INTRODUCTION
Urinary tract infections (UTIs) are among the most common bacterial infections globally and are a significant source of morbidity, particularly among vulnerable populations such as diabetic patients. Individuals with diabetes mellitus (DM) are more prone to infections due to compromised immune responses, making them especially susceptible to genitourinary tract infections. This vulnerability, combined with the frequent use of antibiotics to manage UTIs, has contributed to the growing public health crisis of antimicrobial resistance (AMR). In Tanzania, particularly at Benjamin Mkapa Hospital in Dodoma, the burden of antimicrobial resistance is intensifying among diabetic patients diagnosed with UTIs. The indiscriminate use of antibiotics—often without prescriptions—has exacerbated the emergence of resistant uropathogens, leading to prolonged hospital stays, increased healthcare costs, and treatment failures. This research was conducted to assess the prevalence and associated factors of AMR in diabetic UTI patients and to identify actionable insights for clinical management and public health interventions.
METHODOLOGICAL INSIGHTS
This research adopted a hospital-based cross-sectional study design, enrolling 419 diabetic patients aged 30 years and above diagnosed with urinary tract infections at Benjamin Mkapa Hospital. The methodological rigor was maintained by collecting a single urine specimen from each patient and culturing it on both Cystine Lactose Electrolyte Deficient (CLED) and blood agar media. The purpose was to isolate and identify the causative organisms responsible for UTIs in this population. Data were statistically analyzed using SPSS version 20, with descriptive analysis expressed in proportions and percentages. The study further utilized logistic regression to determine associations between antimicrobial resistance and sociodemographic factors. This methodological approach ensured both the reliability and relevance of the findings in terms of identifying key behavioral and socioeconomic contributors to antibiotic resistance among diabetic UTI patients.
SOCIOECONOMIC DETERMINANTS OF AMR
The study found a strong statistical association between antimicrobial resistance and several socioeconomic factors, including employment status and income level. Working participants exhibited higher levels of antimicrobial resistance (P = 0.000), and similarly, jobless participants were also significantly associated with AMR (P = 0.000), indicating a complex socio-behavioral dynamic. Low-income individuals (P = 0.046) also showed increased prevalence of resistant infections. These findings underscore the need to consider socioeconomic determinants when designing interventions to combat AMR. Awareness campaigns and healthcare strategies must be tailored not only to medical needs but also to economic realities, which often influence access to healthcare, drug affordability, and adherence to prescription guidelines.
MISUSE OF ANTIBIOTICS AND PUBLIC BEHAVIOR
One of the most alarming revelations of this study was the high correlation between antibiotic misuse and the rise of antimicrobial resistance. A significant number of patients admitted to using antibiotics without prescriptions (P = 0.001), which directly contributed to the proliferation of resistant uropathogens. This highlights a critical gap in public health literacy regarding the proper use of antibiotics. Over-the-counter access, lack of regulation, and limited awareness have created an environment where antibiotics are used as quick fixes, often without any microbiological confirmation. Public education, stricter prescription enforcement, and community engagement programs are essential to curb irrational drug use and reduce AMR risks.
MICROBIOLOGICAL CULTURE OUTCOMES
The culturing of urine samples on CLED and blood agar media yielded crucial data on the types of pathogens involved and their resistance patterns. The microbiological analysis served as the backbone of this research, providing empirical evidence to support the prevalence of resistant strains among diabetic UTI patients. These findings are not only important for local treatment guidelines but also contribute to the larger body of global AMR surveillance. Periodic bacterial culture testing and sensitivity profiling should be institutionalized in hospital settings, especially for high-risk groups like diabetics, to ensure targeted antibiotic therapy and minimize empirical treatment that fuels resistance.
RECOMMENDATIONS AND PUBLIC HEALTH IMPLICATIONS
This study concludes with a call to action for healthcare policymakers, practitioners, and community leaders. The results clearly point toward the urgent need for regular epidemiological surveillance of antibiotic resistance patterns, particularly among diabetic patients with UTIs. Public education campaigns must be intensified to promote the responsible use of antibiotics. Hospital infection control protocols should include routine culture and sensitivity testing to guide appropriate treatment. Additionally, socioeconomic disparities must be addressed through policy interventions that improve healthcare access and patient education. Only a coordinated, multidisciplinary approach can effectively halt the growing threat of antimicrobial resistance in vulnerable populations.
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