Multidrug resistance in bacteria causing community-acquired urinary tract infections among adult outpatients attending primary healthcare facilities in Mwanza, Tanzania

Urinary tract infections (UTIs) are a common indication for antibiotic use among adult outpatients in low- and middle-income countries, yet data on community-acquired UTIs (CA-UTIs) and antimicrobial resistance at primary healthcare facilities remain limited. A facility-based cross-sectional study was conducted from May to August 2024 at Igoma and Buzuruga Health Centres in Mwanza, Tanzania. Symptomatic adults without hospitalization within the preceding 30 days or urinary catheterization were enrolled. Clinical and demographic data were collected, and midstream urine specimens were cultured, followed by antimicrobial susceptibility testing using the disc diffusion method. Of 1,005 participants, the median age was 32 years [IQR: 23–49], 727 (72.3%) were female, and 64.3% reported to have been diagnosed with UTI within the previous six months. The median symptom duration before presentation was 8 days [IQR: 5–15]. Culture-confirmed UTI was detected in 221 participants (22.0%; 95% CI: 19.5–24.7), with Escherichia coli (32.9%) and Staphylococcus aureus (24.7%) being the most frequently isolated pathogens. Only 35.7% of culture-confirmed cases are presented with classic urinary symptoms of dysuria, frequency, or urgency. E. coli showed high resistance to ampicillin (93.4%), ciprofloxacin (62.3%), trimethoprim-sulfamethoxazole (60.7%), amoxicillin-clavulanic acid (57.4%), and tetracycline (55.7%); 82.8% were multidrug-resistant and 20.3% exhibited extended-spectrum beta-lactamase phenotypes. Among S. aureus isolates, 64.6% were cefoxitin-resistant, indicating methicillin resistance. CA-UTIs therefore constitutes a substantial burden among adult primary-care outpatients, accompanied by high antimicrobial resistance and frequent atypical clinical presentations. Improved access to UTI diagnostics, strengthened antimicrobial stewardship, and locally informed treatment guidelines are needed, particularly given the high resistance to commonly used empirical antibiotics.