Abstract
Urinary tract infection (UTI) is a common bacterial infection among people living with HIV (PLWHIV) and can cause complications, particularly due to antimicrobial resistance. Data on UTIs among PLWHIV in Ethiopia are limited. This study assessed the bacterial profile, antimicrobial susceptibility, and associated factors of UTIs among 255 PLWHIV attending the ART outpatient clinic at Debre Markos Comprehensive Specialized Hospital from March to June 2025. Clean-catch midstream urine samples were inoculated on MacConkey and blood agar to identify pathogens, and antimicrobial susceptibility tested by Kirby-Bauer disk diffusion method. Statistical significance was set at p ≤ 0.05 with 95% confidence intervals. UTIs were identified in 28 participants (11%), with E. coli (46.4%), S. aureus (21.4%), and P. aeruginosa (14.3%) predominating. Female sex (AOR = 2.48; 95% CI 1.45-6.27; p = 0.010), HIV RNA > 1000 copies/mL (AOR = 6.30; 95% CI 4.52-14.61; p = 0.001), CD4 + 3 (AOR = 3.17; 95% CI 1.14-9.52; p = 0.028), and being symptomatic (AOR = 3.80; 95% CI 1.63-8.74; p = 0.024) were significantly associated with UTIs. The multidrug-resistant prevalence was 17.9%, highlighting the need for strengthened diagnostics, susceptibility-guided therapy, routine screening, and PLWHIV education on perineal hygiene to improve management and limit antimicrobial resistance.