Prevalence of multidrug resistant and ESBL producing Enterobacteriaceae among patients with urinary tract infections in Southwest Shewa, Ethiopia

BACKGROUND: Uropathogenic Enterobacteriaceae with multidrug resistance (MDR) have become a significant threat to global healthcare systems in the treatment of urinary tract infections (UTIs). This present study aimed to evaluate the prevalence of MDR and Extended-Spectrum Beta-Lactamases (ESBL)-producing Enterobacteriaceae among patients suspected of having UTIs in the Southwest Shewa Zone of Ethiopia. METHODS: A hospital-based cross-sectional study was conducted from January to March 2025. Midstream urine specimens were collected from 278 consecutive patients with urinary tract complaints, along with gathering comprehensive sociodemographic data. Enterobacteriaceae were isolated and identified using Gram staining and biochemical characteristics. Antibiotic susceptibility was determined using the Kirby-Bauer method on Mueller-Hinton agar. Logistic regression analysis was employed to identify factors linked to MDR-Enterobacteriaceae-related UTIs, considering a statistically significant P value of < 0.05. RESULT: Among the 278 enrolled patients, Enterobacteriaceae were recovered from 16.9% (47/278) of urine samples. Of these, 51.1% (24/47) were multidrug-resistant Enterobacteriaceae (MDRE) and 44.7% (21/47) were extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE). Escherichia coli predominated among MDRE isolates (38.3%, 18/47), while Klebsiella spp. demonstrated the highest species-level MDR rate (62.5%, 5/8). The isolates exhibited high-level resistance to ampicillin (63.8%, 30/47). Notably, all isolates remained susceptible to piperacillin-tazobactam or carbapenems. ESBL production, a history of UTI, and prior antibiotic use were identified as statistically significant factors associated with MDRE-related UTIs. Among these, prior antibiotic use emerged as the most statistically significant independent predictor of MDRE isolation in patients suspected of having UTIs (AOR 9.38, 95% CI: 1.30-67.65; p = 0.026). CONCLUSION: Enterobacteriaceae isolates from UTI-suspected patients in the study area exhibit a significant and escalating incidence of multidrug resistance. Therefore, the treatment of UTI should be informed by antimicrobial susceptibility patterns to ensure the judicious prescription of antibiotics. CLINICAL TRIAL NUMBER: Not applicable.