URINARY TRACT INFECTIONS PREVALENCE AMONG CANCER PATIENTS UNDERGOING CHEMOTHERAPY AND RADIOTHERAPY AT THE NATIONAL ONCOLOGY CENTRE IN SANA'A, YEMEN

Nuha Abdul Aziz Al-Yousfi1image, Ibrahim Mohammed Amed Nahshal2image, Sami Mohammed Abdo Hassan3image, Emad Hassan Al-Shamahi4image, Khaled Abdul Karim Al-Moyed2image, Nawal Mohammed Al-Hababi4image, Sami Sultan Ahmed Abdu2image, Hassan Abdulwahab Al-Shamahy2*image

1Department of Internal Medicine, Faculty of Medicine and Health Sciences, Sana’a University. 2University of Science and Technology, Sana’a city, Yemen. 3Medical Microbiology and Clinical Immunology Department, Faculty of Medical Sciences, Al-Nasser University, Yemen. 4Department of Ophthalmology, Faculty of Medicine and Health Sciences, Sana’a University.

 

Abstract

Background and aims: Among the most prevalent bacterial infections are UTIs, especially in cancer patients with compromised immune systems. The patients' vulnerability to infection and antibiotic resistance frequently worsen these infections, making empirical treatment challenging. In order to improve the empirical treatment of UTIs with antibiotics, the study is carried out to determine the antibiotic resistance pattern of UTI bacteria among cancer patients at the National Oncology Centre.

Methods: An ongoing prospective follow-up research was conducted at the National Oncology Centre in the city of Sana'a, Yemen, from October to December 2025, involving 290 cancer patients (157 females and 133 males) aged 2 to 76, with a mean age of 32.7 years. Data on clinical, demographic, and factors influencing urinary tract infections (UTIs) were collected, followed by midstream urine samples to culture potential UTI pathogens on blood and MacConkey agar. Results: The largest group of cancer patients is aged 26-35 years (24.1%), with a majority female representation (54.1%). Breast cancer is the most prevalent, constituting 26.9% of cases, followed by Hodgkin's lymphoma and other types at 10.7% each, with leukemia and head and neck cancer at 10%. Pathogenic strains like Escherichia coli and S. saprophyticus were the dominant causes of UTI. Antibiotic susceptibility, revealing E. coli shows 100% resistance to cefixime, while imipenem and meropenem maintain high sensitivity at 68.4%. S. saprophyticus has high sensitivity to vancomycin (95.7%) and linezolid but significant resistance to cefixime (78.3%) and augmentin (56.5%). 

Conclusions: The results highlight two primary health concerns: a high prevalence of cancer among young adults (particularly females with breast cancer) and a widespread crisis of beta-lactam antibiotic resistance in UTI-causing bacteria. Overall, significant resistance to beta-lactam antibiotics was noted among isolates.

Keywords: Antimicrobial resistance, cancers, E. coli, S. saprophyticus, uropathogens.

 

 

INTRODUCTION

 

A class of disorders known as cancer is defined by aberrant cell proliferation that has the potential to spread to other body parts. Millions of new cases are diagnosed each year, making it one of the top causes of mortality globally. The World Health Organisation (WHO) estimates that there were roughly 19.3 million new cases of cancer in 2020, indicating a notable rise in the disease's prevalence1. The most prevalent cancers are lung cancer (about 2.5 million cases, 12.4%), colorectal cancer (about 1.9 million cases, 9.6%), stomach cancer (about 970,000 cases, 4.9%)2-4, and breast cancer (about 2.3 million cases, 11.6%), which is the most common cancer among women globally. About 1.5 million cases (7.3%) of prostate cancer2.

In Yemen, the most common cancers are breast cancer (31.1%), colorectal cancer (7.7%), and stomach cancer (5.0%). Other cancers, including blood cancers like leukemia, exist but are less prevalent in terms of incidence. An aging population, urbanization, and lifestyle changes may contribute to the rising cancer rates5,6. Treatment modalities include surgery, which is the main curative option for localized tumors. Radio-therapy is used alone or with other treatments; advanced techniques reduce side effects. Chemo-therapy is a systemic treatment; toxicity may occur, including myelosuppression and nausea. Drugs that target particular molecular alterations in cancer cells are known as targeted treatment. Immunotherapy works well for a variety of solid tumours and boosts the immune system. Hormone therapy for malignancies that are sensitive to hormones, such as prostate and breast. Palliative care improves quality of life and manages side effects7-9.

The health of cancer patients is affected by several factors, including the type of treatment used. Chemotherapy and radiation therapy are among the common methods for treating cancer; however, they have significant side effects on the immune system6-8. Chemotherapy, for instance, aims to kill cancer cells but can also affect healthy cells, leading to weakened immunity and an increased risk of infections. In this context, UTI is one of the most common types of infections among cancer patients undergoing chemo-therapy or radiation therapy, as these infections can be more severe and sometimes life-threatening due to compromised immunity9. 

The study was carried out to determine the antibiotic resistance pattern in UTI bacterial causes among cancer patients at the National Oncology Centre in Sana'a, Yemen.

 

SUBJECTS AND METHODS

 

An active prospective follow-up research was the methodology used. Every patient who gave their permission to take part and was seen at the National Oncology Centre in Sana'a City, Yemen, throughout the course of three months, beginning in October 2025 and ending in December 2025 (as permitted by the National Oncology Centre). 290 people with a cancer diagnosis were included in the study for its duration. Between the ages of 2 and 76, there are 157 females and 133 men, with a mean age of 32.7±16.5 years. For every cancer patient, clinical, demographic, and UTI-influencing data were gathered.

A midstream urine sample was then collected. The cultures were checked for important possible UTI bacterial pathogens after the samples were aerobically cultivated in blood agar and MacConkey agar. Potential bacterial pathogens were isolated and identified using standard laboratory procedures, and the disc diffusion method for microbial sensitivity testing was described by the Clinical and Laboratory Standards Institute (CLSI)10.

Susceptibility testing

In compliance with National Committee for Clinical Laboratory Standards (NCCLS) approvals, the isolates were tested for antibiotic susceptibility using Muller-Hinton medium and the disc diffusion method10. Tests were conducted on augmentin, norfloxacin, imipenem-pipracillin/tazobenem, meropenem, gentamicin, line-zolid, ciprofloxacin, levofloxacin, cefotaxime, ceftria-xone, cefixime, teicoplanin, and amoxicillin.
Ethical consideration: Patients provided informed consent, and the study was authorised by the Sana'a University Faculty of Medicine and Health Sciences Ethics Committee (document number: 2025-10, dated January 25, 2025).
Data analysis: After the results were totalled, standard descriptive statistics were used. While categorical data are shown as counts and percentages, numerical variables are summarised using mean values.

 

RESULTS            

                 

Table 1 shows the distribution of 290 cancer patients for different age groups, where the highest percentage was observed in the age group 26-35 years (24.1%); in contrast, a lower percentage was seen in the age group 16-25 (13.1%). Regarding the gender, the highest percentage was seen in females (54.1%) rather than in males (45.9%). Table 2 provides a simplified analysis of the cancer patients undergoing chemotherapy and radiotherapy at the National Cancer Centre in Sana'a city, based on the schedule provided. Total cases: 290 cancer cases were analyzed. The most common cancer Breast cancer is the most common type among analyzed cases, accounting for 78 (26.9%). Other notable cancers, Hodgkin's lymphoma and the “others” class, come second, each with 10.7% (31 cases). Leukemia and head and neck cancer are 10% each (29 cases each). It was noted that the very pathogenic bacteria isolates were from the urine of cancer patients undergoing chemotherapy and radiotherapy at the National Oncology Centre in Sana'a city.

They were E. coli, P. aeruginosa, E. faecalis, and S. saprophyticus. Their frequency and percentage were 19 (6.6%), 3 (1.03%), 3 (1.03%), and 23 (7.9%), respect-tively (Table 3). Table 4 illustrates the antibiotic susceptibility patterns of E. coli isolates causing UTIs among cancer patients. The findings reveal high levels of resistance to several antibiotics. The high rate of resistance was observed with cefixime (100%), followed by Augmentin (94.7%), amoxicillin (68.4%), cefotaxime (63.2%), and ceftriaxone (57.9%). Mode-rate resistance rates were also reported for norfloxacin and ciprofloxacin (52.6%). 

On the other hand, some antibiotics demonstrated relatively good effectiveness. Imipenem and mero-penem showed the highest sensitivity rates (68.4%), followed by linezolid (63.2%) and gentamicin (57.9%). Teicoplanin exhibited complete sensitivity (100%) with no detected resistance. 

Table 5 shows the susceptibility pattern of S. saprophyticus isolated from UTIs among cancer patients. High sensitivity was observed for vancomycin and linezolid (95.7% each), followed by nitrofurantoin (91.3%) and trimethoprim sulfamethoxazole (87%). Moderate sensitivity was reported in small proportions across most antibiotics. In contrast, high resistance rates were observed for cefixime (78.3%), augmentin (56.5%), ceftriaxone (52.2%), and cefotaxime (47.8%). Ciprofloxacin and piperacillin/tazobactam also showed notable resistance levels (39.1% and 43.5%, respecti-vely). Overall, the isolates demonstrated high suscep-tibility to vancomycin, linezolid, and nitrofurantoin, while resistance was more prominent against several beta-lactam antibiotics.

DISCUSSION

 

The current study found that the 26–35 age group had the highest incidence of cancer (24.1%), while females had the highest incidence (54.1%) compared to males (45.9%). These results are comparable to those before described in Yemen, where female cancer patients are predominately female due to the high incidence of breast cancer, with women accounting for appro-ximately 53% to 54% of cancer cases. Cancer is the second leading cause of death worldwide and causes about 9.6 million deaths per year1-3. Males are more likely than females to develop childhood malignancies in Yemen, and the prevalence of adult cancer peaks in women between the ages of 30 and 59, whereas the incidence in men is higher than in women over 604-6. In Yemen, the incidence rate of cancer is roughly 89.2 per 100,000 for females (53–54%) and 77.8 per 100,000 for males (46–47%) across all age categories7. With 78 cases (26.9%), breast cancer was the most prevalent type of cancer in the current study.

At 10.7% (31 cases), Hodgkin lymphoma and other types were the second most prevalent. Ten percent (29 instances) each of head and neck malignancies and leukemia. Although the age distribution of the patients varied considerably by type of cancer, the results of this study are comparable to those of the prior study. Although the proportion of patients under the age of 15 was lower, leukemia was the most prevalent malig-nancy in this age group, affecting young males more frequently than females. Due to the earlier beginning of lymphoma in both sexes and breast cancer in women, a significant share of patients seeking treatment were young adults and middle-aged adults (15–49 years old). With colon, rectal, stomach, and esophageal cancers being the most common, primarily affecting older men and women, the elderly (50 years and above) constitute the second largest category5,6. 

Chemotherapy was administered to 84.1% of the patients in the current study, whereas radiation was administered to 15.9% of the patients. The majority of patients had treatment for one to six months (44.1%), more than a year (32.8%), and seven to twelve months (23.1%). The National Cancer Centre in Sana'a and regional centres in towns like Aden and Hadramawt treat the great majority of patients in Yemen's highly centralized oncology services. Because chemotherapy is more widely available than radiotherapy, it is the most popular treatment in Yemen. Many individuals with leukemia and breast cancer between the ages of 30 and 59 are regularly given it. There is very little access to radiotherapy, which frequently causes treatment delays. Many patients must endure lengthy waiting lists or go overseas for treatment due to the state-wide dearth of operating linear accelerators. Because of this, a large number of geriatric and advanced-stage patients who rely on radiation therapy experience serious treatment protocol gaps6-8. Total 16.6% of cancer patients experienced bacterial urinary tract infections (UTIs). E. coli, P. aeruginosa, E. faecalis, and S. saprophyticus were among the causative agents. The current rate (16.6%) falls within the international range, as UTI incidence among cancer patients varies considerably, ranging from 6% to 24%, largely due to weakened immunity, catheterization, and surgical interventions. Gram-negative bacteria isolates are typically the main cause of these infections, with E. coli being the most common pathogen9.

 Inappropriate antibiotic prescribing and misuse can lead to the emergence of antibiotic-resistant pathogenic bacteria, which can restrict treatment options, increase hospital admissions, increase treatment costs, and eventually increase mortality17. In many hospital departments across the world, antimicrobial resistant bacteria are spreading quickly; in Yemen, the issue is more pervasive and complicated10-15. Antimicrobial resistance is expected to be one of the main causes of death for both hospitalised and non-hospitalized people in both developed and developing nations if appro-priate control and preventative measures are not put in place.

Gram-negative rods predominate in the bacterial profiles of cancer patients worldwide; however, multi-drug-resistant (MDR) strains and a sizable percentage of Gram-positive organisms are usually seen. The most frequent bacterial isolates are E. coli: Usually respon-sible for 44% to 58% of all UTI infections in cancer patients16,17. Cefixime (100%) was found to be the most resistant drug for E. coli in the current investigation, followed by amoxicillin (68.4%), cefotaxime (63.2%), ceftriaxone (57.9%), and Augmentin (94.7%). Moderate resistance rates were also recorded for norf-loxacin and ciprofloxacin (52.6%). However, several antibiotics showed comparatively good efficacy. Imip-enem and meropenem showed the highest sensiti-vity rates (68.4%), followed by linezolid (63.2%) and gentamicin (57.9%).

Teicoplanin revealed perfect sensitivity (100%) with no identified resistance. Obtained findings are consistent with high resistance rates (>50%) for ampi-cillin/amoxicillin (70 to 100%), cefixime (third-generation cephalosporin) (88 to 90%), trimethoprim /sulfamethoxazole (cotrimoxazole) (62% to 73%), ciprofloxacin (51 to 77%), amoxicillin/clavulanic acid (65 to 72%), and cefepime (fourth-generation cephal-osporin) (64% to 70%) resistance18-21.

Ceftazidime resistance ranges from 47% to 69% and gentamicin resistance from 36 to 58% for moderate resistance rates (20%–50%). Resistance to amikacin ranges from 4 to 15% for low resistance rates (<20%), while resistance to carbapenems (such as imipenem and meropenem) ranges from 2-16%19-22. E. coli also shows concerning rates of antibiotic resistance in Yemen, especially to first-line oral antibiotics that are frequently used. Extended-spectrum beta-lactamase (ESBL) enzymes are produced by a number of clinical isolates in large cities (such as Sana'a and Aden) that are categorized as multidrug-resistant (MDR)8-13,22,23.

S. saprophyticus, which was isolated from urinary tract infections in cancer patients, had a high susceptibility profile to vancomycin and linezolid (95.7% each), followed by nitrofurantoin (91.3%) and trimethoprim-sulfamethoxazole (87%). On the other hand, cefixime (78.3%), augmentin (56.5%), ceftriaxone (52.2%), and cefotaxime (47.8%) showed substantial resistance rates. One of the main causes of simple UTIs in young women who are sexually active is S. saprophyticus. It is nonetheless quite vulnerable to antibiotics used as first-line treatment for urinary tract infections, such as nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones, and aminoglycosides, even though it is naturally resistant to nalidixic acid and novobiocin22-26. Since S. saprophyticus is intrinsically resistant to many treatments frequently used for E. coli infections, it is essential to comprehend its distinct susceptibility features16. Clinical isolates typically show strong susceptibility to nitrofurantoin, trimeth-oprim-sulfamethoxazole, and fluoroquinolones (e.g., ciprofloxacin)17, which is consistent with our findings about high susceptibility (first-line choices). High rates of resistance to cefixime (78.3%), Augmentin (56.5%), ceftriaxone (52.2%), and cefotaxime (47.8%) were found in S. saprophyticus in the present investigation. In contrast, data from around the world suggest that this bacterium is typically responsive to broad-spectrum antibiotics, such as gentamicin, amoxicillin-clavulanate, and second-generation cephalosporins. Additionally, S. saprophyticus is naturally resistant to novobiocin and nalidixic acid, in contrast to the majority of staphylococci16,21-23. There is growing evidence of methicillin/cefoxitin resistance mediated by the mecA gene in some clinical isolates, despite the fact that the majority of strains are sensitive to beta-lactam antibiotics. Furthermore, in certain regions, up to 20–30% of isolates may exhibit erythromycin and ampicillin resistance16-18.

Limitations of the study

Although the study was successful in identifying bacterial causative agents and resistance patterns among cancer patients at the National oncology Centre in Sana'a, its main limitations include the short time frame of three months and the single-centre design; as a result, the findings may not be applicable throughout Yemen. 

 

CONCLUSIONS

 

The findings highlight two major health concerns: the rising incidence of cancer among young adults (parti-cularly women with breast cancer) and a wide-spread resistance crisis to beta-lactam antibiotics in bacteria causing urinary tract infections (UTIs). The highest concentration of cancer patients is observed among young adults aged 26–35 (24.1%), with a slight majority being female (54.1%). Breast cancer is the most common (26.9%), followed by Hodgkin lymphoma (10.7%) and leukemia (10%). E. coli and S. saprophyticus are the leading causes of UTIs. The results indicate a resistance crisis, with isolates exhibiting significant resistance to beta-lactam antibiotics. E. coli shows complete resistance (100%) to cefixime. Similarly, S. saprophyticus shows high resistance to both cefixime (78.3%) and augmentin (56.5%). There are therapeutic alternatives in which imipenem and meropenem are effective against E. coli (sensitivity ~68.4%), while vancomycin (95.7%) and linezolid remain highly effective against S. saprophyticus.

 

ACKNOWLEDGEMENTS

 

The authors are grateful to Sana'a City's Oncology centre for their kind cooperation.

 

AUTHOR’S CONTRIBUTIONS

 

Al-Yousfi NAA: formal analysis, conceptualization, writing original draft. Nahshal IMA: conceptu-alization, data organization. Hassan SMA: critical review. Al-Shamahi EH: data organization. Al-Moyed KAK: formal analysis. Al-Hababi NM: supervision, critical review. Abdu SSA: supervision, critical review. Al-Shamahy HA: supervision, critical review. Final manuscript was checked and approved by all authors. 

 

DATA AVAILABILITY

 

The related author can provide the empirical data supporting the study's conclusions upon request. 

 

CONFLICT OF INTEREST

 

Regarding this project, there are no conflicts of interest.

 

REFERENCES

             

  1. Bray F, Laversanne M, Weiderpass E, et al. The ever-increasing importance of cancer as a leading cause of premature death worldwide. Cancer 2021;127(16):3029-3030.https://doi.org/10.1002/cncr.33587
  1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide. CA Cancer J Clin 2021;71(3): 209-249.https://doi.org/10.3322/caac.21660
  1. Ferlay J, Ervik M, Lam F, et al. Global cancer observatory: Cancer tomorrow. International agency for research on cancer. factsheets. Accessed November 2024.
  2. Alkubati SA, Halboup AM, Zoromba MA, et al. Prevalence and determinants of depression and its association with social support among cancer patients: Implications for enhancing oncology care. BMC Psychol 2025 Mar 12;13(1):232.https://doi.org/10.1186/s40359-025-02584-5 
  1. Ibrahim A, El Baldi M, Mohammed S et al. Cancer statistics in Yemen: incidence and mortality, in 2020. BMC Public Health 24, 962 (2024).https://doi.org/10.1186/s12889-024-18207-4
  1. In: The United Nations in Yemen: Sociodemographic profile. Sana'a, Yemen: United Nations; 2020. https://yemen.un.org/en/about/about-the-un.
  2. NIC/Yemen. The Republic of Yemen has administrative governorates. National Information Center; 2014.https://yemen-nic.info/yemen/gover/#.
  1. In: Yemen demographics: life expectancy in Yemen. Worldometers; 2020. https://www.worldometers.info/demographics/yemen-demographics/#life-exp.
  1. Khemiri S, Masmoudi S, Mezghanni S, et al. Urinary tract infections in patients with solid tumours: Retrospective study. J Clin Nephrol Ren Care 2022; 8:075https://doi.org/10.23937/2572-3286.1510075
  1. Hassan SMA, Al-Moyed KA, Abdu SSA, et al. Antibiotic resistance rates of bacterial isolates from urinary tract infections in diabetic patients in Sana’a, Yemen. Universal J Pharm Res 2026; 11(2): 6-11. http://doi.org/10.22270/ujpr.v11i2.1528
  1. Alhasani AH, Ishag RA, Al Shamahy HA, et al. Association between the Streptococcus mutans biofilm formation and dental caries experience and antibiotic resistance in adult females. Universal J Pharm Res 2020; 5(6):1-3.https://doi.org/10.22270/ujpr.v5i5.478
  1. Abbas AM, Al-Kibsi TAM, Al-Akwa AAY, et al. Characterisation and antibiotic sensitivity of bacteria in orofacial abscesses of odontogenic origin. Universal J Pharm Res 2020; 5(6):36-42.https://doi.org/10.22270/ujpr.v5i6.510
  1. AL-Haddad KA, Ali Al-Najhi MM, Al-Shamahy HA, et al. Antimicrobial susceptibility of Aggregatibacter actinomycete-mcomitans isolated from localised aggressive periodontitis (LAP) cases. J Dent Ora Heal Ad 2021; 103. https://doi.org/10.1111/j.1600-0463.2007.apm_630.x
  1. Al-Akwa AA, Zabara A, Al-Shamahy HA. Actinomycete-mcomitans. Prevalence of Staphylococcus aureus in dental infections and the occurrence of MRSA in isolates. Universal J Pharm Res 2020; 5(2):1-6.https://doi.org/10.22270/ujpr.v5i2.384
  1. Al-Deen HS, Al-Ankoshy AAM, Al-Shamahy HA, et al. Porphyromonas gingivalis: Biofilm formation and antimicrobial susceptibility of isolates from cases of localised aggressive periodontitis (LAP). Universal J Pharm Res 2021; 6(4):1-7. https://doi.org/10.22270/ujpr.v6i4.633
  2. Khoshbakht R, Salimi A, Shirzad Aski H, et al. Antibiotic susceptibility of bacterial strains isolated from urinary tract infections in Karaj, Iran. Jundishapur J Microbiol 2012;6(1): 86-90. https://doi.org/10.5812/jjm.4830
  3. Farajnia S, Alikhani MY, Ghotaslou R, et al. Causative agents and antimicrobial susceptibilities of urinary tract infections in the northwest of Iran. Int J Infect Dis 2009;13(2):140-4.https://doi.org/10.1016/j.ijid.2008.04.014
  1. Ishak AA, Alhadi AM, Al-Moyed KAA, et al. Childhood urinary tract infection: Clinical signs, bacterial causes and antibiotic susceptibility. Universal J Pharm Res 2021; 6(4):1-8.https://doi.org/10.22270/ujpr.v6i4.643
  1. Abdulmogni SS, Hassan SMA, Al-Moyed KA, et al. Prevalence of urinary tract infections, aetiology, associated risk factors, and dietary adherence to the occurrence of urinary tract infections in diabetic patients. Universal J Pharm Res 2025; 10(6): 12-18. https://doi.org/10.22270/ujpr.v10i6.1456
  2. Nasher AA, Assayaghi RM, Al-Shamahy HA, et al. Vulvovaginal candidiasis among Yemeni women: Prevalence of Candida species, biofilm formation rates, antifungal susceptibility patterns, and biofilm-associated genes ALS1 and HWP1. BMC Microbiol 2026.https://doi.org/10.1186/s12866-026-05241-y
  1. Saleh AAM, Al-Shamahy HA, Al-Hrazi RMA, et al. Biofilm formation and antibiotic susceptibility of uropathogens in patients with catheter-associated urinary tract infections in Ibb City, Yemen. Universal J Pharm Res 2019; 4(6):1-7.https://doi.org/10.22270/ujpr.v4i6.329
  1. Al-Haifi AY,  Al  Makdad  ASM, Al-Shamahy  HA, et al.  Urinary  tract  infections  in  postoperative   patients:   prevalence   rate,   bacterial profile,  antibiotic  sensitivity  and  specific  risk factors.   Universal J Pharm Res 2020; 5(3):21-26. https://doi.org/10.22270/ujpr.v5i3.411
  2. Al-Khawi MA, Bahaj SS, Al-Shami HZ, et al. Knowledge and practice in using the antimicrobial susceptibility test towards Enterobacteriaceae isolated from urinary tract infection. Universal J Pharm Res 2025; 10:3. https://doi.org/10.22270/ujpr.v10i3.1350
  1. Alhadi YAA, Al-Kibsi TAM, Al-Shamahy HA, Aldeen YAAS. Surgical site Infections: Prevalence, associated factors and antimicrobial susceptibility patterns of the bacterial isolates among postoperative patients in Sana’a, Yemen. Universal J Pharm Res 2022; 7(3):32-39.https://doi.org/10.22270/ujpr.v6i1.532
  1. Sheikholeslami Z, Hassanshahi G. The frequency of coagulase-negative staphylococci urinary infections with antimicrobial resistance patterns in Rafsanjan. Pak J Med Sci. 2010; 26(1):107-10.
  2. Chinaemerem OH, Alexander I, Romanus II. Prevalence of multidrug-resistant Escherichia coli and Klebsiella pneumoniae species isolated from urine samples of patients at Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria. Universal J Pharm Res 2023; 8(1):15-22. https://doi.org/10.22270/ujpr.v8i1.892