Prevalence of antimicrobial resistance in acute community-acquired urinary tract infections in Sub-Saharan Africa: a systematic review

This systematic review of 41 studies from 19 Sub-Saharan African countries found that antimicrobial resistance in community-acquired urinary tract infections is widespread and poorly documented, with major gaps in available data and inconsistent laboratory methods. Across more than 7,000 bacterial isolates, resistance to trimethoprim–sulfamethoxazole was extremely high in both E. coli (63%) and Klebsiella spp. (66%), while nitrofurantoin showed the lowest resistance levels, supporting its role as a first-line treatment. Resistance to ceftriaxone and ciprofloxacin was moderate, and no clear temporal or geographic patterns emerged due to substantial heterogeneity between studies. The findings highlight the need to reconsider empirical use of trimethoprim–sulfamethoxazole, strengthen laboratory standards and expand surveillance to better guide UTI management in the region.