# Urinary Tract Infections Among Patients in Primary Healthcare Centres in Bahrain: A cross-sectional study

## TL;DR

This study analyzed urinary tract infections in Bahrain's primary healthcare centers, finding high rates of antibiotic-resistant bacteria, especially in older patients and those with certain risk factors.

## Contribution

The study provides new insights into the prevalence of resistant uropathogens in primary care settings in Bahrain and identifies key risk factors for resistance.

## Key findings

- Escherichia coli and Klebsiella were the most common uropathogens in UTIs.
- About 20.8% of patients had resistant uropathogens, with ESBL being the most prevalent.
- Older patients, those with antibiotic use, hospitalization, or ESBL history had higher resistance rates.

## Abstract

This study aimed to determine the clinical and microbiological profiles of patients with urinary tract infections (UTIs) in primary healthcare centres in Bahrain.

This retrospective cross-sectional study was conducted at 27 primary care centres in Bahrain between January and December 2022. All patients with positive urine cultures, defined as the presence of ≥100,000 colony-forming units/mL were included. Participants' sociodemographic characteristics, comorbidities, risk factors for resistant uropathogens, uropathogen types and antibiotic sensitivity outcomes were assessed. Descriptive and inferential statistics were analysed.

A total of 1,985 patients were included, with an average age of 40.57 ± 20.18 years. Most participants were female (n = 1,802, 90.8%) and Bahraini (n = 1,699, 85.6%). Diabetes mellitus (20.1%) and hypertension (17.9%) were the most prevalent comorbidities among the participants. Escherichia coli (n = 1,220, 61.5%) and Klebsiella (n = 342, 17.2%) were the most common uropathogens identified. Nearly 1 in 5 patients had resistant uropathogens (n = 412, 20.8%), with extended-spectrum β-lactamase (ESBL) uropathogens being the most prevalent (n = 401, 20.2%). Patients with diabetes (P <0.001), hypertension (P <0.001), a history of previous ESBL infections (P <0.001), previous carbapenem-resistant Enterobacterales (P = 0.019), a history of antibiotic use (P <0.001) and recent hospitalisation (P <0.001) exhibited a higher prevalence of resistant uropathogens. Logistic regression analysis indicated that older patients (P = 0.002) and participants who had used antibiotics (odds ratio [OR] = 1.470; P = 0.002) or had been hospitalised (OR = 1.762; P = 0.017) had higher rates of resistant UTIs. A personal history of ESBL infections increased the risk of having resistant uropathogens by 3-fold (OR = 3.347; P <0.001).

Resistant uropathogens are common among patients with culture-positive UTIs in primary care settings in Bahrain, especially among older patients, those with recent antibiotic use and hospitalisation and those who had ESBL UTIs. Rational antibiotic use based on sensitivity patterns and ongoing surveillance is important to mitigate the risks of resistant UTIs.