Biofilm Formation and Antimicrobial Resistance in Catheter-Associated Urinary Tract Infections in Africa: A PRISMA-ScR Scoping Review

Biofilm Formation and Antimicrobial Resistance in Catheter-Associated Urinary Tract Infections in Africa: A PRISMA-ScR Scoping Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Biofilm Formation and Antimicrobial Resistance in Catheter-Associated Urinary Tract Infections in Africa: A PRISMA-ScR Scoping Review Scholastica Kunambi, Lilian Nkinda, Mecky Isaac Matee This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9091318/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections globally, with rising antimicrobial resistance (AMR) complicating treatment. Biofilm formation on urinary catheters promotes bacterial persistence, recurrent infections, and multidrug resistance (MDR). While this mechanism is well documented globally, evidence on biofilm-associated CAUTIs in Africa remains sparse. Objective To provide the first continent-wide synthesis of evidence on biofilm formation and antimicrobial resistance in CAUTIs across African healthcare settings, identifying critical knowledge gaps to inform clinical management and public health strategies. Methods A scoping review was conducted following PRISMA-ScR guidelines. PubMed, Web of Science, Scopus, and African Journals Online were searched for English-language studies published between 2020 and 2026 reporting microbiological, AMR, or biofilm data among CAUTI patients in Africa. Two reviewers independently screened studies, extracted data, and synthesized findings narratively. Results Of 245 records identified, 13 studies (11 published, including one meta-analysis, and 2 unpublished datasets) from eight African countries met inclusion criteria. Gram-negative bacteria accounted for 82–83% of CAUTIs, predominantly Escherichia coli (30–52%) and Klebsiella spp. (17–36%). MDR prevalence ranged from 16% to 88%, with frequent ESBL production. Resistance was highest to ampicillin and co-trimoxazole, whereas amikacin, nitrofurantoin, and carbapenems retained activity. Biofilm formation was assessed in only two studies, with 51–71% of E. coli isolates demonstrating biofilm capacity. Significant methodological heterogeneity and limited molecular characterization restricted cross-study comparisons and highlight major knowledge gaps. Conclusions African CAUTIs are predominantly caused by MDR Gram-negative pathogens, yet biofilm-mediated persistence and molecular resistance mechanisms remain critically understudied. This review underscores the urgent need for routine biofilm assessment, molecular AMR characterization, and multicenter surveillance to guide empiric therapy, infection prevention, and antimicrobial stewardship across the continent. Molecular Epidemiology catheter-associated urinary tract infection biofilm antimicrobial resistance multidrug resistance ESBL Africa scoping review Figures Figure 1 Figure 2 Introduction Catheter-associated urinary tract infections (CAUTIs) are common in hospitals and account for over 30% of healthcare-acquired infections worldwide (CDC, 2025). In Africa, the burden is high, with 43.3% of catheterized patients developing CAUTIs, posing a significant threat to patient safety and healthcare systems (Asmare et al. 2024 ). Gram-negative bacteria dominate these infections. Escherichia coli accounts for 45.1% of isolates and Klebsiella spp. for 24.2%, with Gram-negative pathogens representing 82.9% of infections (Asmare et al. 2024 ; Mohamed et al., 2022 ). CAUTIs occur when microorganisms colonize catheter surfaces and form biofilms. Biofilms protect bacteria from immune responses and antimicrobials, leading to persistent and recurrent infections (Tegegne et al. 2025 ). Despite their significance, CAUTIs are inadequately addressed in Africa, particularly in settings with limited infection prevention, antimicrobial stewardship, and diagnostic capacity (Abbas, 2024 ). Multidrug resistance (MDR) is widespread. In Ethiopia, 86.5% of Gram-negative bacilli were MDR, and 19.2% produced ESBLs (Asmare et al. 2024 b). In Somalia, over 60% of E. coli were resistant to fluoroquinolones and cephalosporins, limiting treatment options and prolonging hospital stays; nearly half of affected patients were hospitalized for more than two weeks (Mohamed et al., 2022 ). Biofilm formation compounds the challenge. In Ethiopia and Tanzania, 51–71% of E. coli isolates formed biofilms (Oumer et al. 2021 ; Mlugu et al. 2023 ). Molecular characterization of resistance determinants and biofilm mechanisms is largely absent, representing a critical gap in understanding persistence and treatment failure (Gahimbare et al. 2024 ; Mlugu et al. 2023 ). Evidence on pathogens, resistance, and biofilms is fragmented. Central, North, and parts of West Africa are underrepresented, limiting generalizability (Asmare et al. 2024 ; Tegegne et al. 2025 ). Methodological differences in bacterial identification, susceptibility testing, and biofilm assays further limit comparisons (Mlugu et al. 2023 ; Lakoh et al. 2023 ; Tegegne et al. 2025 ). These gaps hinder development of evidence-based guidelines for CAUTI prevention, diagnosis, and management in Africa (WHO, 2021; Asmare et al. 2024 ; Mlugu et al. 2023 ; Tegegne et al. 2025 ). Given high MDR prevalence and the role of biofilms in treatment failure, a comprehensive synthesis is urgently needed. This scoping review aims to map available data, highlight knowledge gaps, and provide actionable insights for clinical management, infection prevention, and antimicrobial stewardship across Africa. To our knowledge, this is the first review integrating CAUTI pathogen, resistance, and biofilm data across multiple African countries , offering a continent-wide perspective for clinical and public health strategies. Methods Study Design This was a scoping review, chosen to map evidence on biofilm formation and antimicrobial resistance in CAUTIs across African healthcare settings because the available data are limited, heterogeneous, and variably reported, making quantitative synthesis unsuitable. The sparse and inconsistent nature of the studies precluded a systematic review or meta-analysis. The methodology followed PRISMA-ScR guidelines (Tricco et al., 2018 ). Eligibility Criteria Studies were included if they met all of the following criteria: Reported microbiological data on CAUTI pathogens in African healthcare settings. Provided antimicrobial resistance profiles, including multidrug resistance (MDR), extended-spectrum β-lactamase (ESBL) production, or carbapenem resistance. Assessed biofilm formation in bacterial isolates from catheterized patients, where available. Were original research articles, including cross-sectional, cohort, case-control, or surveillance studies. Published in English between 2020 and 2026 to reflect contemporary AMR trends. Exclusion criteria: Studies on general UTIs without catheter association. Reports lacking microbiological or AMR data. Reviews, editorials, commentaries, or conference abstracts without primary data. Studies conducted outside Africa or lacking clear African clinical context. Studies with insufficient laboratory or methodological detail. Information Sources and Search Strategy A systematic search was conducted in PubMed, Web of Science, Scopus, and African Journals Online (AJOL) from inception to March 2026. The search combined controlled vocabulary (MeSH) and free-text terms related to CAUTIs, biofilm formation, antimicrobial resistance, and African countries. A sample search string for PubMed was: ("catheter-associated urinary tract infection" OR "CAUTI") AND ("biofilm" OR "biofilm formation") AND ("antimicrobial resistance" OR "drug resistance") AND (Africa OR [list of African countries]) The full search strategy is provided in supplementary Table 1. Reference lists of included studies were manually screened to identify additional relevant articles. Duplicate records were removed using EndNote 20. Study Selection Of 245 records identified, 35 duplicates were removed, leaving 210 for screening. After excluding 150 based on title and abstract, 60 full-text articles were assessed, of which 40 were excluded for not being CAUTI-related (n = 18), lacking AMR/biofilm data (n = 12), non-original research (n = 6), or insufficient methodology (n = 4). Thirteen studies were included, comprising 11 published studies (including one meta-analysis summarizing 20 studies) and two unpublished datasets, with biofilm data reported in two. The meta-analysis was counted as one study, and unpublished datasets were excluded from quantitative synthesis (Fig. 1 ). Data Extraction A standardized data extraction form was developed in Microsoft Excel. Two reviewers independently extracted the following data: Study characteristics: author, year, country, healthcare setting, study design Patient characteristics: age, sex, catheter type, and duration Microbiology: bacterial species, prevalence, biofilm formation assays Antimicrobial resistance: susceptibility profiles, MDR, ESBL, carbapenemase production Molecular data: genes associated with AMR and biofilm formation, if reported Disagreements were resolved through discussion and consensus. Data Synthesis Due to heterogeneity in study designs, laboratory methods, and reporting standards, findings were synthesized narratively. Key outcomes included: Prevalence and distribution of CAUTI pathogens Patterns of antimicrobial resistance, including MDR and ESBL production Proportion of isolates capable of forming biofilms Molecular mechanisms of resistance and biofilm formation Data are presented in tables, graphs, and maps. A meta-analysis was not performed because of methodological heterogeneity. Quality Assessment Although scoping reviews do not require formal risk-of-bias evaluation, included studies were appraised for methodological rigor, including sample size, pathogen identification methods, and antimicrobial susceptibility testing standards. This assessment allowed us to contextualize findings, highlight methodological gaps, and consider the reliability of evidence when interpreting MDR and biofilm prevalence across African CAUTI studies (Tricco et al., 2018 ). Handling of Unpublished Datasets Two unpublished institutional datasets were included to illustrate regional data gaps and expand geographic coverage. These datasets were not included in quantitative synthesis due to incomplete AMR profiling, lack of standardized methodology, and absence of formal peer review, but they provide important context for underrepresented regions and highlight areas for future research. Findings Catheter-associated urinary tract infections (CAUTIs) in Africa are predominantly caused by Gram-negative bacteria, especially E. coli and Klebsiella spp., with multidrug resistance (MDR) rates ranging from 16% to 88% and frequent extended-spectrum β-lactamase (ESBL) production (Asmare et al., 2024 ; Oumer et al., 2021 ; Lakoh et al., 2023 ). Resistance is highest to ampicillin and co-trimoxazole, whereas amikacin, nitrofurantoin, and carbapenems generally retain activity. Biofilm formation was reported in only ~ 12% of included studies, yet when assessed, 51–71% of E. coli isolates were capable of forming biofilms (Oumer et al., 2021 ; Mlugu et al., 2023 ). This underscores the role of biofilms in persistent infections, recurrent CAUTIs, and treatment challenges , and highlights a major evidence gap in African studies. The studies included in this review collectively cover eight African countries (Ethiopia, Tanzania, Uganda, Sierra Leone, Zambia, Somalia, Egypt, and Nigeria), in addition to a multi-country meta-analysis (Table 1 and Fig. 2 ). Unpublished datasets are clearly indicated. Table 1 Summary of CAUTI Pathogens, Antimicrobial Resistance, and Biofilm Data from African Studies and Datasets Study (Author, Year) Country / Setting Pathogen Findings AMR Patterns Biofilm Data Asmare et al., 2024 (Meta-analysis, includes 20 studies) Multi-country Africa E. coli ~ 45.1%; Klebsiella ~ 24.2%; Gram-negatives ~ 82.9% High MDR trends across studies Not reported¹ Asmare et al., 2024 (Incidence & ESBL/Carbapenemase) Ethiopia (Bahir Dar) E. coli 34.6%, Proteus spp. 13.5%, P. aeruginosa 11.5% MDR ~ 86.5%; ESBL ~ 19.2%; Carbapenemase ~ 5.8% Not assessed Oumer et al., 2021 Ethiopia (Arba Minch) E. coli 40.5%, Klebsiella 21.4%, Enterococcus 11.9% MDR ~ 88.1%; high cotrimoxazole, cefoxitin, tetracycline resistance Biofilm ~ 71.4% Lakoh et al., 2023 Sierra Leone (Dual hospitals) E. coli 23.7%, K. pneumoniae 17%, K. oxytoca 13.6% ESBL ~ 56%; resistance higher to penicillins/cephalosporins; preserved activity with carbapenems & amikacin Not assessed Northern Tanzania CAUTI (local dataset) Tanzania (Bugando Medical Centre) E. coli , Klebsiella spp., other Gram-negatives High resistance to ampicillin & fluoroquinolones Not assessed Mlugu et al., 2023 Tanzania (Morogoro) E. coli ~ 47%, Klebsiella ~ 30%, Proteus mirabilis ~ 10% MDR ~ 51%; high ampicillin and cotrimoxazole resistance Biofilm ~ 51.5% ( E. coli ) Niccodem et al., 2023 Tanzania (Dar es Salaam) Mixed uropathogens ( E. coli , Klebsiella ) MDR common; ESBL reported Not assessed Musinguzi et al., 2019 Uganda (Kabale RRH) E. coli 52%, K. pneumoniae 26%, S. aureus 13%, Pseudomonas spp. 8.7% High ESBL among Gram-negatives (~ 83.3%); high cotrimoxazole resistance Not assessed Mohamed et al., 2022 Somalia (Mogadishu) E. coli 26.3%, A. baumannii 24.3%, P. aeruginosa 19.2%, K. pneumoniae 13.1% CAUTI prevalence ~ 12.7%; MDR ~ 47%; ESBL ~ 13% Not assessed Moono et al., 2020 Zambia (Lusaka) K. pneumoniae ~ 28%, E. coli ~ 25.2% High resistance to ampicillin, nalidixic acid, norfloxacin, ciprofloxacin; lower for amikacin, nitrofurantoin Not assessed Alexandria ICU Dataset (unpublished) Egypt (Alexandria ICU) Mixed bacterial & fungal CAUTI Limited AMR detail Not assessed Eladawy et al., 2025 Egypt (Mansoura) E. coli ~ 50.7%, P. aeruginosa ~ 10.6%, K. pneumoniae ~ 8.3%, Proteus mirabilis ~ 6.8% MDR ~ 16.7%; XDR ~ 47%; high ceftazidime & ciprofloxacin resistance Not assessed Hassuna et al., 2025 Egypt (Minia) Proteus mirabilis MDR ~ 70.9%; high SXT, AMC, ceftazidime, imipenem resistance; ESBL ~ 37.9% Not assessed Table 1 . Summary of CAUTI pathogens, antimicrobial resistance, and biofilm data from African studies and datasets. Note: The first row (Asmare et al., 2024 meta-analysis) summarizes 20 individual studies, but is presented as a single entry here. Unpublished/local datasets are included to illustrate regional gaps and are not included in quantitative synthesis. In total, the table contains 13 entries (11 published studies + 2 unpublished datasets). Studies were conducted in eight African countries (Fig. 2 ), with notable gaps in Central and parts of West Africa Discussion Overview This scoping review provides the first continent-wide synthesis of catheter-associated urinary tract infection (CAUTI) pathogens, antimicrobial resistance (AMR), and biofilm formation in African healthcare settings. By consolidating fragmented evidence, it highlights critical gaps in biofilm research, underrepresented regions, and the absence of molecular characterization, providing guidance for clinicians, researchers, and policymakers on prevention, treatment, and stewardship strategies. Pathogen Distribution and Antimicrobial Resistance Consistent with global trends, Gram-negative bacteria predominate in African CAUTIs. Escherichia coli (30–52%) and Klebsiella spp. (17–36%) are the most common pathogens (Asmare et al. 2024 ; Oumer et al., 2021 ; Lakoh et al., 2023 ). Multidrug resistance is widespread (16–88%), with frequent extended-spectrum β-lactamase (ESBL) production (Eladawy et al., 2025 ; Oumer et al., 2021 ). Resistance is highest to ampicillin (70–100%) and co-trimoxazole (60–90%), whereas amikacin, nitrofurantoin, and carbapenems retain high efficacy (> 85% susceptibility) (Oumer et al., 2021 ; Mlugu et al., 2023 ; Mohamed et al., 2022 ). Knowledge Gaps Biofilm Research Only two studies (12% of included studies) assessed biofilm formation in African CAUTI isolates, reporting that 51–71% of E. coli formed biofilms, frequently associated with MDR (Oumer et al., 2021 ; Mlugu et al., 2023 ). Catheter-associated biofilms confer up to 100–1000-fold increased tolerance to antibiotics compared with planktonic bacteria, promoting persistent infections, recurrence, prolonged hospitalization, and treatment failure (Abu Lila et al., 2023 ; Mancuso et al., 2024 ; He et al., 2024 ; Tegegne et al., 2025 ). The scarcity of biofilm-focused studies in Africa hampers understanding of these clinically important outcomes. Methodological Heterogeneity Variations in study design, pathogen identification, and antimicrobial susceptibility testing limit comparability. Included studies ranged from cross-sectional to prospective cohort designs with differing laboratory methods (Musinguzi et al., 2019 ; Lakoh et al., 2023 ; Mlugu et al., 2023 ), complicating pooled analysis and synthesis. Geographic and Molecular Gaps Available evidence covers eight African countries, with notable underrepresentation of Central, West, and parts of North Africa (Asmare et al., 2024 ; Tegegne et al., 2025 ). Molecular characterization of resistance genes and biofilm mechanisms is largely absent, restricting understanding of CAUTI persistence and AMR evolution. Clinical Implications MDR CAUTIs prolong hospitalization, increase costs, and constrain empiric therapy. Clinicians should rely on local susceptibility patterns, avoid agents with high resistance rates, and consider amikacin, nitrofurantoin, or carbapenems where appropriate. Standardized catheter care, timely removal, and staff training are essential. Recurrent infections should prompt evaluation for biofilm-mediated persistence, while antimicrobial stewardship programs should integrate CAUTI-specific monitoring and hygiene protocols. Research and Policy Recommendations Future studies should routinely assess biofilm formation and include molecular analyses to elucidate mechanisms driving AMR and persistence (Mlugu et al., 2023 ; Tegegne et al., 2025 ). Strengthened surveillance, standardized catheter protocols, and interventional studies are needed to guide evidence-based policies and support global AMR mitigation efforts. Strengths and Limitations Strengths: This is the first continent-wide synthesis of CAUTI pathogens, AMR, and biofilm formation in Africa, conducted using a PRISMA-ScR framework. Inclusion of unpublished regional data provides additional context. Limitations: Only two studies assessed biofilm formation. Methodological heterogeneity, language restrictions, underrepresented regions, and limited molecular data constrain the generalizability of findings and interpretation of AMR prevalence. Conclusion This review provides the first integration of CAUTI pathogens, antimicrobial resistance, and biofilm formation across African healthcare settings. Although only two studies assessed biofilms, 51–71% of E. coli isolates formed biofilms, often associated with multidrug resistance, indicating a likely role in persistent and recurrent infections. The widespread MDR, combined with the paucity of biofilm-focused and molecular studies, underscores the urgent need for routine biofilm assessment, genomic characterization, and multi-center longitudinal research. Strengthening evidence on biofilm-mediated persistence will inform empiric therapy, improve infection prevention, and guide antimicrobial stewardship policies across African healthcare systems. Abbreviations AMC Amoxicillin-Clavulanic Acid AMR Antimicrobial Resistance CAUTI Catheter-Associated Urinary Tract Infection CDC Centers for Disease Control and Prevention ESBL Extended-Spectrum β-Lactamase ICU Intensive Care Unit MDR Multidrug Resistance PRISMA-ScR Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews SXT Co-trimoxazole (Trimethoprim-Sulfamethoxazole) UTI Urinary Tract Infection XDR Extensively Drug-Resistant Declarations Ethics approval and consent to participate As this study is a literature-based scoping review, no ethical approval was required. All included studies were conducted in accordance with the ethical standards of their respective institutions. Consent for publication Not applicable. Availability of data and materials All data generated and analyzed during this study are included in this published article. Competing interests The author declares to have no competing interests. Funding This study was not funded. Authors’ Contributions SK: Conceptualized the study, developed the search strategy, screened articles, extracted data, and drafted the manuscript, LN: Assisted with study selection, data extraction, synthesis of findings, and critically reviewed the manuscript for intellectual content, MIM: Provided overall supervision, guided study design and methodology, contributed to data interpretation, and critically revised the manuscript for scientific accuracy. All authors read and approved the final manuscript. AI Disclosure Authors utilized an AI tool (GPT-5, chat.openai.com) to assist with editing and formatting. Authors retain full responsibility for the content, analyses, and interpretations presented in this manuscript. Acknowledgements Not applicable Authors' information Scolastika Kunambi, BSc Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania. Email: [email protected] Lillian Nkinda, BSc, MSc Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania. Email: [email protected] Mecky Isaac Matee, PhD Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania; SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania Email: [email protected] References Abbas S (2024) The challenges of implementing infection prevention and antimicrobial stewardship programs in resource constrained settings. Antimicrob Steward Healthc Epidemiol 4:e45. 10.1017/ash.2024.35 Abu Lila AS, Rajab AAH, Abdallah MH, Rizvi SMD, Moin A, Khafagy ES et al (2023) Biofilm lifestyle in recurrent urinary tract infections. Life 13(1):148. 10.3390/life13010148 Asmare Z, Awoke T, Genet C, Admas A, Melese A, Mulu W (2024) Incidence of catheter associated urinary tract infections by Gram negative bacilli and their ESBL and carbapenemase production in specialized hospitals of Bahir Dar, northwest Ethiopia. Antimicrob Resist Infect Control 13(1):10. 10.1186/s13756-024-01368-7 Asmare Z, Erkihun M, Abebe W, Ashagre A, Misganaw T, Feleke S (2024) Catheter associated urinary tract infections in Africa: systematic review and meta analysis. Infect Dis Health 29(3):172–179. 10.1016/j.idh.2024.02.005 Centers for Disease Control and Prevention (2025) Clinical Safety: Preventing Catheter associated Urinary Tract Infections (CAUTIs). Atlanta, GA: CDC [cited 2026 Mar 7]. Available from: https://www.cdc.gov/uti/hcp/clinical-safety/index.html Eladawy M, Heslop N, Negus D, Thomas JC, Hoyles L (2025) Phenotype–genotype discordance in antimicrobial resistance profiles of Gram negative uropathogens recovered from catheter associated urinary tract infections in Egypt. J Antimicrob Chemother. 80(11):3123–3132. 10.1093/jac/dkaf352 . PMID: 40985147 Flores C, Rohn JL (2025) Bacterial adhesion strategies and countermeasures in urinary tract infection. Nat Microbiol 10:627–645. 10.1038/s41564-025-01926-8 Gahimbare L, Muvunyi CM, Guessennd NAK, Rutanga JP, Gashema P, Fuller W et al (2024) Antimicrobial Resistance in the WHO African Region: A Systematic Literature Review 2016–2020. Antibiot (Basel) 13(7):659. 10.3390/antibiotics13070659 Hassuna NA, Kotb DN, Lami M, Abdelrahim SS (2025) Characterization of antimicrobial resistance among Proteus mirabilis isolates from catheter associated urinary tract infections and non CAUTIs in Minia, Egypt. BMC Infect Dis 25:767. 10.1186/s12879-025-11118-8 He W, Ma P, Li L, Wang D, Li X, Wen X et al (2024) Efficacy and safety of preventing catheter-associated urinary tract infection by inhibiting catheter bacterial biofilm formation: a multicenter randomized controlled trial. Antimicrob Resist Infect Control 13:96. 10.1186/s13756-024-01450-0 Kelly T, Ai C, Jung M, Yu K (2024) Catheter-associated urinary tract infections (CAUTIs) and non-CAUTI hospital-onset urinary tract infections: Relative burden, cost, outcomes and related hospital-onset bacteremia and fungemia infections. Infect Control Hosp Epidemiol 45(7):864–871. 10.1017/ice.2024.26 Lakoh S, Yi L, Russell JB et al (2023) High incidence of catheter associated urinary tract infections and related antibiotic resistance in two hospitals of different geographic regions of Sierra Leone: a prospective cohort study. BMC Res Notes 16(1):301. 10.1186/s13104-023-06591-w Liu HY, Prentice EL, Webber MA (2024) Mechanisms of antimicrobial resistance in biofilms. npj Antimicrob Resist 2(1):27. 10.1038/s44259-024-00046-3 Mancuso G, Trinchera M, Midiri A, Zummo S, Vitale G, Biondo C (2024) Novel antimicrobial approaches to combat bacterial biofilms associated with urinary tract infections. Antibiot (Basel) 13(2):154. 10.3390/antibiotics13020154 Mlugu EM, Mohamedi JA, Sangeda RZ, Mwambete KD (2023) Prevalence of urinary tract infection and antimicrobial resistance patterns of uropathogens with biofilm forming capacity among outpatients in Morogoro, Tanzania: a cross sectional study. BMC Infect Dis 23:660. 10.1186/s12879-023-08641-x Mohamed AH, Sheikh Omar NM, Osman MM, Mohamud HA, Eraslan A, Gur M (2022) Antimicrobial Resistance and Predisposing Factors Associated with Catheter-Associated UTI Caused by Uropathogens Exhibiting Multidrug-Resistant Patterns: A 3-Year Retrospective Study at a Tertiary Hospital in Mogadishu, Somalia. Trop Med Infect Dis 7(3):42. 10.3390/tropicalmed7030042 Moono M, Spasojevic N, Mapulanga V (2021) Bacteriology and antibiotic sensitivity patterns of urine in urology patients with indwelling urinary catheters at the University Teaching Hospital in Lusaka, Zambia. J Agric Biomed Sci 5(3):13–34. 10.53974/unza.jabs.5.3.692 Musinguzi B, Kabajulizi I, Mpeirwe M, Turugurwa J, Kabanda T (2019) Incidence and etiology of catheter associated urinary tract infection among admitted patients at Kabale Regional Referral Hospital, South Western Uganda. Adv Infect Dis 9(3):183–196. 10.4236/aid.2019.93014 Niccodem EM, Mwingwa A, Shangali A, Manyahi J, Msafiri F, Matee M, Majigo M, Joachim A (2023) Predominance of multidrug resistant bacteria causing urinary tract infections among men with prostate enlargement attending a tertiary hospital in Dar es Salaam, Tanzania. Bull Natl Res Cent 47:54. 10.1186/s42269-023-01030-z Oumer YA, Dadi BR, Seid M, Biresaw G, Manilal A (2021) Catheter-associated urinary tract infection: incidence, associated factors and drug resistance patterns of bacterial isolates in Southern Ethiopia. Infect Drug Resist 14:4511–4522. 10.2147/IDR.S329452 Taiwo SS, Aderounmu AOA (2024) Catheter associated urinary tract infection: Aetiologic agents and antimicrobial susceptibility pattern in Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria. Afr J Biomed Res 9(3):141–148. 10.4314/ajbr.v9i3.141 Tegegne DT, Abbott IJ, Poźniak B (2025) Catheter Associated Urinary Tract Infections: Understanding the Interplay Between Bacterial Biofilm and Antimicrobial Resistance. Int J Mol Sci 26(18):9193. 10.3390/ijms26189193 Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D et al (2018) PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med 169(7):467–473. 10.7326/M18-0850 World Health Organization (2025) Global antibiotic resistance surveillance report 2025. Geneva: World Health Organization. Available from: https://www.who.int/publications/i/item/9789240116337 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9091318","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":604255825,"identity":"50be498b-c708-4c33-a7c9-b454a37c6d92","order_by":0,"name":"Scholastica Kunambi","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Scholastica","middleName":"","lastName":"Kunambi","suffix":""},{"id":604255826,"identity":"ada94423-16e3-43eb-8ecd-5f68087b00e9","order_by":1,"name":"Lilian Nkinda","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Lilian","middleName":"","lastName":"Nkinda","suffix":""},{"id":604255827,"identity":"446f7f2d-03ee-43df-842d-91bf12d5e447","order_by":2,"name":"Mecky Isaac Matee","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYDADCQbmAwyMDUSpZYZpYUsgWQuPAXFadNvPH3zwMcdGXnJGzjeJnzts5BjYDx/dgE+L2ZlkZsOZ29IMZ0vkbpPsPZNmzMCTlnYDr5YDyWzSvNsOJ8gBtUjwth1ObJDgMcOv5fxj9t9/t/0Hasl5JvmXKC03ktmYGbcdSJCWyAFaR5yWx8aSvduSDWf2PDO2lm1LM2Yj6JfziQ8//NxmJy9xPPnhzbdtNnL87IeP4dWCAAIJLBIgmo045SDAf4D5A/GqR8EoGAWjYCQBAI6FS5hB/dKMAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-6900-1533","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":true,"prefix":"","firstName":"Mecky","middleName":"Isaac","lastName":"Matee","suffix":""}],"badges":[],"createdAt":"2026-03-11 07:33:29","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-9091318/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9091318/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104781419,"identity":"674f399b-980c-4568-87c9-bc3f9e5fc48f","added_by":"auto","created_at":"2026-03-17 07:55:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1086941,"visible":true,"origin":"","legend":"\u003cp\u003eA flow diagram depicting the study selection process\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9091318/v1/7e14f3bffd98302eddc306ca.png"},{"id":104583019,"identity":"0c6539b1-5e6a-42f8-85a0-7e54c07c0bce","added_by":"auto","created_at":"2026-03-13 15:17:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":769216,"visible":true,"origin":"","legend":"\u003cp\u003eGeographical distribution of African countries with reported CAUTI studies.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9091318/v1/9c75c3b1773cca3be9d31c95.png"},{"id":104784559,"identity":"2d38583b-1d64-413c-a26d-de5e2a602ddf","added_by":"auto","created_at":"2026-03-17 08:08:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3448569,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9091318/v1/1408f96f-dbd5-4794-8931-6f20678e315c.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eBiofilm Formation and Antimicrobial Resistance in Catheter-Associated Urinary Tract Infections in Africa: A PRISMA-ScR Scoping Review\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCatheter-associated urinary tract infections (CAUTIs) are common in hospitals and account for over 30% of healthcare-acquired infections worldwide (CDC, 2025). In Africa, the burden is high, with 43.3% of catheterized patients developing CAUTIs, posing a significant threat to patient safety and healthcare systems (Asmare et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Gram-negative bacteria dominate these infections. \u003cem\u003eEscherichia coli\u003c/em\u003e accounts for 45.1% of isolates and \u003cem\u003eKlebsiella\u003c/em\u003e spp. for 24.2%, with Gram-negative pathogens representing 82.9% of infections (Asmare et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Mohamed et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). CAUTIs occur when microorganisms colonize catheter surfaces and form biofilms. Biofilms protect bacteria from immune responses and antimicrobials, leading to persistent and recurrent infections (Tegegne et al. \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Despite their significance, CAUTIs are inadequately addressed in Africa, particularly in settings with limited infection prevention, antimicrobial stewardship, and diagnostic capacity (Abbas, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMultidrug resistance (MDR) is widespread. In Ethiopia, 86.5% of Gram-negative bacilli were MDR, and 19.2% produced ESBLs (Asmare et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003eb). In Somalia, over 60% of \u003cem\u003eE. coli\u003c/em\u003e were resistant to fluoroquinolones and cephalosporins, limiting treatment options and prolonging hospital stays; nearly half of affected patients were hospitalized for more than two weeks (Mohamed et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBiofilm formation compounds the challenge. In Ethiopia and Tanzania, 51\u0026ndash;71% of \u003cem\u003eE. coli\u003c/em\u003e isolates formed biofilms (Oumer et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Mlugu et al. \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Molecular characterization of resistance determinants and biofilm mechanisms is largely absent, representing a critical gap in understanding persistence and treatment failure (Gahimbare et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Mlugu et al. \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEvidence on pathogens, resistance, and biofilms is fragmented. Central, North, and parts of West Africa are underrepresented, limiting generalizability (Asmare et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Tegegne et al. \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Methodological differences in bacterial identification, susceptibility testing, and biofilm assays further limit comparisons (Mlugu et al. \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Lakoh et al. \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Tegegne et al. \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese gaps hinder development of evidence-based guidelines for CAUTI prevention, diagnosis, and management in Africa (WHO, 2021; Asmare et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Mlugu et al. \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Tegegne et al. \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven high MDR prevalence and the role of biofilms in treatment failure, a comprehensive synthesis is urgently needed. This scoping review aims to \u003cb\u003emap available data, highlight knowledge gaps, and provide actionable insights\u003c/b\u003e for clinical management, infection prevention, and antimicrobial stewardship across Africa.\u003c/p\u003e \u003cp\u003eTo our knowledge, this is the \u003cb\u003efirst review integrating CAUTI pathogen, resistance, and biofilm data across multiple African countries\u003c/b\u003e, offering a continent-wide perspective for clinical and public health strategies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis was a scoping review, chosen to map evidence on biofilm formation and antimicrobial resistance in CAUTIs across African healthcare settings because the available data are limited, heterogeneous, and variably reported, making quantitative synthesis unsuitable. The sparse and inconsistent nature of the studies precluded a systematic review or meta-analysis. The methodology followed PRISMA-ScR guidelines (Tricco et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEligibility Criteria\u003c/h3\u003e\n\u003cp\u003eStudies were included if they met all of the following criteria:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eReported microbiological data on CAUTI pathogens in African healthcare settings.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eProvided antimicrobial resistance profiles, including multidrug resistance (MDR), extended-spectrum β-lactamase (ESBL) production, or carbapenem resistance.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAssessed biofilm formation in bacterial isolates from catheterized patients, where available.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWere original research articles, including cross-sectional, cohort, case-control, or surveillance studies.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePublished in English between 2020 and 2026 to reflect contemporary AMR trends.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eExclusion criteria:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eStudies on general UTIs without catheter association.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eReports lacking microbiological or AMR data.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eReviews, editorials, commentaries, or conference abstracts without primary data.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudies conducted outside Africa or lacking clear African clinical context.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudies with insufficient laboratory or methodological detail.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eInformation Sources and Search Strategy\u003c/h3\u003e\n\u003cp\u003eA systematic search was conducted in PubMed, Web of Science, Scopus, and African Journals Online (AJOL) from inception to March 2026. The search combined controlled vocabulary (MeSH) and free-text terms related to CAUTIs, biofilm formation, antimicrobial resistance, and African countries. A sample search string for PubMed was:\u003c/p\u003e \u003cp\u003e(\"catheter-associated urinary tract infection\" OR \"CAUTI\") AND\u003c/p\u003e \u003cp\u003e(\"biofilm\" OR \"biofilm formation\") AND\u003c/p\u003e \u003cp\u003e(\"antimicrobial resistance\" OR \"drug resistance\") AND\u003c/p\u003e \u003cp\u003e(Africa OR [list of African countries])\u003c/p\u003e \u003cp\u003eThe full search strategy is provided in supplementary Table\u0026nbsp;1.\u003c/p\u003e \u003cp\u003eReference lists of included studies were manually screened to identify additional relevant articles. Duplicate records were removed using EndNote 20.\u003c/p\u003e\n\u003ch3\u003eStudy Selection\u003c/h3\u003e\n\u003cp\u003eOf 245 records identified, 35 duplicates were removed, leaving 210 for screening. After excluding 150 based on title and abstract, 60 full-text articles were assessed, of which 40 were excluded for not being CAUTI-related (n\u0026thinsp;=\u0026thinsp;18), lacking AMR/biofilm data (n\u0026thinsp;=\u0026thinsp;12), non-original research (n\u0026thinsp;=\u0026thinsp;6), or insufficient methodology (n\u0026thinsp;=\u0026thinsp;4). Thirteen studies were included, comprising 11 published studies (including one meta-analysis summarizing 20 studies) and two unpublished datasets, with biofilm data reported in two. The meta-analysis was counted as one study, and unpublished datasets were excluded from quantitative synthesis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eData Extraction\u003c/h3\u003e\n\u003cp\u003eA standardized data extraction form was developed in Microsoft Excel. Two reviewers independently extracted the following data:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eStudy characteristics: author, year, country, healthcare setting, study design\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePatient characteristics: age, sex, catheter type, and duration\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMicrobiology: bacterial species, prevalence, biofilm formation assays\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAntimicrobial resistance: susceptibility profiles, MDR, ESBL, carbapenemase production\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMolecular data: genes associated with AMR and biofilm formation, if reported\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eDisagreements were resolved through discussion and consensus.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Synthesis\u003c/h2\u003e \u003cp\u003eDue to heterogeneity in study designs, laboratory methods, and reporting standards, findings were synthesized narratively. Key outcomes included:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePrevalence and distribution of CAUTI pathogens\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePatterns of antimicrobial resistance, including MDR and ESBL production\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eProportion of isolates capable of forming biofilms\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMolecular mechanisms of resistance and biofilm formation\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eData are presented in tables, graphs, and maps. A meta-analysis was not performed because of methodological heterogeneity.\u003c/p\u003e \u003cp\u003e \u003cb\u003eQuality Assessment\u003c/b\u003eAlthough scoping reviews do not require formal risk-of-bias evaluation, included studies were appraised for methodological rigor, including sample size, pathogen identification methods, and antimicrobial susceptibility testing standards. This assessment allowed us to contextualize findings, highlight methodological gaps, and consider the reliability of evidence when interpreting MDR and biofilm prevalence across African CAUTI studies (Tricco et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eHandling of Unpublished Datasets\u003c/b\u003eTwo unpublished institutional datasets were included to illustrate regional data gaps and expand geographic coverage. These datasets were not included in quantitative synthesis due to incomplete AMR profiling, lack of standardized methodology, and absence of formal peer review, but they provide important context for underrepresented regions and highlight areas for future research.\u003c/p\u003e \u003c/div\u003e"},{"header":"Findings","content":"\u003cp\u003eCatheter-associated urinary tract infections (CAUTIs) in Africa are predominantly caused by Gram-negative bacteria, especially \u003cem\u003eE. coli\u003c/em\u003e and \u003cem\u003eKlebsiella\u003c/em\u003e spp., with multidrug resistance (MDR) rates ranging from 16% to 88% and frequent extended-spectrum β-lactamase (ESBL) production (Asmare et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Oumer et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Lakoh et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Resistance is highest to ampicillin and co-trimoxazole, whereas amikacin, nitrofurantoin, and carbapenems generally retain activity.\u003c/p\u003e \u003cp\u003eBiofilm formation was reported in only\u0026thinsp;~\u0026thinsp;12% of included studies, yet when assessed, 51\u0026ndash;71% of \u003cem\u003eE. coli\u003c/em\u003e isolates were capable of forming biofilms (Oumer et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Mlugu et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This underscores the role of biofilms in \u003cb\u003epersistent infections, recurrent CAUTIs, and treatment challenges\u003c/b\u003e, and highlights a major evidence gap in African studies.\u003c/p\u003e \u003cp\u003eThe studies included in this review collectively cover eight African countries (Ethiopia, Tanzania, Uganda, Sierra Leone, Zambia, Somalia, Egypt, and Nigeria), in addition to a multi-country meta-analysis (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Unpublished datasets are clearly indicated.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of CAUTI Pathogens, Antimicrobial Resistance, and Biofilm Data from African Studies and Datasets\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy (Author, Year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCountry / Setting\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePathogen Findings\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAMR Patterns\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBiofilm Data\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsmare et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e (Meta-analysis, includes 20 studies)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMulti-country Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u0026thinsp;~\u0026thinsp;45.1%; \u003cem\u003eKlebsiella\u003c/em\u003e\u0026thinsp;~\u0026thinsp;24.2%; Gram-negatives\u0026thinsp;~\u0026thinsp;82.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh MDR trends across studies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot reported\u0026sup1;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsmare et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e (Incidence \u0026amp; ESBL/Carbapenemase)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEthiopia (Bahir Dar)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e 34.6%, \u003cem\u003eProteus spp.\u003c/em\u003e 13.5%, \u003cem\u003eP. aeruginosa\u003c/em\u003e 11.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMDR\u0026thinsp;~\u0026thinsp;86.5%; ESBL\u0026thinsp;~\u0026thinsp;19.2%; Carbapenemase\u0026thinsp;~\u0026thinsp;5.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot assessed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOumer et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEthiopia (Arba Minch)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e 40.5%, \u003cem\u003eKlebsiella\u003c/em\u003e 21.4%, \u003cem\u003eEnterococcus\u003c/em\u003e 11.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMDR\u0026thinsp;~\u0026thinsp;88.1%; high cotrimoxazole, cefoxitin, tetracycline resistance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBiofilm\u0026thinsp;~\u0026thinsp;71.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLakoh et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSierra Leone (Dual hospitals)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e 23.7%, \u003cem\u003eK. pneumoniae\u003c/em\u003e 17%, \u003cem\u003eK. oxytoca\u003c/em\u003e 13.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eESBL\u0026thinsp;~\u0026thinsp;56%; resistance higher to penicillins/cephalosporins; preserved activity with carbapenems \u0026amp; amikacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot assessed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorthern Tanzania CAUTI (local dataset)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTanzania (Bugando Medical Centre)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e, \u003cem\u003eKlebsiella\u003c/em\u003e spp., other Gram-negatives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh resistance to ampicillin \u0026amp; fluoroquinolones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot assessed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMlugu et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTanzania (Morogoro)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u0026thinsp;~\u0026thinsp;47%, \u003cem\u003eKlebsiella\u003c/em\u003e\u0026thinsp;~\u0026thinsp;30%, \u003cem\u003eProteus mirabilis\u003c/em\u003e\u0026thinsp;~\u0026thinsp;10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMDR\u0026thinsp;~\u0026thinsp;51%; high ampicillin and cotrimoxazole resistance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBiofilm\u0026thinsp;~\u0026thinsp;51.5% (\u003cem\u003eE. coli\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNiccodem et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2023\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTanzania (Dar es Salaam)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMixed uropathogens (\u003cem\u003eE. coli\u003c/em\u003e, \u003cem\u003eKlebsiella\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMDR common; ESBL reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot assessed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMusinguzi et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2019\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUganda (Kabale RRH)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e 52%, \u003cem\u003eK. pneumoniae\u003c/em\u003e 26%, \u003cem\u003eS. aureus\u003c/em\u003e 13%, \u003cem\u003ePseudomonas spp.\u003c/em\u003e 8.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh ESBL among Gram-negatives (~\u0026thinsp;83.3%); high cotrimoxazole resistance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot assessed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMohamed et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSomalia (Mogadishu)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e 26.3%, \u003cem\u003eA. baumannii\u003c/em\u003e 24.3%, \u003cem\u003eP. aeruginosa\u003c/em\u003e 19.2%, \u003cem\u003eK. pneumoniae\u003c/em\u003e 13.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCAUTI prevalence\u0026thinsp;~\u0026thinsp;12.7%; MDR\u0026thinsp;~\u0026thinsp;47%; ESBL\u0026thinsp;~\u0026thinsp;13%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot assessed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoono et al., 2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eZambia (Lusaka)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eK. pneumoniae\u003c/em\u003e\u0026thinsp;~\u0026thinsp;28%, \u003cem\u003eE. coli\u003c/em\u003e\u0026thinsp;~\u0026thinsp;25.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh resistance to ampicillin, nalidixic acid, norfloxacin, ciprofloxacin; lower for amikacin, nitrofurantoin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot assessed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlexandria ICU Dataset (unpublished)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEgypt (Alexandria ICU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMixed bacterial \u0026amp; fungal CAUTI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLimited AMR detail\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot assessed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEladawy et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2025\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEgypt (Mansoura)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u0026thinsp;~\u0026thinsp;50.7%, \u003cem\u003eP. aeruginosa\u003c/em\u003e\u0026thinsp;~\u0026thinsp;10.6%, \u003cem\u003eK. pneumoniae\u003c/em\u003e\u0026thinsp;~\u0026thinsp;8.3%, \u003cem\u003eProteus mirabilis\u003c/em\u003e\u0026thinsp;~\u0026thinsp;6.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMDR\u0026thinsp;~\u0026thinsp;16.7%; XDR\u0026thinsp;~\u0026thinsp;47%; high ceftazidime \u0026amp; ciprofloxacin resistance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot assessed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHassuna et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2025\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEgypt (Minia)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eProteus mirabilis\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMDR\u0026thinsp;~\u0026thinsp;70.9%; high SXT, AMC, ceftazidime, imipenem resistance; ESBL\u0026thinsp;~\u0026thinsp;37.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot assessed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Summary of CAUTI pathogens, antimicrobial resistance, and biofilm data from African studies and datasets. Note: The first row (Asmare et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e meta-analysis) summarizes 20 individual studies, but is presented as a single entry here. Unpublished/local datasets are included to illustrate regional gaps and are not included in quantitative synthesis. In total, the table contains 13 entries (11 published studies\u0026thinsp;+\u0026thinsp;2 unpublished datasets).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eStudies were conducted in eight African countries (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), with notable gaps in Central and parts of West Africa\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eOverview\u003c/h2\u003e \u003cp\u003eThis scoping review provides the first continent-wide synthesis of catheter-associated urinary tract infection (CAUTI) pathogens, antimicrobial resistance (AMR), and biofilm formation in African healthcare settings. By consolidating fragmented evidence, it highlights critical gaps in biofilm research, underrepresented regions, and the absence of molecular characterization, providing guidance for clinicians, researchers, and policymakers on prevention, treatment, and stewardship strategies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePathogen Distribution and Antimicrobial Resistance\u003c/h2\u003e \u003cp\u003eConsistent with global trends, Gram-negative bacteria predominate in African CAUTIs. \u003cem\u003eEscherichia coli\u003c/em\u003e (30\u0026ndash;52%) and \u003cem\u003eKlebsiella\u003c/em\u003e spp. (17\u0026ndash;36%) are the most common pathogens (Asmare et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Oumer et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Lakoh et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Multidrug resistance is widespread (16\u0026ndash;88%), with frequent extended-spectrum β-lactamase (ESBL) production (Eladawy et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Oumer et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Resistance is highest to ampicillin (70\u0026ndash;100%) and co-trimoxazole (60\u0026ndash;90%), whereas amikacin, nitrofurantoin, and carbapenems retain high efficacy (\u0026gt;\u0026thinsp;85% susceptibility) (Oumer et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Mlugu et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Mohamed et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge Gaps\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003eBiofilm Research\u003c/h2\u003e \u003cp\u003eOnly two studies (12% of included studies) assessed biofilm formation in African CAUTI isolates, reporting that 51\u0026ndash;71% of \u003cem\u003eE. coli\u003c/em\u003e formed biofilms, frequently associated with MDR (Oumer et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Mlugu et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Catheter-associated biofilms confer up to 100\u0026ndash;1000-fold increased tolerance to antibiotics compared with planktonic bacteria, promoting persistent infections, recurrence, prolonged hospitalization, and treatment failure (Abu Lila et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Mancuso et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; He et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Tegegne et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). The scarcity of biofilm-focused studies in Africa hampers understanding of these clinically important outcomes.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eMethodological Heterogeneity\u003c/h2\u003e \u003cp\u003eVariations in study design, pathogen identification, and antimicrobial susceptibility testing limit comparability. Included studies ranged from cross-sectional to prospective cohort designs with differing laboratory methods (Musinguzi et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Lakoh et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Mlugu et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), complicating pooled analysis and synthesis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eGeographic and Molecular Gaps\u003c/h2\u003e \u003cp\u003eAvailable evidence covers eight African countries, with notable underrepresentation of Central, West, and parts of North Africa (Asmare et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Tegegne et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Molecular characterization of resistance genes and biofilm mechanisms is largely absent, restricting understanding of CAUTI persistence and AMR evolution.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eClinical Implications\u003c/h2\u003e \u003cp\u003eMDR CAUTIs prolong hospitalization, increase costs, and constrain empiric therapy. Clinicians should rely on local susceptibility patterns, avoid agents with high resistance rates, and consider amikacin, nitrofurantoin, or carbapenems where appropriate. Standardized catheter care, timely removal, and staff training are essential. Recurrent infections should prompt evaluation for biofilm-mediated persistence, while antimicrobial stewardship programs should integrate CAUTI-specific monitoring and hygiene protocols.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eResearch and Policy Recommendations\u003c/h2\u003e \u003cp\u003eFuture studies should routinely assess biofilm formation and include molecular analyses to elucidate mechanisms driving AMR and persistence (Mlugu et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Tegegne et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Strengthened surveillance, standardized catheter protocols, and interventional studies are needed to guide evidence-based policies and support global AMR mitigation efforts.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eStrengths: This is the first continent-wide synthesis of CAUTI pathogens, AMR, and biofilm formation in Africa, conducted using a PRISMA-ScR framework. Inclusion of unpublished regional data provides additional context. Limitations: Only two studies assessed biofilm formation. Methodological heterogeneity, language restrictions, underrepresented regions, and limited molecular data constrain the generalizability of findings and interpretation of AMR prevalence.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis review provides the first integration of CAUTI pathogens, antimicrobial resistance, and biofilm formation across African healthcare settings. Although only two studies assessed biofilms, 51\u0026ndash;71% of \u003cem\u003eE. coli\u003c/em\u003e isolates formed biofilms, often associated with multidrug resistance, indicating a likely role in persistent and recurrent infections. The widespread MDR, combined with the paucity of biofilm-focused and molecular studies, underscores the urgent need for routine biofilm assessment, genomic characterization, and multi-center longitudinal research. Strengthening evidence on biofilm-mediated persistence will inform empiric therapy, improve infection prevention, and guide antimicrobial stewardship policies across African healthcare systems.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAmoxicillin-Clavulanic Acid\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAMR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAntimicrobial Resistance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCAUTI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCatheter-Associated Urinary Tract Infection\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCDC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCenters for Disease Control and Prevention\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eESBL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eExtended-Spectrum \u0026beta;-Lactamase\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIntensive Care Unit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMDR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMultidrug Resistance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePRISMA-ScR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePreferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSXT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCo-trimoxazole (Trimethoprim-Sulfamethoxazole)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eUTI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eUrinary Tract Infection\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eXDR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eExtensively Drug-Resistant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs this study is a literature-based scoping review, no ethical approval was required. All included studies were conducted in accordance with the ethical standards of their respective institutions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated and analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares to have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was not funded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSK:\u0026nbsp;\u003c/strong\u003eConceptualized the study, developed the search strategy, screened articles, extracted data, and drafted the manuscript, \u003cstrong\u003eLN:\u003c/strong\u003e Assisted with study selection, data extraction, synthesis of findings, and critically reviewed the manuscript for intellectual content, \u003cstrong\u003eMIM:\u0026nbsp;\u003c/strong\u003eProvided overall supervision, guided study design and methodology, contributed to data interpretation, and critically revised the manuscript for scientific accuracy. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAI Disclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors utilized an AI tool (GPT-5, chat.openai.com) to assist with editing and formatting. Authors retain full responsibility for the content, analyses, and interpretations presented in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eScolastika Kunambi, BSc\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.\u003cbr\u003e\u0026nbsp;Email: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLillian Nkinda, BSc, MSc\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.\u003cbr\u003e\u0026nbsp;Email: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMecky Isaac Matee, PhD\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania; SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Email: [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbbas S (2024) The challenges of implementing infection prevention and antimicrobial stewardship programs in resource constrained settings. Antimicrob Steward Healthc Epidemiol 4:e45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1017/ash.2024.35\u003c/span\u003e\u003cspan address=\"10.1017/ash.2024.35\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbu Lila AS, Rajab AAH, Abdallah MH, Rizvi SMD, Moin A, Khafagy ES et al (2023) Biofilm lifestyle in recurrent urinary tract infections. Life 13(1):148. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/life13010148\u003c/span\u003e\u003cspan address=\"10.3390/life13010148\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsmare Z, Awoke T, Genet C, Admas A, Melese A, Mulu W (2024) Incidence of catheter associated urinary tract infections by Gram negative bacilli and their ESBL and carbapenemase production in specialized hospitals of Bahir Dar, northwest Ethiopia. Antimicrob Resist Infect Control 13(1):10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13756-024-01368-7\u003c/span\u003e\u003cspan address=\"10.1186/s13756-024-01368-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsmare Z, Erkihun M, Abebe W, Ashagre A, Misganaw T, Feleke S (2024) Catheter associated urinary tract infections in Africa: systematic review and meta analysis. Infect Dis Health 29(3):172\u0026ndash;179. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.idh.2024.02.005\u003c/span\u003e\u003cspan address=\"10.1016/j.idh.2024.02.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCenters for Disease Control and Prevention (2025) Clinical Safety: Preventing Catheter associated Urinary Tract Infections (CAUTIs). Atlanta, GA: CDC [cited 2026 Mar 7]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/uti/hcp/clinical-safety/index.html\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/uti/hcp/clinical-safety/index.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEladawy M, Heslop N, Negus D, Thomas JC, Hoyles L (2025) Phenotype\u0026ndash;genotype discordance in antimicrobial resistance profiles of Gram negative uropathogens recovered from catheter associated urinary tract infections in Egypt. J Antimicrob Chemother. 80(11):3123\u0026ndash;3132. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/jac/dkaf352\u003c/span\u003e\u003cspan address=\"10.1093/jac/dkaf352\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 40985147\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlores C, Rohn JL (2025) Bacterial adhesion strategies and countermeasures in urinary tract infection. Nat Microbiol 10:627\u0026ndash;645. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41564-025-01926-8\u003c/span\u003e\u003cspan address=\"10.1038/s41564-025-01926-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGahimbare L, Muvunyi CM, Guessennd NAK, Rutanga JP, Gashema P, Fuller W et al (2024) Antimicrobial Resistance in the WHO African Region: A Systematic Literature Review 2016\u0026ndash;2020. Antibiot (Basel) 13(7):659. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/antibiotics13070659\u003c/span\u003e\u003cspan address=\"10.3390/antibiotics13070659\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHassuna NA, Kotb DN, Lami M, Abdelrahim SS (2025) Characterization of antimicrobial resistance among Proteus mirabilis isolates from catheter associated urinary tract infections and non CAUTIs in Minia, Egypt. BMC Infect Dis 25:767. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12879-025-11118-8\u003c/span\u003e\u003cspan address=\"10.1186/s12879-025-11118-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe W, Ma P, Li L, Wang D, Li X, Wen X et al (2024) Efficacy and safety of preventing catheter-associated urinary tract infection by inhibiting catheter bacterial biofilm formation: a multicenter randomized controlled trial. Antimicrob Resist Infect Control 13:96. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13756-024-01450-0\u003c/span\u003e\u003cspan address=\"10.1186/s13756-024-01450-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKelly T, Ai C, Jung M, Yu K (2024) Catheter-associated urinary tract infections (CAUTIs) and non-CAUTI hospital-onset urinary tract infections: Relative burden, cost, outcomes and related hospital-onset bacteremia and fungemia infections. Infect Control Hosp Epidemiol 45(7):864\u0026ndash;871. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1017/ice.2024.26\u003c/span\u003e\u003cspan address=\"10.1017/ice.2024.26\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLakoh S, Yi L, Russell JB et al (2023) High incidence of catheter associated urinary tract infections and related antibiotic resistance in two hospitals of different geographic regions of Sierra Leone: a prospective cohort study. BMC Res Notes 16(1):301. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13104-023-06591-w\u003c/span\u003e\u003cspan address=\"10.1186/s13104-023-06591-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu HY, Prentice EL, Webber MA (2024) Mechanisms of antimicrobial resistance in biofilms. npj Antimicrob Resist 2(1):27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s44259-024-00046-3\u003c/span\u003e\u003cspan address=\"10.1038/s44259-024-00046-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMancuso G, Trinchera M, Midiri A, Zummo S, Vitale G, Biondo C (2024) Novel antimicrobial approaches to combat bacterial biofilms associated with urinary tract infections. Antibiot (Basel) 13(2):154. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/antibiotics13020154\u003c/span\u003e\u003cspan address=\"10.3390/antibiotics13020154\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMlugu EM, Mohamedi JA, Sangeda RZ, Mwambete KD (2023) Prevalence of urinary tract infection and antimicrobial resistance patterns of uropathogens with biofilm forming capacity among outpatients in Morogoro, Tanzania: a cross sectional study. BMC Infect Dis 23:660. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12879-023-08641-x\u003c/span\u003e\u003cspan address=\"10.1186/s12879-023-08641-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohamed AH, Sheikh Omar NM, Osman MM, Mohamud HA, Eraslan A, Gur M (2022) Antimicrobial Resistance and Predisposing Factors Associated with Catheter-Associated UTI Caused by Uropathogens Exhibiting Multidrug-Resistant Patterns: A 3-Year Retrospective Study at a Tertiary Hospital in Mogadishu, Somalia. Trop Med Infect Dis 7(3):42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/tropicalmed7030042\u003c/span\u003e\u003cspan address=\"10.3390/tropicalmed7030042\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoono M, Spasojevic N, Mapulanga V (2021) Bacteriology and antibiotic sensitivity patterns of urine in urology patients with indwelling urinary catheters at the University Teaching Hospital in Lusaka, Zambia. J Agric Biomed Sci 5(3):13\u0026ndash;34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.53974/unza.jabs.5.3.692\u003c/span\u003e\u003cspan address=\"10.53974/unza.jabs.5.3.692\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMusinguzi B, Kabajulizi I, Mpeirwe M, Turugurwa J, Kabanda T (2019) Incidence and etiology of catheter associated urinary tract infection among admitted patients at Kabale Regional Referral Hospital, South Western Uganda. Adv Infect Dis 9(3):183\u0026ndash;196. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4236/aid.2019.93014\u003c/span\u003e\u003cspan address=\"10.4236/aid.2019.93014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNiccodem EM, Mwingwa A, Shangali A, Manyahi J, Msafiri F, Matee M, Majigo M, Joachim A (2023) Predominance of multidrug resistant bacteria causing urinary tract infections among men with prostate enlargement attending a tertiary hospital in Dar es Salaam, Tanzania. Bull Natl Res Cent 47:54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s42269-023-01030-z\u003c/span\u003e\u003cspan address=\"10.1186/s42269-023-01030-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOumer YA, Dadi BR, Seid M, Biresaw G, Manilal A (2021) Catheter-associated urinary tract infection: incidence, associated factors and drug resistance patterns of bacterial isolates in Southern Ethiopia. Infect Drug Resist 14:4511\u0026ndash;4522. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/IDR.S329452\u003c/span\u003e\u003cspan address=\"10.2147/IDR.S329452\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaiwo SS, Aderounmu AOA (2024) Catheter associated urinary tract infection: Aetiologic agents and antimicrobial susceptibility pattern in Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria. Afr J Biomed Res 9(3):141\u0026ndash;148. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4314/ajbr.v9i3.141\u003c/span\u003e\u003cspan address=\"10.4314/ajbr.v9i3.141\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTegegne DT, Abbott IJ, Poźniak B (2025) Catheter Associated Urinary Tract Infections: Understanding the Interplay Between Bacterial Biofilm and Antimicrobial Resistance. Int J Mol Sci 26(18):9193. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijms26189193\u003c/span\u003e\u003cspan address=\"10.3390/ijms26189193\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTricco AC, Lillie E, Zarin W, O\u0026rsquo;Brien KK, Colquhoun H, Levac D et al (2018) PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med 169(7):467\u0026ndash;473. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7326/M18-0850\u003c/span\u003e\u003cspan address=\"10.7326/M18-0850\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (2025) Global antibiotic resistance surveillance report 2025. Geneva: World Health Organization. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240116337\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240116337\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Muhimbili University of Health and Allied Sciences","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"catheter-associated urinary tract infection, biofilm, antimicrobial resistance, multidrug resistance, ESBL, Africa, scoping review","lastPublishedDoi":"10.21203/rs.3.rs-9091318/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9091318/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCatheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections globally, with rising antimicrobial resistance (AMR) complicating treatment. Biofilm formation on urinary catheters promotes bacterial persistence, recurrent infections, and multidrug resistance (MDR). While this mechanism is well documented globally, evidence on biofilm-associated CAUTIs in Africa remains sparse.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo provide the first continent-wide synthesis of evidence on biofilm formation and antimicrobial resistance in CAUTIs across African healthcare settings, identifying critical knowledge gaps to inform clinical management and public health strategies.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA scoping review was conducted following PRISMA-ScR guidelines. PubMed, Web of Science, Scopus, and African Journals Online were searched for English-language studies published between 2020 and 2026 reporting microbiological, AMR, or biofilm data among CAUTI patients in Africa. Two reviewers independently screened studies, extracted data, and synthesized findings narratively.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf 245 records identified, 13 studies (11 published, including one meta-analysis, and 2 unpublished datasets) from eight African countries met inclusion criteria. Gram-negative bacteria accounted for 82\u0026ndash;83% of CAUTIs, predominantly \u003cem\u003eEscherichia coli\u003c/em\u003e (30\u0026ndash;52%) and \u003cem\u003eKlebsiella\u003c/em\u003e spp. (17\u0026ndash;36%). MDR prevalence ranged from 16% to 88%, with frequent ESBL production. Resistance was highest to ampicillin and co-trimoxazole, whereas amikacin, nitrofurantoin, and carbapenems retained activity. Biofilm formation was assessed in only two studies, with 51\u0026ndash;71% of \u003cem\u003eE. coli\u003c/em\u003e isolates demonstrating biofilm capacity. Significant methodological heterogeneity and limited molecular characterization restricted cross-study comparisons and highlight major knowledge gaps.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAfrican CAUTIs are predominantly caused by MDR Gram-negative pathogens, yet biofilm-mediated persistence and molecular resistance mechanisms remain critically understudied. This review underscores the urgent need for routine biofilm assessment, molecular AMR characterization, and multicenter surveillance to guide empiric therapy, infection prevention, and antimicrobial stewardship across the continent.\u003c/p\u003e","manuscriptTitle":"Biofilm Formation and Antimicrobial Resistance in Catheter-Associated Urinary Tract Infections in Africa: A PRISMA-ScR Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-13 15:16:55","doi":"10.21203/rs.3.rs-9091318/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c3bdc487-f197-4afa-9bce-30fa71681bfa","owner":[],"postedDate":"March 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":64299183,"name":"Molecular Epidemiology"}],"tags":[],"updatedAt":"2026-03-13T15:16:55+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-13 15:16:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9091318","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9091318","identity":"rs-9091318","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}