High burden of urinary tract infections and antimicrobial resistance among menopausal women in Jos, Nigeria

Abstract

Menopausal women are at increased risk of urinary tract infections (UTIs) due to estrogen deficiency–associated urogenital changes. Rising antimicrobial resistance (AMR) among uropathogens further complicates empirical therapy, particularly in low- and middle-income settings. This study investigated the prevalence, bacterial profile, antimicrobial susceptibility patterns, and associated risk factors of UTIs among menopausal women attending Plateau Specialist Hospital, Jos, Nigeria. A cross-sectional study was conducted among 139 menopausal women aged 45–66 years. Midstream urine samples were collected from subjects with symptoms suggestive of urinary tract infections and cultured using standard microbiological techniques. Isolates were identified by biochemical characterization. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion method according to CLSI guidelines. Risk factors were assessed using structured questionnaires and analyzed statistically. Out of the 139 urine samples analyzed, 90 were culture-positive, yielding an overall UTI prevalence of 64.7%. The highest prevalence was observed among women aged 55–59 years (86.4%). Escherichia coli was the predominant uropathogen, followed by Staphylococcus aureus , Klebsiella spp., and Pseudomonas spp. Ciprofloxacin and pefloxacin demonstrated the greatest activity against the predominant Gram-negative isolates, whereas Proteus spp. and Streptococcus spp. exhibited 100% resistance to amoxicillin, cefuroxime, and levofloxacin. Likewise, E. coli showed complete resistance to amoxicillin and cefuroxime. Significant risk factors associated with UTI included lack of hormone replacement therapy ( p = 0.0074), previous UTI history ( p = 0.0373), inadequate water intake ( p = 0.0247), and non-use of vaginal estrogen therapy ( p = 0.027). Menopausal women in Jos experience a high burden of UTIs caused by uropathogens with substantial antimicrobial resistance, limiting the effectiveness of commonly used antibiotics. These findings highlight the need for routine urine culture and antimicrobial susceptibility testing, strengthened antimicrobial stewardship, and targeted preventive strategies to improve empirical treatment and reduce the spread of resistant uropathogens in this vulnerable population.