Patterns and trends of antimicrobial resistance in bacterial isolates from urine cultures in Eritrea, 2010 – 2021: a secondary dataset analysis

Although the threat posed by antimicrobial resistance (AMR) in urinary tract infections (UTI) is well documented; significant knowledge gaps remain for most countries in Sub Saharan Africa. In this study, we aimed to describe the most common uropathogens in Eritrea. The magnitude, trends, and factors associated with AMR and multidrug-resistance (MDR) were also assessed. A retrospective record review of data (January 2010 – 2021) collected from all urine samples from patients from multiple treatment centers in Eritrea and analyzed at the microbiology department at the National Reference Laboratory (NHL) was undertaken. SPSS was used for statistical analysis, and Microsoft Excel was used to plot figures. A total of 2,999 isolates were recovered from 2010 to 2021. Of these, 91% (2728) were gram negative bacteria (GNB). In decreasing frequency, the most common organisms included E. coli (39.7%, n = 1,190); Klebsiella spp. (10.7%, n = 322), Citrobacter spp. (8.7%, n = 260), Enterobacter spp. (7.1%, n = 213), Proteus spp (7%, n = 209), Streptococcus Group D (6.5%, n = 194) and Pseudomonas aeruginosa (6.4%, n = 193). The prevalence of AMR in UTI was high with an equally high prevalence of MDR organisms (2414 (80.5%)). Furthermore, a multiple antibiotic resistance (MAR) index > 2 in GNB was obtained in 81.1% of the isolates. Although age and the presence of indwelling devices were significantly associated with the probability of MDR in the adjusted prevalence ratio; the relationship was attenuated in the unadjusted prevalence ratio (uPR). Finally, only sex (higher in males: uPR: 2.97) and isolates of a specific genus were associated with MDR. Compared to Escherichia coli, the probability of MDR followed the following sequence: Pseudomonas aeruginosa >; (uPR: 16.9) > Proteus spp. (uPR: 5.2) > other GNBs (uPR: 2.1) > Citrobacter spp (uPR: 1.67). Interestingly, all gram positive bacteria (GPBs) (S. aureus, Streptococcus group D) had a reduced likelihood of MDR. We identified a high and increasing prevalence of AMR and MDR in patients with UTI in Eritrea. The findings underscore the urgent need for improved AMR testing strategies, AMR surveillance, and infection control measures. While this study did not directly assess laboratory infrastructure, the high resistance rates highlight the importance of strengthening diagnostic capacity and utilizing locally generated data to optimize treatment guidelines.