. Culture and antimicrobial susceptibility testing were performed by Kirby-Bauer disk diffusion, and zone diameters were interpreted using organism-specific CLSI M100 (33rd edition) criteria. Drug and organism combinations without CLSI criteria, or with intrinsic resistance, were not interpreted. Sociodemographic, behavioural and health-system data were collected through structured interviews. AMR was defined as resistance to at least one agent for which criteria applied. Intermediate results were classified as not resistant. Associations were assessed using chi-square or Fisher’s exact tests and multivariable logistic regression. Of 164 isolates, 69 (42.1%, 95% CI 34.4–50.0%) were resistant to at least one agent. Escherichia coli was the most frequent uropathogen (85 isolates, 51.8%), and 51 (60.0%) of these were resistant to at least one agent. Resistance to at least one agent occurred in 7/34 (20.6%) Klebsiella spp., 6/18 (33.3%) Proteus spp . and 5/5 Enterococcus spp. isolates. None of the 12 Pseudomonas spp. or 10 Staphylococcus spp . isolates was resistant to the agents with applicable criteria. Among Enterobacterales ( n = 137), resistance was highest to ampicillin (32.0%), ceftriaxone (23.4%) and ceftazidime (16.1%), and lowest to cotrimoxazole and meropenem (2.2% each). In multivariable analysis, tertiary education was associated with lower odds of AMR (adjusted odds ratio [AOR] 0.36; 95% CI 0.16–0.77; p = 0.010). Being married (AOR 2.60; 95% CI 1.12–6.43; p = 0.031), not using herbal medicines (AOR 2.10; 95% CI 1.03–4.38; p = 0.044) and not having received AMR health education (AOR 2.11; 95% CI 1.05–4.32; p = 0.038) were associated with higher odds. Resistance to at least one antimicrobial agent was present in 42.1% of culture-confirmed UTI isolates and in 60.0% of E. coli isolates. In this cross-sectional study, lower education and no receipt of AMR health education were associated with higher odds of AMR. Patient education and antimicrobial stewardship at regional hospitals need to be evaluated and supported.