{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:54:51Z","timestamp":1791482091793,"version":"4.3.4"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>\n                    Urinary tract infections (UTIs) are a common indication for antibiotic use among adult outpatients in low- and middle-income countries, yet data on community-acquired UTIs (CA-UTIs) and antimicrobial resistance at primary healthcare facilities remain limited. A facility-based cross-sectional study was conducted from May to August 2024 at Igoma and Buzuruga Health Centres in Mwanza, Tanzania. Symptomatic adults without hospitalization within the preceding 30 days or urinary catheterization were enrolled. Clinical and demographic data were collected, and midstream urine specimens were cultured, followed by antimicrobial susceptibility testing using the disc diffusion method. Of 1,005 participants, the median age was 32 years [IQR: 23\u201349], 727 (72.3%) were female, and 64.3% reported to have been diagnosed with UTI within the previous six months. The median symptom duration before presentation was 8 days [IQR: 5\u201315]. Culture-confirmed UTI was detected in 221 participants (22.0%; 95% CI: 19.5\u201324.7), with\n                    <jats:italic>Escherichia coli<\/jats:italic>\n                    (32.9%) and\n                    <jats:italic>Staphylococcus aureus<\/jats:italic>\n                    (24.7%) being the most frequently isolated pathogens. Only 35.7% of culture-confirmed cases are presented with classic urinary symptoms of dysuria, frequency, or urgency.\n                    <jats:italic>E. coli<\/jats:italic>\n                    showed high resistance to ampicillin (93.4%), ciprofloxacin (62.3%), trimethoprim-sulfamethoxazole (60.7%), amoxicillin-clavulanic acid (57.4%), and tetracycline (55.7%); 82.8% were multidrug-resistant and 20.3% exhibited extended-spectrum beta-lactamase phenotypes. Among\n                    <jats:italic>S. aureus<\/jats:italic>\n                    isolates, 64.6% were cefoxitin-resistant, indicating methicillin resistance. CA-UTIs therefore constitutes a substantial burden among adult primary-care outpatients, accompanied by high antimicrobial resistance and frequent atypical clinical presentations. Improved access to UTI diagnostics, strengthened antimicrobial stewardship, and locally informed treatment guidelines are needed, particularly given the high resistance to commonly used empirical antibiotics.\n                  <\/jats:p>","DOI":"10.1371\/journal.pgph.0005638","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:23:51Z","timestamp":1791480231000},"page":"e0005638","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multidrug resistance in bacteria causing community-acquired urinary tract infections among adult outpatients attending primary healthcare facilities in Mwanza, Tanzania"],"prefix":"10.1371","volume":"6","author":[{"given":"Eunice G.","family":"Emmanuel","sequence":"first","affiliation":[{"name":"Weil Bugando School of Medicine, Catholic University of Health and Allied Sciences","place":["Mwanza, Tanzania"]},{"name":"Pharmacy Department, Igoma Health Centre","place":["Mwanza, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1301-1748","authenticated-orcid":true,"given":"Ashura","family":"Khamis","sequence":"additional","affiliation":[{"name":"Weil Bugando School of Medicine, Catholic University of Health and Allied Sciences","place":["Mwanza, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6203-8297","authenticated-orcid":true,"given":"Elikana","family":"Michael","sequence":"additional","affiliation":[{"name":"Weil Bugando School of Medicine, Catholic University of Health and Allied Sciences","place":["Mwanza, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6866-8333","authenticated-orcid":true,"given":"Dorina","family":"Muhizi","sequence":"additional","affiliation":[{"name":"Weil Bugando School of Medicine, Catholic University of Health and Allied Sciences","place":["Mwanza, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2389-3902","authenticated-orcid":true,"given":"James","family":"Thomas","sequence":"additional","affiliation":[{"name":"Weil Bugando School of Medicine, Catholic University of Health and Allied Sciences","place":["Mwanza, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Okamo","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Molecular Biology Catholic University of Health and Allied Sciences","place":["Mwanza, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9589-3830","authenticated-orcid":true,"given":"Farida I.","family":"Mkassy","sequence":"additional","affiliation":[{"name":"Biostatistics and Behavioural science, School of Public Health, Catholic University of Health and Allied Sciences","place":["Mwanza, Tanzania"],"department":["Department of Epidemiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eveline T.","family":"Konje","sequence":"additional","affiliation":[{"name":"Biostatistics and Behavioural science, School of Public Health, Catholic University of Health and Allied Sciences","place":["Mwanza, Tanzania"],"department":["Department of Epidemiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vitus","family":"Silago","sequence":"additional","affiliation":[{"name":"Weil Bugando School of Medicine, Catholic University of Health and Allied Sciences","place":["Mwanza, Tanzania"],"department":["Department of Microbiology and immunology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3511-2523","authenticated-orcid":true,"given":"Martha F.","family":"Mushi","sequence":"additional","affiliation":[{"name":"Weil Bugando School of Medicine, Catholic University of Health and Allied Sciences","place":["Mwanza, Tanzania"],"department":["Department of Microbiology and immunology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen E.","family":"Mshana","sequence":"additional","affiliation":[{"name":"Weil Bugando School of Medicine, Catholic University of Health and Allied Sciences","place":["Mwanza, Tanzania"],"department":["Department of Microbiology and immunology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"pgph.0005638.ref001","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.2147\/IDR.S204880","article-title":"Community acquired urinary tract infections among adults in Accra, Ghana","author":"ES Donkor","year":"2019","journal-title":"Infection and Drug Resistance"},{"issue":"10325","key":"pgph.0005638.ref002","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"CJ Murray","year":"2022","journal-title":"The Lancet"},{"issue":"2","key":"pgph.0005638.ref003","doi-asserted-by":"crossref","first-page":"180","DOI":"10.3390\/pathogens12020180","article-title":"Molecular characterizations of the coagulase-negative staphylococci species causing urinary tract infection in tanzania: a laboratory-based cross-sectional study","volume":"12","author":"S Phillip","year":"2023","journal-title":"Pathogens"},{"issue":"1","key":"pgph.0005638.ref004","doi-asserted-by":"crossref","DOI":"10.1093\/jacamr\/dlae019","article-title":"Predominance of multidrug-resistant bacteria causing urinary tract infections among symptomatic patients in East Africa: a call for action","volume":"6","author":"A Maldonado-Barrag\u00e1n","year":"2024","journal-title":"JAC-antimicrobial resistance"},{"issue":"1","key":"pgph.0005638.ref005","doi-asserted-by":"crossref","DOI":"10.1186\/0778-7367-70-4","article-title":"Prevalence and predictors of urinary tract infection and severe malaria among febrile children attending Makongoro health centre in Mwanza city, North-Western Tanzania","volume":"70","author":"BP Msaki","year":"2012","journal-title":"Arch Public Health"},{"issue":"1","key":"pgph.0005638.ref006","doi-asserted-by":"crossref","first-page":"53","DOI":"10.24248\/eahrj.v1i1.388","article-title":"Prevalence, aetiology, and antimicrobial susceptibility patterns of urinary tract infection amongst children admitted at Kilimanjaro Christian Medical Centre, Moshi, Tanzania","volume":"1","author":"J Gidabayda","year":"2017","journal-title":"East African Health Res J"},{"key":"pgph.0005638.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2017\/4042686","article-title":"Urinary tract infections among hiv-positive pregnant women in Mwanza city, Tanzania, are high and predicted by low CD4+ count","volume":"2017","author":"T Chaula","year":"2017","journal-title":"Int J Microbiol"},{"issue":"1","key":"pgph.0005638.ref008","doi-asserted-by":"crossref","DOI":"10.1186\/s42269-023-01159-x","article-title":"Utility of dipstick urinalysis in the diagnosis of urinary tract infections among outpatients in Mwanza and Dar es Salaam regions in Tanzania","volume":"48","author":"SS Masoud","year":"2024","journal-title":"Bull Natl Res Cent"},{"issue":"12","key":"pgph.0005638.ref009","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.3390\/antibiotics11121718","article-title":"Multidrug-resistant uropathogens causing community acquired urinary tract infections among patients attending health facilities in Mwanza and Dar es Salaam, Tanzania","volume":"11","author":"V Silago","year":"2022","journal-title":"Antibiotics"},{"key":"pgph.0005638.ref010","article-title":"Prevalence of extended spectrum \u03b2-lactamase and ampc \u03b2-lactamase producing bacteria in urinary tract infection patients in Bangladesh","author":"FS Mitu","year":"2019","journal-title":"Malaysian J Microbiol"},{"issue":"5","key":"pgph.0005638.ref011","doi-asserted-by":"crossref","first-page":"800","DOI":"10.3390\/diagnostics11050800","article-title":"Mechanisms of resistance in gram-negative urinary pathogens: from country-specific molecular insights to global clinical relevance","volume":"11","author":"B Bedeni\u0107","year":"2021","journal-title":"Diagnostics"},{"issue":"4","key":"pgph.0005638.ref012","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.4314\/ahs.v16i4.31","article-title":"Factors associated with community-acquired urinary tract infections among adults attending assessment centre, Mulago Hospital Uganda","volume":"16","author":"D Kabugo","year":"2016","journal-title":"African Health Sciences"},{"issue":"1","key":"pgph.0005638.ref013","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-023-08641-x","article-title":"Prevalence of urinary tract infection and antimicrobial resistance patterns of uropathogens with biofilm forming capacity among outpatients in morogoro, Tanzania: a cross-sectional study","volume":"23","author":"EM Mlugu","year":"2023","journal-title":"BMC Infect Dis"},{"key":"pgph.0005638.ref014","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.2147\/IDR.S299776","article-title":"Prevalence of multidrug resistant UTI among people living with HIV in Northern Tanzania","author":"BN Ngowi","year":"2021","journal-title":"Infection and Drug Resistance"},{"issue":"12","key":"pgph.0005638.ref015","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-074833","article-title":"Five-year cross-sectional study to determine the burden ofCandidaspp. infections of the urinary tract system among patients attending tertiary hospital in Northwestern Tanzania","volume":"13","author":"ET Konje","year":"2023","journal-title":"BMJ Open"},{"key":"pgph.0005638.ref016","volume-title":"Standard Treatment Guidelines and National Essential Medicines List","author":"MOH","year":"2021"},{"key":"pgph.0005638.ref017","volume-title":"Standard treatment guidelines and national essential medicines list for Tanzania mainland","author":"Ministry of Health CD, Gender, Elderly and Children","year":"2021","edition":"6"},{"issue":"4","key":"pgph.0005638.ref018","doi-asserted-by":"crossref","first-page":"564","DOI":"10.2307\/2091346","article-title":"Sampling Organizations and Groups of Unequal Sizes","volume":"30","author":"L Kish","year":"1965","journal-title":"Am Sociol Rev"},{"issue":"5","key":"pgph.0005638.ref019","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1093\/oxfordjournals.humrep.a137722","article-title":"REVIEW: Pregnancy tests: a review","volume":"7","author":"T Chard","year":"1992","journal-title":"Human Reproduction"},{"issue":"5","key":"pgph.0005638.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0304388","article-title":"Protocol for surveillance of antimicrobial-resistant bacteria causing community-acquired urinary tract infections in low-income countries","volume":"19","author":"MV Majigo","year":"2024","journal-title":"PLoS ONE"},{"key":"pgph.0005638.ref021","volume-title":"Koneman\u2019s Color Atlas and Textbook of Diagnostic Microbiology","author":"P DA, G WG, D LC, G SH, W MJ, K EW","year":"2017"},{"issue":"1","key":"pgph.0005638.ref022","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-021-06460-6","article-title":"Evaluation of asymptomatic bacteruria management before and after antimicrobial stewardship program implementation: retrospective study","volume":"21","author":"A Alghamdi","year":"2021","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pgph.0005638.ref023","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.clinbiochem.2010.06.017","article-title":"MALDI-TOF mass spectrometry tools for bacterial identification in clinical microbiology laboratory","volume":"44","author":"E Carbonnelle","year":"2011","journal-title":"Clinical Biochemistry"},{"key":"pgph.0005638.ref024","volume-title":"Performance standards for antimicrobial susceptibility testing","author":"CLSI","year":"2023"},{"issue":"1","key":"pgph.0005638.ref025","doi-asserted-by":"crossref","DOI":"10.1186\/s12875-022-01905-6","article-title":"Non-prescribed antibiotic dispensing practices for symptoms of urinary tract infection in community pharmacies and accredited drug dispensing outlets in Tanzania: a simulated clients approach","volume":"23","author":"PM Ndaki","year":"2022","journal-title":"BMC Prim Care"},{"issue":"1","key":"pgph.0005638.ref026","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-025-21553-6","article-title":"Drivers of inappropriate use of antibiotics among community members in low- and middle-income countries: a systematic review of qualitative studies","volume":"25","author":"PM Ndaki","year":"2025","journal-title":"BMC Public Health"},{"issue":"5","key":"pgph.0005638.ref027","doi-asserted-by":"crossref","first-page":"325","DOI":"10.7196\/SAMJ.9644","article-title":"The World Health Organization Global Action Plan for antimicrobial resistance","volume":"105","author":"M Mendelson","year":"2015","journal-title":"S Afr Med J"},{"key":"pgph.0005638.ref028","volume-title":"Antimicrobial stewardship programmes in health-care facilities in low-and middle-income countries: a WHO practical toolkit","author":"Organization WH","year":"2019"},{"key":"pgph.0005638.ref029","volume-title":"Antimicrobial resistance: global report on surveillance","author":"World Health Organization","year":"2014"},{"key":"pgph.0005638.ref030","volume-title":"Kenya national action plan on antimicrobial resistance: review of progress in the human health sector","author":"World Health Organization WH","year":"2022"},{"issue":"3","key":"pgph.0005638.ref031","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(23)00019-0","article-title":"An analysis of existing national action plans for antimicrobial resistance\u2014gaps and opportunities in strategies optimising antibiotic use in human populations","volume":"11","author":"E Charani","year":"2023","journal-title":"The Lancet Global Health"},{"key":"pgph.0005638.ref032","volume-title":"WHO AWaRe Classification of Antibiotics for Evaluation and Monitoring of Use","author":"Organization WH","year":"2019"},{"issue":"1","key":"pgph.0005638.ref033","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(22)00423-5","article-title":"The role of multidimensional poverty in antibiotic misuse: a mixed-methods study of self-medication and non-adherence in Kenya, Tanzania, and Uganda","volume":"11","author":"DL Green","year":"2023","journal-title":"The Lancet Global Health"},{"issue":"5","key":"pgph.0005638.ref034","doi-asserted-by":"crossref","first-page":"2378","DOI":"10.3390\/ijms27052378","article-title":"The Citrobacter freundii Complex as an Emerging Pathogen: Genomic Plasticity, Virulence, and Antimicrobial Resistance","volume":"27","author":"A-E Duduveche","year":"2026","journal-title":"IJMS"},{"issue":"5","key":"pgph.0005638.ref035","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1128\/AAC.46.5.1190-1198.2002","article-title":"Origin and Evolution of the AmpC \u03b2-Lactamases of Citrobacter freundii","volume":"46","author":"M Barlow","year":"2002","journal-title":"Antimicrob Agents Chemother"},{"issue":"5","key":"pgph.0005638.ref036","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1038\/nrmicro3432","article-title":"Urinary tract infections: epidemiology, mechanisms of infection and treatment options","volume":"13","author":"AL Flores-Mireles","year":"2015","journal-title":"Nat Rev Microbiol"},{"issue":"2","key":"pgph.0005638.ref037","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1038\/s41579-024-01092-4","article-title":"Urinary tract infections: pathogenesis, host susceptibility and emerging therapeutics","volume":"23","author":"MR Timm","year":"2024","journal-title":"Nat Rev Microbiol"},{"key":"pgph.0005638.ref038","volume-title":"Standard treatment guidelines and national essential medicines list for Tanzania mainland","author":"MoHT","year":"2021","edition":"6"},{"issue":"2","key":"pgph.0005638.ref039","doi-asserted-by":"crossref","DOI":"10.1093\/jacamr\/dlaf038","article-title":"Patterns of antibiotic resistance in urinary tract infections before and during the COVID-19 pandemic in Uganda and Tanzania","volume":"7","author":"V Silago","year":"2025","journal-title":"JAC-Antimicrobial Resistance"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005638","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:24:00Z","timestamp":1791480240000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005638"}},"subtitle":[],"editor":[{"given":"Emmanuel","family":"Olamijuwon","sequence":"first","affiliation":[{"name":"University of St Andrews","place":["UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,8]]},"references-count":39,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0005638","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,8]]}}}