Clinical profiles of patients with antibiotic-resistant infections at select tertiary hospitals in Uganda: a retrospective study of clinical records

Antibiotic resistance (ABR) remains a critical global health threat, with disproportionate burden in low-resource settings.

This retrospective study analyzed the clinical records of 599 patients across nine Uganda tertiary hospitals between March 2023 and April 2024. We described ABR rates and used multivariable mixed effects modified Poisson regression to determine the factors associated with ABR. We defined non-multidrug-resistance (non-MDR) as resistance to less than three antibiotic classes, MDR as resistance to at least three antibiotic classes, extremely drug-resistance (XDR) as resistance to at least one antibiotic in all but two or less antibiotic classes and pan drug resistance (PDR) as resistance to all antibiotics classes.

The 325 samples from patients with culture confirmed infections yielded 378 pathogens. Of the pathogens tested against three or more antibiotic classes (362), 126/362 (34.8%) were non-MDR and 236/362 (65.2%) MDR. Among the MDR, 165 (47.3%) were XDR, and 18 (5.2%) PDR. The prevalence of ABR was highest on surgical 168 (92%), maternity 30 (91%), and ICU 24 (89%) wards. Regression analysis identified ward type as a key predictor: surgical and “other” wards (gynecology, private, and orthopedic) had a 22% (PR, 1.22, 95% CI 1.09–1.37, p < 0.001) and 26% (PR, 1.26, 95% CI 1.05–1.52 p = 0.016) higher ABR risks, respectively. Antibiotics prescription on admission was associated with a reduced risk for ABR while age, sex, referral status, and Human Immunodeficiency Virus status were not associated with ABR. Overall ABR associated mortality was 12.7%, higher among inpatients admitted for shorter hospital days (median 8 vs. 20 days, p < 0.001), intubated patients, and those admitted to the ICU. Patients with resistance stayed in the hospital five days longer than those with no resistance. Escherichia coli, Klebsiella spp. and Staphylococcus aureus, the most isolated pathogens, were highly resistant to commonly used antibiotics, including extended-spectrum beta-lactamase (ESBL) and methicillin-resistant Staphylococcus aureus (MRSA) phenotypes.

These findings highlight the clinical impact of ABR in Uganda, especially in high-risk wards such as the ICU and among intubated patients. Strategies for strengthening antibiotic stewardship, infection prevention and diagnostics to combat ABR in Uganda are urgently needed.

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