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Antimicrobial Resistance Trends in Urinary Tract Infections in 6 African Countries
Lala Fanomezantsoa Rafetrarivony1, Félix Cheysson2, Dissou Affolabi3,4
1Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar.
JAMA Network Open
|July 9, 2026
Summary
Antimicrobial resistance in urinary Escherichia coli and Klebsiella pneumoniae is alarmingly high and increasing across Africa. Urgent interventions are needed to combat rising resistance to common antibiotics like cephalosporins and fluoroquinolones.
Area of Science:
- Clinical microbiology
- Infectious diseases
- Public health
Background:
- Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are leading causes of urinary tract infections (UTIs).
- Antimicrobial resistance (AMR) in these pathogens is a significant global health concern.
- Data on AMR trends in African countries are limited, particularly for urine isolates.
Purpose of the Study:
- To analyze antimicrobial resistance trends in E. coli and K. pneumoniae urinary isolates from six African nations.
- To project future resistance patterns for these critical UTI pathogens.
Main Methods:
- Retrospective analysis of urine isolates from clinical laboratories in Cameroon, Central African Republic, Madagascar, Morocco, Senegal, and Benin (2010-2022).
- Assessed resistance to key antibiotic classes including aminopenicillins, fluoroquinolones, cephalosporins, and carbapenems.
- Utilized logistic regression with generalized estimating equations to model resistance trends.
Main Results:
- Over 44,000 isolates showed high E. coli resistance to amoxicillin (>85%) and amoxicillin-clavulanate (>50%) by study end.
- Resistance to third-generation cephalosporins (3GCs) and fluoroquinolones exceeded 35% for E. coli and increased significantly in K. pneumoniae in most countries.
- Carbapenem resistance remained below 18% but reached concerning levels in Madagascar for both species.
Conclusions:
- The study reveals elevated and escalating AMR in E. coli and K. pneumoniae urinary isolates across Africa.
- Findings highlight the urgent need for enhanced antimicrobial stewardship and infection control measures in the region.
- Projected resistance suggests a critical future burden if current trends persist.
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