Community-Acquired Urinary Tract Infection Among Sexually Active Women: Risk Factors, Bacterial Profile and Their Antimicrobial Susceptibility Patterns, Arba Minch, Southern Ethiopia

Abstract

Background

Globally, urinary tract infections (UTIs) are a common health issue among women. Investigating risk factors associated with culture-proven UTIs and the antimicrobial resistance profile of uropathogens would provide insight into planning prevention and control measures.

Objective

To identify the risk factors associated with UTIs among sexually active women and determine antimicrobial susceptibility patterns of uropathogenic bacterial isolates.

Methods

A case-control study was conducted from February to June 2021, involving 296 women (62 case group and 234 control group in a ratio of 4:1). Cases were defined as culture-confirmed UTIs, and controls were non-UTIs. A semi-structured questionnaire was used to collect demographic, clinical, and behavioral data. The antimicrobial susceptibility test was done by the Kirby-Bauer disc diffusion method. The data were analyzed using SPSS version 25. Bivariable and multivariable logistic regressions were used to identify risk factors, and the strength of association was measured by adjusted odds ratios and a 95% confidence interval used at P-values < 0.05.

Results

The results revealed that recent coitus and frequency of coitus more than three times per week (P=0.001) were independent predictors of UTIs. Swabbing from back to front, a history of UTI and a delay in voiding were also independent predictors (P < 0.05). On the other hand, a daily water intake of 1 to 2 litres reduced the risk of UTI (P= 0.001). The predominant uropathogenic isolate was Escherichia coli (35.48%). Over 60% of isolates were resistant to cotrimoxazole, penicillin, cephalosporin, and fluoroquinolones. The most effective antibiotics included piperacillin-tazobactam, aminoglycosides, carbapenem, and nitrofurantoin. 85% and 50% of isolates were MDR and ESBL producers, respectively.

Conclusion

The finding indicates the importance of public intervention targeting the identified risk factors and the resistance phenotype to reduce the burden of UTIs with antimicrobial resistance in the study area.

Keywords:

• risk factors
• adolescents and young women
• bacteriuria
• symptomatic UTIs
• uropathogens
• antimicrobial resistance
• ESBL producing
• case-control
• Ethiopia

Abbreviations

AOR, Adjusted Odds Ratio; CLSI, Clinical and Laboratory Standards Institute. ESBL, Extended Spectrum Beta-Lactamase; HPF, High Power Field; SNNP, South Nation Nationality People; SPSS, Statistical Package for Social Science, UTI, Urinary Tract Infection; WHO, World Health Organization; MDR, multi-drug resistance; COR, crude odds ratio; AOR, adjusted odds ratio; ESBL, Extended-spectrum β-lactamase.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Acknowledgments

The authors are greatly indebted to Yetnayet Tadele, Mistru Gibe, Liulsege Yirgu, Zenit Elias, Moges Molla, and Meron Assefa for assistance during the data collection. In addition, the authors would like to thank the CEO, medical director, and the staff (clinicians and others) of Arba Minch General Hospital for assistance with study participant enrollment. Thanks to other staff in the Department of Medical Laboratory Science for the comment and guidance in developing the study protocols, data collection and data analysis. Finally, we are very grateful to all of the study participants.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

No specific grant was received for this research from any funding agencies in the public, commercial, or not-for-profit sectors.