Background Evidence-based empirical antibiotic prescribing requires knowledge of local antimicrobial resistance patterns. The spectrum of pathogens and their susceptibility strongly influences guidelines for empirical therapies for urinary tract infections (UTI) management. Objective This study aimed to determine the prevalence of UTI causative bacteria and their corresponding antibiotic resistance profiles in three counties of Kenya. Such data could be used to determine the optimal empirical therapy. Methods In this cross-sectional study, urine samples were collected from patients who presented with symptoms suggestive of UTI in the following healthcare facilities; Kenyatta National Hospital, Kiambu Hospital, Mbagathi, Makueni, Nanyuki, Centre for Microbiology Research, and Mukuru Health Centres. Urine cultures were done on Cystine Lactose Electrolyte Deficient (CLED) to isolate UTI bacterial etiologies, while antibiotic sensitivity testing was done using the Kirby-Bauer disk diffusion using CLSI guidelines and interpretive criteria. Results A total of 1,027(54%) uropathogens were isolated from the urine samples of 1898 participants. Staphylococcus spp. and Escherichia coli were the main uropathogens at 37.6% and 30.9%, respectively. The percentage resistance to commonly used drugs for the treatment of UTI were as follows: trimethoprim (64%), sulfamethoxazole (57%), nalidixic acid(57%), ciprofloxacin (27%), amoxicillin-clavulanic acid (5%), and nitrofurantoin (9%) and cefixime (9%). Resistance rates to broad-spectrum antimicrobials, such as ceftazidime, gentamicin, and ceftriaxone, were 15%, 14%, and 11%, respectively. Additionally, the proportion of Multidrug-resistant (MDR) bacteria was 66%. Conclusion High resistance rates toward fluoroquinolones, sulfamethoxazole, and trimethoprim were reported. These antibiotics are commonly used drugs as they are inexpensive and readily available. Based on these findings, more robust standardised surveillance is needed to confirm the patterns observed while recognising the potential impact of sampling biases on observed resistance rates.

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.

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.

Background  Evidence-based empirical antibiotic prescribing requires knowledge of local antimicrobial resistance patterns. This study investigated the prevalence of UTI causative bacteria and their corresponding antibiotic resistance profiles in three counties to determine the best empirical therapies for UTIs management. Objective The main aim of the present study was to determine the prevalence of UTIs among patients seeking treatment in selected healthcare facilities in Kenya and the antibiotic resistance profile of the etiologic agents. Methods In this mixed methods study, urine samples were collected from patients who presented with UTI-like symptoms in the following healthcare facilities; KNH, Kiambu hospital, Mbagathi, Makueni, Nanyuki, Centre for Microbiology Research, and Mukuru health centers. Urine cultures were done on CLED to isolate UTI bacterial etiologies, while antibiotic sensitivity testing was done using the disk diffusion and their antibiotic susceptibilities Kirky Bauer technique Results  A total of 1,027( 54%) uropathogens were isolated from urine samples of 1898 respondants. Staphylococcus spps and E. coli were the main uropathogens at 34.2% and 26.1 %, respectively. Average resistance profiles for commonly used drugs for the treatment of UTI were as follows; Trimethoprim (64%), Sulfamethoxazole (57%), Nalidixic Acid(54%), Ciprofloxacin (26%), Cefuroxime (13%), Amoxicillin-clavulanic acid (10%), Nitrofurantoin (9%), Cefixime (7%). Resistance to broad-spectrum antimicrobials, such as Ceftazidime,  Gentamicin, and Ceftriaxone,  was at 15%, 14%, and 11%, respectively. Additionally, the proportion of Multidrug-resistant( MDR) bacteria was 66%. Conclusion  High resistance rates towards Floro/quinolones, Sulfamethoxazole, and Trimethoprim were reported, which are the commonly used drugs as they are cheap to buy and readily available.  Based on these findings, there is need for adapted UTIs antibiotic treatment therapy, informed by routine surveillance.