A study of urinary tract infections (UTIs) in six African countries found high and increasing levels of antimicrobial resistance (AMR), researchers reported last week in JAMA Network Open.

In an analysis of 44,367 urinary isolates from clinical labs in Benin, Cameroon, Central African Republic, Madagascar, Morocco, and Senegal, a team of investigators assessed drug-resistance trends in Escherichia coli and Klebsiella pneumoniae—two of the primary causative pathogens of UTIs. Data collection spanned from 2008 through 2023, with a shared observation period from October 2014 to December 2021. Resistance was analyzed for seven antibiotic classes in E coli and six in K pneumoniae.

The researchers note that resistance data on E coli and K pneumoniae in Africa “remain scarce or fragmented.”

“Monitoring resistance trends is essential to understanding AMR evolution and intercountry differences and forecasting resistance trajectories,” the study authors wrote. “Such insights are critical for informing health policy, guiding empirical treatment, and supporting strategies to contain multidrug-resistant organisms.”

Resistance to first-line antibiotics was widespread, with amoxicillin resistance in E coli exceeding 85% across sites and amoxicillin-clavulanic acid resistance exceeding 50% in for both pathogens in all countries except Madagascar and Cameroon. Resistance to broader-spectrum antibiotics was also high, with fluoroquinolone resistance exceeding 40% for both pathogens in all sites and resistance to third- and fourth-generation cephalosporins surpassing 45% in all countries except Morocco.

While resistance to carbapenems—a last-resort antibiotic class—remained below 18% for both pathogens, a modeling projection estimated that carbapenem and third-generation cephalosporin resistance could exceed 90% in all six countries by 2050.

The authors say the findings indicate that stronger measures against AMR are urgently needed in Africa.

“These estimations underscore the urgent need for strengthened standardized stewardship, enhanced surveillance, improved infection prevention and control, and expanded health care capacity,” they wrote.