Protocol for surveillance of antimicrobial-resistant bacteria causing community-acquired urinary tract infections in low-income countries

PLoS One. 2024 May 31;19(5):e0304388. doi: 10.1371/journal.pone.0304388. eCollection 2024.


The spread of drug-resistant bacteria into the community is an urgent threat. In most low-middle-income countries (LMICs) settings, community-acquired infection (CAI) is empirically treated with no data to support the choice of antibiotics, hence contributing to resistance development. Continuous antimicrobial resistance (AMR) data on community-acquired pathogens are needed to draft empirical treatment guidelines, especially for areas with limited culture and susceptibility testing. Despite the importance of addressing antibiotic-resistant pathogens in the community setting, protocols for the surveillance of AMR bacterial infections are lacking in most (LMICs). We present a protocol for surveillance of AMR in LMICs using urinary tract infection (UTI) as a proxy for CAI to enable users to quantify and establish the drivers of AMR bacteria causing UTI. The protocol intends to assist users in designing a sustainable surveillance program for AMR in the community involving children above two years of age and adults presenting to a primary health facility for healthcare. Implementation of the protocol requires initial preparation of the laboratories to be involved, surveillance areas, selection of priority bacteria and antimicrobials to be used, and the design of a coordinated sampling plan. Recruitment should occur continuously in selected health facilities for at least 12 months to observe seasonal trends of AMR. At least 10 mL of clean-catch mid-stream urine must be collected into 20 mL calibrated sterile screw-capped universal bottles lined with 0.2 mg boric acid and transported to the testing laboratory. Utilise the data system that generates standard reports for patient care to be shared internally and externally in the regions and the world through global platforms such as the Global Antimicrobial Resistance Surveillance System.

MeSH terms

  • Adult
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Bacteria / drug effects
  • Bacteria / isolation & purification
  • Child
  • Community-Acquired Infections* / drug therapy
  • Community-Acquired Infections* / epidemiology
  • Community-Acquired Infections* / microbiology
  • Developing Countries*
  • Drug Resistance, Bacterial
  • Humans
  • Urinary Tract Infections* / drug therapy
  • Urinary Tract Infections* / epidemiology
  • Urinary Tract Infections* / microbiology


  • Anti-Bacterial Agents

Grants and funding

The Fleming Fund Round 2 Regional Grant number FF49/440 funded the development of this protocol. The funder had no involvement in the design and development of the protocol.