Abstract
<title>Abstract</title> <p> Background Antimicrobial resistance among uropathogenic bacteria is a major public health concern worldwide, particularly in low- and middle-income countries where surveillance data remain limited. This study compared the antibiotic resistance profiles of <italic>Escherichia coli</italic> and <italic>Klebsiella pneumoniae</italic> isolated from urinary tract infections (UTIs) at the National Reference University Hospital Center (CHU-RN), Chad, and the Military Region Hospital N°1 (HMR1), Cameroon. Methods A prospective cross-sectional study was conducted from February to July 2025. Midstream urine specimens were collected from 300 patients at CHU-RN and 250 patients at HMR1. Only one isolate per patient was retained for analysis. Bacterial identification was performed using standard culture methods and the API 20E system. Antimicrobial susceptibility testing was carried out by Kirby–Bauer disk diffusion on Müller-Hinton agar and interpreted according to CA-SFM/EUCAST 2025 breakpoints. Results Among 300 urine samples analyzed at CHURN and 250 at HMR1, culture positivity rates were 31.7% and 22.0%, respectively. <italic>E. coli</italic> was the predominant pathogen, accounting for 19.3% of isolates at CHURN and 10.8% at HMR1, followed by <italic>K. pneumoniae</italic> at 6.7% and 6.0%, respectively. Most patients at CHU-RN were male (66.0%), whereas females predominated at HMR1 (64.4%). High resistance rates were observed for amoxicillin (70.5–95.0%) and amoxicillin–clavulanic acid (52.0–75.0%) in both bacterial species. Fluoroquinolone resistance was particularly elevated among <italic>E. coli</italic> isolates from CHURN, reaching 65.5% for ciprofloxacin and 63.8% for levofloxacin. Imipenem remained the most effective antibiotic, with resistance rates below 20.0% in all isolates. Significant differences in resistance patterns were observed between hospitals (p < 0.001). Conclusion Uropathogenic <italic>E. coli</italic> and <italic>K. pneumoniae</italic> exhibit high resistance to commonly prescribed antibiotics in both Chad and Cameroon. Continuous antimicrobial resistance surveillance and evidence-based antibiotic stewardship programs are urgently needed to improve UTI management and preserve the effectiveness of last-resort antibiotics in Central Africa. </p>