Multi-drug resistant (MDR) bacterial urinary tract infection (UTI) is a significant health threat in the geriatric population, with limited data in this study area. Therefore, this study aimed to assess the burden of MDR bacterial isolates and associated risk factors among UTI-confirmed geriatrics in Gondar, providing essential information for geriatric patients, healthcare workers, scientists, and policymakers to guide antibiotic stewardship interventions. A prospective cross-sectional study was conducted among 204 UTI-confirmed geriatrics. Socio-demographic data were collected via a structured questionnaire, and bacterial identification and drug resistance testing followed standard microbiological techniques. Data were entered using Epi Data version 4.0.0 and analyzed by Stata/IC version 14.0, with bivariate and multivariate logistic regressions to identify risk factors. A P-value < 0.05 was considered statistically significant. The overall prevalence of MDR UTI-confirmed geriatrics and MDR bacterial isolates were 115 (56.4%) and 126 (49.6%), respectively. The MDR Gram-negative isolates accounted for 105 (83.3%), and Gram-positive isolates 21 (16.7%). The predominant MDR bacterium was E. coli 60 (47.6%), followed by K. pneumoniae 24 (19.1%), S. aureus 13 (10.3%), P. mirabilis and S. saprophyticus 8 (6.4%), Pseudomonas spp. 6 (4.8%), P. vulgaris 4 (3.2%) and K. rhinos 3 (2.4%). Extensive (XDR) and pan-drug resistant (PDR) isolates were 63 (24.8%) and 6 (4.8%), respectively. Risk factors such as recurrent UTI, hospitalization (≥ 4 days), antibiotic and urinary catheter use were statistically significant. This study found a high prevalence of MDR bacterial isolates in UTI-confirmed geriatrics, with most isolates resistant to tetracycline, beta-lactams, and quinolones. Escherichia coli was the most common MDR and XDR bacteria, while Pseudomonas was the only PDR isolate. Independent risk factors included recurrent UTI, hospitalization (≥ 4 days), antibiotic and urinary catheter use. Therefore, efforts should focus on reducing hospital stays, promoting rational drug use, and further research.

Background: The human intestinal tract contains many commensals. However, during an imbalance of the normal microbiota following exposure to antibiotics, extended-spectrum β-lactamase- and carbapenemase-producing Enterobacterales emerge. Individuals colonized with these bacteria may develop subsequent infections themselves. Therefore, this review aimed to estimate the colonization rate of extended-spectrum β-lactamase- and carbapenemase-producing Enterobacterales in Ethiopia. Methods: The protocol was registered (PROSPERO ID: CRD42024550137). A systematic literature search was conducted in electronic databases, including PubMed, Google Scholar, and Hinari, to retrieve potential studies. The quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal tool. The data were extracted from the eligible studies using Microsoft Excel 2019 and analyzed using STATA version 11. Heterogeneity between studies was checked using I² test statistics. Publication bias was assessed using funnel plots and Egger’s test. A random-effects model of DerSimonian-Laird method was employed to estimate the outcomes. Results: A total of 15 studies with 4713 participants were included in the meta-analysis. The overall pooled colonization rates of extended-spectrum β-lactamase-producing and carbapenemase-producing Enterobacterales in Ethiopia were 28.5% (95% CI: 16.4-40.5%, I² = 95.9%, p < 0.001) and 4.4% (95% CI: 0.9–7.9%, I² = 0.0%, p = 0.64), respectively. The majority of the extended-spectrum β-lactamase producers were E. coli (20.6%, 95% CI: 9.3–31.9%, I² = 94.4%, p < 0.001), followed by Klebsiella spp. (11.1%, 95% CI: 7.7–14.6%, I² = 20.2%, p = 0.245). Similarly, the predominant carbapenemase producers were E. coli (2.7%, 95% CI: -1.3–6.7, I² = 0.0%, p = 0.941) and Klebsiella spp. (2.1%, 95% CI: -1.7–5.9%, I² = 0.0%, p = 0.999). Furthermore, the pooled estimate of multidrug resistance among extended-spectrum β-lactamase producers was 71.7% (95% CI: 55.25–88.05%, I² = 92.9%, p < 0.001). Conclusion and recommendations: Approximately one-quarter of Ethiopians are colonized with ESBL-PE, while about one in 25 is colonized with CPE. These findings were obtained from studies with a moderate-to-low risk of bias. However, the results for ESBL-PE showed significant variability, indicating high heterogeneity among the studies. This colonization may lead to subsequent extraintestinal infections. Therefore, proactive action from all stakeholders is required to combat the unrecognized spread of extended-spectrum β-lactamase- and carbapenemase-producing Enterobacterales in humans.

Background: Bacterial urinary tract infection (UTI) is the second most frequent infection next to respiratory tract infection within the geriatric population both in the community and hospital settings. There is a limited data regarding geriatrics UTI in this study area. Therefore, the current study aimed to assess the status of the community and hospital-acquired urinary tract infections, and antimicrobial susceptibility patterns among UTI suspected geriatrics which is essential to physicians and health care workers to implement appropriate intervention. Methods: A comparative cross-sectional study was conducted among 460 UTI suspected geriatrics admitted at the University of Gondar Comprehensive Specialized Hospital and attended in Gondar town (Kallen Bnakafl and Menna Geriatrics Support Center Clinics) from 1^st May 2022–14^th July 2022. Socio-demographic data were collected using structured questionnaires. Urine culture was performed and isolates were counted for significant growth by a colony counter, and their antibiotic susceptibility was done by the Kirby–Bauer disc diffusion method. Data were entered using Epi Data version 4.0.0 and analyzed by Stata/IC version 14.0. P-value < 0.05 at 95% CI was considered statistically significant. Result: The overall prevalence of UTI in geriatrics was 44.4%. The prevalence of UTI among community and hospitalized suspected patients was 38.7% and 50%, respectively. Escherichia coli (E. coli) (38.6%) predominated across the two groups, followed by Klebsiella spp. (15.8%), S. saprophyticus (12.2%), P. mirabilis (9.1%), S. aureus (5.9%), and Citrobacter spp. (2.8%). Pseudomonas spp. (7.1%), K. rhinoscleromatis (5.1%), and P. vulgaris (2.8%), were isolated from only hospitalized patients. Piperacillin-tazobactam susceptibly was 100% in both study groups. Nalidixic acid resistance was 50% to 87.5% and 50% to 100% in the isolates from community and hospitalized UTI suspects, respectively. Conclusion: This study found a high prevalence of bacterial UTI in geriatrics and a high rate of bacterial resistance was observed to most antimicrobial drugs tested. Piperacillin-tazobactam and meropenem were the most active antimicrobials for UTI. Therefore, expanding routine bacterial culture and antimicrobial susceptibility testing and strengthening regular surveillance systems are essential for appropriate patient care.