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

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 Results Of 245 records identified, 13 studies (11 published, including one meta-analysis, and 2 unpublished datasets) from eight African countries met inclusion criteria.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.