Urinary tract infections, risk factors and antimicrobial resistance patterns in heart failure patients on sodium-glucose transporter 2 inhibitors: Evidence from Jakaya Kikwete Cardiac Institute in Tanzania.
UTIs are common among HF patients on SGLT2 inhibitors, with E. coli as the predominant pathogen and a concerning resistance to commonly used antibiotics, underscoring the need for routine urine culture and sensitivity testing to guide appropriate therapy and promote antimicrobial stewardship, particularly in resource-constrained settings.
Key Findings
Results
The prevalence of UTIs among heart failure patients on SGLT2 inhibitors was 15.9%.
Out of 138 urine samples processed, 22 (15.9%) showed significant growth.
The study was conducted from March to June 2024 at Jakaya Kikwete Cardiac Institute (JKCI) in Tanzania.
Participants were HF patients aged ≥18 years on SGLT2 inhibitors.
Midstream clean-catch urine samples were collected in sterile containers and processed using semi-quantitative urine culture on CLED and blood agar.
Results
Escherichia coli was the most common uropathogen isolated, followed by Klebsiella pneumoniae, Pseudomonas aeruginosa, and Candida spp.
E. coli accounted for 50.0% of isolates.
Klebsiella pneumoniae accounted for 13.6% of isolates.
Pseudomonas aeruginosa accounted for 9.1% of isolates.
Candida spp. accounted for 9.1% of isolates.
Results
Age greater than 60 years was a significant risk factor for UTI in HF patients on SGLT2 inhibitors.
Adjusted prevalence ratio (aPR) of 3.77 (95% CI: 1.42–10.01) for age >60 years.
Analysis was performed using modified Poisson regression.
Data were collected using structured questionnaires and medical records.
Results
Female sex was a significant risk factor for UTI in HF patients on SGLT2 inhibitors.
Adjusted prevalence ratio (aPR) of 2.92 (95% CI: 1.19–7.15) for female sex.
Analysis was performed using modified Poisson regression.
Results
SGLT2 inhibitor use for 4 months or longer was a significant risk factor for UTI.
Adjusted prevalence ratio (aPR) of 3.19 (95% CI: 1.70–5.96) for SGLT2 inhibitor use ≥4 months.
SGLT2 inhibitors studied included dapagliflozin and empagliflozin.
Analysis was performed using modified Poisson regression.
Results
Bacterial isolates showed high resistance to ampicillin, tetracycline, and ceftazidime.
Resistance to ampicillin was 100%.
Resistance to tetracycline was 69.2%.
Resistance to ceftazidime was 53.8%.
Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method per CLSI M100 (2024) guidelines.
Results
Bacterial isolates showed high susceptibility to nitrofurantoin and meropenem.
Susceptibility to nitrofurantoin was 84.6%.
Susceptibility to meropenem was 100%.
Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method per CLSI M100 (2024) guidelines.
Kaaya J, Manguzu M, Buma D, Mlyuka H, Rweyemamu S, Ntukula A, et al.. (2026). Urinary tract infections, risk factors and antimicrobial resistance patterns in heart failure patients on sodium-glucose transporter 2 inhibitors: Evidence from Jakaya Kikwete Cardiac Institute in Tanzania.. PloS one. https://doi.org/10.1371/journal.pone.0344986