Gut dysbiosis and antimicrobial resistance among women living with HIV, with recurrent urinary tract infections in Uganda: a cross-sectional study

The relationship between the gut microbiome and recurrent urinary tract infections (rUTIs) among women living with HIV (WLHIV) remains underexplored, despite growing evidence that gut dysbiosis may play a critical role in uropathogen colonisation and recurrence of UTIs, let alone treatment outcomes of these patients. Considering the increasing rates of Antimicrobial Resistance (AMR), rUTIs are still on the rise and are a big health burden among WLHIV. Understanding bacterial aetiologies, antimicrobial susceptibility patterns, risk factors for recurrent UTIs among WLHIV, and the role of gut microbiota in uropathogenesis is therefore essential in developing appropriate treatment and prevention guidelines to tackle this public health burden. We conducted a cross-sectional study among WLHIV attending care at an HIV clinic in Uganda. Participants were grouped into two categories: Isolated UTI and Recurrent UTI, based on evidence of UTI episodes within the last 12 months. Voided clean catch midstream urine was collected for culture and sensitivity testing to identify bacterial uropathogens and their antimicrobial resistance profiles. Stool samples were also collected for gut microbiome analysis through 16s rRNA sequencing. Urine culture positivity rate was 19.8%, with Escherichia coli accounting for over 80% of isolates. E.coli exhibited high resistance to Ampicillin, Trimethoprim-Sulfamethoxazole, 3rd-generation cephalosporins, and Ciprofloxacin but complete Susceptibility to Nitrofurantoin and Imipenem. Prior antibiotic use within the last six months emerged as the most significant clinical factor associated with UTI occurrence (p < 0.001). Gut microbiome analysis showed reduced diversity and altered microbial composition among women with recurrent UTIs compared to those with isolated UTIs, with specific taxa being differentially abundant in the recurrent group.