Bacterial Urinary Tract Infections, Antimicrobial Susceptibility Patterns and Associated Risk factors Among Fistula patients at Hamlin Fistula Hospital, Mekelle, Tigray, North of Ethiopia

Abstract

Background: Urinary tract infections (UTIs) are one of the most common bacterial infections in humans, both in the community and hospital. UTIs are a significant cause of hospital admissions, a widespread concern, affecting millions of people worldwide and causing significant morbidity, mortality, and serious healthcare costs. Patients with obstetric fistula usually suffer from urinary and stool incontinence that can predispose them to frequent infections with urinary tract infection. Despite this fact, there is lack of data on the prevalence, causative pathogens, and antimicrobial susceptibility patterns of UTIs, particularly in lower resource settings like Tigray, Ethiopia. Objective: The study aimed to assess the prevalence of bacterial urinary tract infection, evaluate antimicrobial susceptibility patterns and identify associated risk factors among fistula patients at Hamlin Fistula Hospital in Mekelle, Tigray, Ethiopia. Method: A cross-sectional study was conducted from January to May 2025 at Hamlin Fistula Hospital in Mekelle, Tigray. Socio-demographic characteristics and other urinary tract infection related risk factors were collected from study participants using structured questionnaires. The mid-stream urine was collected and cultured on Cysteine lactose electrolyte deficient agar, and MacConkey agar. Bacterial isolates of gram negative and gram positive were characterized using series of biochemical tests. Antimicrobial susceptibility was determined using the disc diffusion method and interpreted according to the Clinical and Laboratory Standards Institute (CLSI2020) guidelines. The data was entered and analyzed using SPSS version 27. Results: Out of the 151 patients sampled, 104 (68.8.6%) were found to have significant bacteria infecting the urinary tract. Isolation of significant bacteriuria was strongly associated with the history of previous UTI and history of catheterization (p=0.01). Eight different species of bacterial uropathogens were identified from the samples. The bacteria isolated were 94.2 % gram negative and 5.8% gram positive. The most predominant bacteria identified were E. coli followed by P.vulgaris. The isolated bacteria had shown the highest resistance rate (72.2%) to Tetracyllin followed by Ampicillin (69.2%) and highest susceptibility to Amikacin (100%) followed by Meropenem (98.1%). Twenty-six of the isolated bacteria (98) were found to be ESBL-producing gram-negative bacteria. Conclusion and recommendation: The overall prevalence of urinary tract infection among fistula patients is high. The predominant pathogen of UTI isolated was E. coli followed by P.vulgaris and K. peumoniae. All the bacterial isolates have shown multiple antibiotic resistance pattern. Based on the findings of the present study, routine screening, urine culture and antimicrobial susceptibility testing are recommended for all fistula patients.