Urinary tract infections are among the most prevalent extra-intestinal infections, with high prevalence globally. This cross-sectional study established prevalence of bacterial aetiology causing urinary tract infection (UTI) and their antimicrobial susceptibility profiles. A questionnaire was used to capture socio-demographic data and possible UTI risk factors among the 206 consented adults seeking medicare at Kiambu Level 5 Hospital. The collected midstream urine samples were subjected to dipstick analysis, microscopy and culture for UTI diagnosis. Results: The overall prevalence rate of UTIs was 27.6%, with women's prevalence rate being significantly higher at 80.7% compared to men 19.2%. Pregnant women had UTI prevalence at 34% which was higher than other sets of participants. Women who did not frequently change their underpants daily had a higher UTI cases at 34.8%. Escherichia coli, Staphylococcus aureus and Klebsiella pneumoniae were the most prevalent bacterial pathogens at 38.5%, 21% and 19.3%, respectively. Antimicrobial sensitivity analysis revealed high resistances towards Sulfamethoxazole and Ampicillin at range between 50% -85%, suggesting that these drugs are no longer effective for UTI empirical treatment. The resistance patterns towards Cefotaxime, Cefepime and Ciprofloxacin were below 40%. However, more resistance patterns at a range between 14% -40% revealed towards Amoxicillin-clavulanic and Nitrofurantoin imply that these are drugs remain potent but there is the need to revise the current UTI management guidelines.

Introduction. Culture is the gold-standard diagnosis for urinary tract infections (UTIs). However, most hospitals in low-resource countries lack adequately equipped laboratories and relevant expertise to perform culture and, therefore, rely heavily on dipstick tests for UTI diagnosis. Research gap. In many Kenyan hospitals, routine evaluations are rarely done to assess the accuracy of popular screening tests such as the dipstick test. As such, there is a substantial risk of misdiagnosis emanating from inaccuracy in proxy screening tests. This may result in misuse, under-use or over-use of antimicrobials. Aim. The present study aimed to assess the accuracy of the urine dipstick test as a proxy for the diagnosis of UTIs in selected Kenyan hospitals. Methods. A hospital-based cross-sectional method was used. The utility of dipstick in the diagnosis of UTIs was assessed using midstream urine against culture as the gold standard. Results. The dipstick test predicted 1416 positive UTIs, but only 1027 were confirmed positive by culture, translating to a prevalence of 54.1 %. The sensitivity of the dipstick test was better when leucocytes and nitrite tests were combined (63.1 %) than when the two tests were separate (62.6 and 50.7 %, respectively). Similarly, the two tests combined had a better positive predictive value (87.0 %) than either test alone. The nitrite test had the best specificity (89.8 %) and negative predictive value (97.4 %) than leucocytes esterase (L.E) or both tests combined. In addition, sensitivity in samples from inpatients (69.2 %) was higher than from outpatients (62.7 %). Furthermore, the dipstick test had a better sensitivity and positive predictive value among female (66.0 and 88.6 %) than male patients (44.3 and 73.9 %). Among the various patient age groups, the dipstick test’s sensitivity and positive predictive value were exceptionally high in patients ≥75 years old (87.5 and 93.3 %). Conclusion. Discrepancies in prevalence from the urine dipstick test and culture, the gold standard, indicate dipstick test inadequacy for accurate UTI diagnosis. The finding also demonstrates the need for urine culture for accurate UTI diagnosis. However, considering it is not always possible to perform a culture, especially in low-resource settings, future studies are needed to combine specific UTI symptoms and dipstick results to assess possible increases in the test’s sensitivity. There is also a need to develop readily available and affordable algorithms that can detect UTIs where culture is not available.

Introduction Culture is the gold-standard diagnosis for Urinary Tract Infections (UTIs). However, most hospitals in poor-resource countries lack adequately equipped laboratories and relevant expertise to perform culture and therefore heavily rely on dipstick tests as an alternative diagnostic method for UTIs. Research gap In many Kenyan hospitals, routine evaluations are rarely done to assess the reliability of popular screening tests such as the dipstick test. As such, there is a high risk of misdiagnosis emanating from inappropriate or insufficient use of proxy screening tests over the goal standards. As a result, this may lead to misuse, under-use, or over-use of antimicrobials and treatment failure.   Aim The present study sought to assess the reliability of the urine dipstick test as a proxy for the diagnosis of urinary tract infections in selected Kenyan hospitals. Results Using a cross-sectional hospital-based approach, the present study evaluated the performance of urine dipstick test in UTI diagnosis using culture as the gold standard. A UTI prevalence of 54.1% was found using culture. This was lower than the 66.4% recorded by the dipstick test. Estimated UTI prevalence by Nitrate test, RBCs, and Leukocyte's esterase (L.E) was 11.9%, 28.1 %, and 46%, which were lower than the observed. The nitrate test had a sensitivity of 19.8%, which was lower than 32.9%, 65.5%, and 66.2% by RBCs, all dipstick parameters, and L.E, respectively. Nitrate test (97.4%) and RBCs (77.6%) had a better specificity compared to L.E (56.5%) and all dipstick parameters combined (68.3%). Conclusion The prevalence discrepancies from the observed and low sensitivity and Specificity imply dipstick test inadequacy for accurate UTI diagnosis. The finding also demonstrates the need for urine culture for accurate UTI diagnosis.

The menace of antimicrobial resistance to public health is constantly arising globally. Many pathogenic bacteria use mechanisms such as mutations and biofilm formation, which significantly reduces efficacy of antimicrobial agents. In this cross-sectional study, we aimed at determining the prevalence of selected extended spectrum β-lactamase (ESβLs) genes and analyse the possible biofilm formation abilities of the isolated bacteria causing urinary tract infection among adult patients seeking medicare at Kiambu Level 5 hospital, Kenya. The double-disk synergy test was used for phenotypic identification of ESβLs producing isolates, while microtiter plate assays with some modifications were used to test biofilm formation analysis. A total of 10 isolates were bioassayed for ESβL genes presence out of 57 bacteria isolates obtained from urine samples. From this study, theblaTEMgenes were found to be the most prevalent ESβLs genes (100%), followed byblaOXAandblaSHVgenes at 40% and 30% respectively. In addition, the co-carriage ofblaTEMandblaSHVwas revealed at 50% lower than that ofblaTEM+ blaOXAgenes at 66.7% among the studyE. coliisolates. Biofilm formation finding disclosed that most of the isolates form biofilms 36 (63.2%), with Gram-negatives being the most biofilm formers 25 (69.4%) compared to the Gram-positive 11 (30.6%).E. coli15(41.7 %),Klebsiella sp. 7(19.4%) andS. aureus7(19.4%) were the most common biofilm formers. Further analysis showed no significant difference in biofilm formation among all tested isolates with a p-value of more than 0.05. However, overall Gram-positive isolates had a significant P-value of 0.056. Although biofilm formation’s impact on urinary tract infections is not fully recognized, the carriage of ESβLs resistance genes and the biofilm formation ability negatively impact effectiveness of UTI treatment. Therefore, we advocate for surveillance studies to map ESβLs distribution and biofilm formation genes among UTI etiological agents to halt UTI treatment failure.

Introduction Culture is the gold-standard diagnosis for Urinary Tract Infections (UTIs). However, most hospitals in poor-resource countries lack adequately equipped laboratories and relevant expertise to perform culture and, therefore, rely heavily on dipstick tests for UTI diagnosis. Research gap In many Kenyan hospitals, routine evaluations are rarely done to assess the accuracy of popular screening tests such as the dipstick test. As such, there is a substantial risk of misdiagnosis emanating from inaccuracy in proxy screening tests. This may result in misuse, under-use, or over-use of antimicrobials. Aim The present study aimed to assess the accuracy of the urine dipstick test as a proxy for the diagnosis of urinary tract infections in selected Kenyan hospitals. Methods A hospital-based cross-sectional method was used in the present study. Utility of dipstick  in the diagnosis of UTI was assessed using Mid stream urine against culture as gold standard Results The dipstick test predicted 1,416 positive UTIs, but only 1,027 were confirmed positive by culture, translating to a true prevalence of 54.1%. The sensitivity of the dipstick test was better when leukocytes and nitrite tests were combined (63.1%) than when the two tests were separate (62.6% and 50.7%, respectively). Similarly, the two tests combined had a better positive predictive value (87.0%) than either test alone. The nitrite test had the best specificity (89.8%) and negative predictive value (97.4%) than leukocytes esterase (L.E) or both tests combined. In addition, sensitivity in samples from the inpatients (69.2%) was higher than outpatients (62.7%). Furthermore, the dipstick test had a better sensitivity and positive predictive value among female (66.0% and 88.6%) patients than male patients (44.3% and 73.9%). Among the various patients' age groups, the dipstick test's sensitivity and positive predictive value were exceptionally high in patients ≥75 years  (87.5% and 93.3%). Conclusion The prevalence discrepancies from the urine dipstick test and culture, the gold standard, indicate dipstick test inadequacy for accurate UTI diagnosis. The finding also demonstrates the need for urine culture for accurate UTI diagnosis. However considering it’s not always possible to perform a culture, especially in low resource settings, future studies can combine specific UTI symptoms and dipstick results to assess possible increase in the test’s sensitivity. There is also need to develop readily available and affordable algorithms that can detected UTI where culture is not available.