Multidrug-resistant urinary infection bacteria highly prevalent in East Africa, review finds

Roughly three in five urinary tract infection bacteria included in a new regional analysis were resistant to multiple antibiotic classes, according to a systematic review and meta-analysis published in BMC Infectious Diseases. The pooled analysis, led by Muhidn Jemal, Zufan Berhanu and Bahailu Balcha, estimated that 61.4 percent of culture-confirmed uropathogens in East Africa were multidrug-resistant, a figure the authors themselves urge readers to treat with considerable caution. The research team followed the PRISMA 2020 reporting guideline and registered the review protocol in PROSPERO under registration number CRD420251249266.

They searched six electronic databases — PubMed/MEDLINE, Scopus, ScienceDirect, Embase, African Journals Online and Google Scholar — for observational studies published between 1 January 2005 and 11 December 2025. To qualify, a study had to report the prevalence of multidrug resistance among bacteria isolated from patients with laboratory-confirmed urinary tract infections in East African countries. Study quality was appraised with the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies, and the pooled estimate was calculated with a random-effects meta-analysis in STATA version 14.0.

Sixteen studies covering 7,625 participants met the inclusion criteria. The geographic distribution was heavily skewed: eleven of the sixteen studies came from Ethiopia, three from Uganda, and one each from Kenya and Tanzania. That imbalance matters, because a pooled estimate is only as representative as the studies feeding into it, and the authors explicitly flag the Ethiopian predominance as a factor to weigh when interpreting the regional figure.

The headline number — 61.4 percent, with a 95 percent confidence interval stretching from 47.5 to 75.3 — comes with an unusually wide margin of uncertainty. The between-study heterogeneity was very substantial, with an I² statistic of 98.3 percent and a p-value below 0.001. In practical terms, this means the individual studies differed so markedly from one another that combining them into a single regional prevalence estimate is statistically fragile.

The authors state plainly that, given this heterogeneity and the wide confidence interval, the pooled estimate should be interpreted cautiously and should not be regarded as a stable or uniformly applicable regional prevalence figure. What is clear is that the included studies span a search window covering 2005 to 2025, a period long enough for the underlying data to vary considerably. The review's sensitivity analysis offered some reassurance on one front — no single study substantially influenced the pooled estimate — but that does not resolve the deeper problem of combining studies that may not be measuring quite the same thing.

Publication bias was evaluated using funnel plots and Egger's test, standard tools for detecting whether smaller studies with striking results are disproportionately represented in a meta-analysis. The review was published as an open-access article on 24 October 2026, shared early to provide faster access to peer-reviewed, accepted research; the version carries a permanent DOI and is citable, though it remains subject to further edits before the final Version of Record replaces it. The authors describe multidrug-resistant uropathogens as an increasing public health concern in East Africa, compromising the effective management of urinary tract infections in the region.

That characterization frames the review's motivation: resistance among the bacteria that cause these infections undermines effective treatment, which is why the team set out to quantify how widespread the problem is across the available studies. The review's conclusions point less toward a single alarming number and more toward what needs to happen next. The authors call for continued antimicrobial resistance surveillance, standardized reporting of multidrug resistance, and well-designed epidemiological studies to better characterize the regional burden.

Better data, they argue, are needed to inform evidence-based policies and interventions rather than relying on pooled estimates whose precision the current evidence base cannot support. For readers, the takeaway is twofold. The evidence assembled here is consistent with a heavy burden of multidrug-resistant urinary pathogens across the studies included, and the direction of concern is clear.

But the precise regional prevalence cannot be pinned down from this evidence base: with sixteen studies, extreme heterogeneity and a confidence interval spanning nearly thirty percentage points, the 61.4 percent figure is best understood as a signal of a serious problem rather than a definitive measurement of it.

Subject of Research: Pooled prevalence of multidrug-resistant uropathogens causing urinary tract infections in East Africa: a systematic review and meta-analysis

Article Title: Pooled prevalence of multidrug-resistant uropathogens causing urinary tract infections in East Africa: a systematic review and meta-analysis

Article References: Jemal, M., Berhanu, Z., & Balcha, B. (2026). Pooled prevalence of multidrug-resistant uropathogens causing urinary tract infections in East Africa: a systematic review and meta-analysis. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14723-3

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14723-3

Keywords: Pooled, prevalence, multidrug-resistant, uropathogens, causing, urinary, tract, infections, East, Africa, systematic, review