Prevalence and Antimicrobial Susceptibility of Klebsiella pneumoniae in Urinary Tract Infections among Outpatient Women in Rural Zambia

Abstract

Background: Urinary tract infections (UTIs) are among the most common bacterial infections affecting women worldwide. Klebsiella pneumoniae has emerged as an important uropathogen, particularly in settings with increasing antimicrobial resistance. Data from rural district hospitals in Zambia remain limited. Objective: To determine the prevalence of Klebsiella pneumoniae among urinary tract infections in outpatient women at Kalindawalo General Hospital and to assess the antimicrobial susceptibility patterns of the isolates. Methods: A retrospective cross-sectional descriptive study was conducted using laboratory records from January to December 2024. Urine culture and antimicrobial susceptibility data of female outpatients aged ≥15 years with culture-confirmed UTIs were reviewed. Bacterial identification and susceptibility testing were performed using standard microbiological techniques. Data were analyzed using SPSS version 26, with results summarized using frequencies and percentages. Results: A total of 162 female outpatients with culture-confirmed UTIs were included. The majority were aged 25–34 years (41.1%). Escherichia coli was the most common uropathogen (60.5%), followed by Klebsiella pneumoniae (19.1%). K. pneumoniae isolates showed high resistance to ampicillin (100%), co-trimoxazole (83.9%), ceftriaxone (67.7%), and ciprofloxacin (61.3%). Moderate susceptibility was observed for gentamicin (64.5%) and nitrofurantoin (58.1%), while imipenem demonstrated the highest activity (93.5% susceptibility). A substantial proportion of isolates exhibited multidrug resistance. Conclusion: Klebsiella pneumoniae is a significant cause of UTIs among outpatient women at Kalindawalo General Hospital and exhibits high levels of resistance to commonly used antibiotics. Routine urine culture and susceptibility testing, alongside strengthened antimicrobial stewardship, are essential to guide effective treatment and limit the spread of resistant strains in rural healthcare settings.