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Older adults, recently hospitalised patients and those who used antibiotics in the last few months are more likely to get hard-to-treat urinary tract infections (UTIs), according to a new medical Bahrain-based study.
The ‘Urinary Tract Infections Among Patients in Primary Healthcare Centres in Bahrain’ cross-sectional study looked at nearly 2,000 people with confirmed UTIs who visited government health centres across the country in 2022, also finding that more than one in five of those infections were caused by bacteria that became resistant to regular antibiotics.
“Participants who had used antibiotics in the past three months and those who had been hospitalised, exhibited a nearly two-fold increase in
the resistant UTI rate,” the study said.
The research was done by a team of doctors in Bahrain and published online this month in the Sultan Qaboos University Medical Journal.
Researchers included Mahmood Alawainati, Zahra Ayoob, Eman Almajed, Safaa Alkhawaja, Noof Abdulaal, Rehab Alkhnaizi, Hanin Shaheen, Fatema Hubail and Nermin Kamal Saeed.
It is the first study to look at how common these infections are in Bahrain’s primary health centres, where most people first go for care.
“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,” researchers found.
“Rational antibiotic use based on sensitivity patterns and ongoing surveillance is important to mitigate the risks of resistant UTIs.”
People who had these kinds of infections before were also found to be more at risk.
“A personal history of ESBL (extended spectrum beta-lactamase, an enzyme found in antibiotic resistant strains of bacteria) was associated with a three-fold increase in
the risk of harbouring resistant uropathogens,” the authors wrote.
The study looked at 1,985 patients with positive urine tests. Most of them were Bahraini (86 per cent) and female (91pc), with an average age of 40.
The most common bacteria causing infections was Escherichia coli, or E coli, which caused six out of 10 cases. The next most common was Klebsiella.
Doctors also tested which antibiotics worked best.
“Most cases of E coli were sensitive to nitrofurantoin (98.3pc),” the study said, indicating that nitrofurantoin, a common antibiotic, worked in most cases.
But for the harder-to-treat infections, the picture was more complex.
“Most resistant uropathogens exhibited resistance to amoxicillin-clavulanic acid, cephalothin and cefuroxime,” the study noted, finding that many of the usual antibiotics didn’t work.
Although the study found that diabetes and high blood pressure were common in patients with these infections, those health conditions were not directly linked to a higher risk.
Similar studies around the world have also found rising numbers of drug-resistant UTIs, especially in older adults and people with recent hospital stays.
The doctors in the study said knowing which antibiotics still work was key.
“Knowledge of antibiotic sensitivity profiles in patients with UTIs informs physicians about the most effective antibiotic choices,” they added.
They also warned that overusing antibiotics can make infections harder to treat.
“The implementation of rational antibiotic choice is essential to reduce the prevalence of resistant UTIs,” the paper said.
The authors called for better tracking of these infections and smarter use of antibiotics to help protect patients in the future.
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