Etiology, Prevalence, and Antimicrobial Resistance Patterns in Urinary Tract Infections in Patients Attending Victoria Chitepo Provincial Hospital from 2023–2025

Abstract

Urinary Tract Infections (UTIs) constitute a major global public health challenge, contributing significantly to morbidity and healthcare costs. The escalating crisis of antimicrobial resistance (AMR) severely compromises the effective management of UTIs, particularly in resource-limited settings where empirical prescribing is escalating. In Zimbabwe, a critical gap exists in current, local data on the causative uropathogens and their evolving resistance profiles, leading to potential treatment failures. This study aimed to investigate the etiology, prevalence, and antimicrobial resistance patterns of uropathogens isolated from patients aged 18–75 attending Victoria Chitepo Provincial Hospital in Mutare from 2023 to 2025, to inform local treatment guidelines and stewardship efforts. A laboratory-based, cross-sectional study design was employed, analyzing retrospective data from the hospital's microbiology department. A calculated sample size of 182 confirmed UTI cases was obtained through stratified random sampling, ensuring representation across different age groups and genders. Data extraction focused on patient demographics, identified pathogens, and results from antimicrobial susceptibility testing (AST), which was performed using standard disk diffusion methods. Data analysis involved descriptive statistics to determine prevalence and resistance rates. The analysis revealed a consistent female predominance in UTI cases, with peaks in the 26–35 and 66–75 age groups. Gram-negative bacteria were responsible for 73.9% of all infections, with Escherichia coli (37.5% in 2023, 37.7% in 2025) and Klebsiella pneumoniae (23.4% to 24.6%) as the predominant pathogens. A trend of escalating resistance was observed as follows: ampicillin (78% to 85%), amoxicillin (72% to 80%), ciprofloxacin (65% to 74%), and ceftriaxone (60% to 70%), indicating a rise in Extended Spectrum Beta-Lactamase (ESBL) producers. In contrast, nitrofurantoin (18-22% resistance) and gentamicin (28-32% resistance) demonstrated sustained and reliable efficacy. This study provides compelling evidence of a high and persistent burden of UTIs driven by multidrug-resistant Gram negative bacteria in this Zimbabwean setting. The year-on-year increase in resistance to essential antibiotics renders many current empirical therapies obsolete. The research thus recommends the immediate formal revision of hospital treatment guidelines to promote nitrofurantoin as a more efficient choice of first-line agents, the establishment of a robust antimicrobial stewardship program and the enhancement of laboratory capacity to include routine ESBL confirmatory testing. These actions are vital to curbing AMR, improving clinical outcomes, and safeguarding public health.