Distribution and Drug-Resistance Analysis of Uropathogens in Urinary Tract Infections

Urinary tract infections (UTIs) are a major global health concern with increasing antimicrobial resistance. Regional data on pathogen distribution and resistance patterns are essential for guiding empirical therapy. This study aimed to investigate the distribution and antimicrobial resistance profiles of UTI pathogens in Shanghai, China, and identify risk factors associated with UTIs.

A retrospective analysis was conducted on urine culture records from 61,450 patients suspected of UTIs, collected between January 1 and December 31, 2023, from two general hospitals in Shanghai. Pathogen identification and antimicrobial susceptibility testing were performed according to CLSI guidelines (2021). Multivariable logistic regression was used to analyze risk factors for UTIs.

Among 5671 confirmed UTI cases, Escherichia coli was the predominant pathogen (36.1%), followed by Enterococcus faecalis (11.2%) and Klebsiella pneumoniae (8.2%). E. coli exhibited high resistance to ampicillin (75.9%), levofloxacin (59.2%), and cefazolin (49.1%) but low resistance to carbapenems (1.0%). K. pneumoniae showed higher resistance rates, with the highest to ampicillin (97.3%) and levofloxacin (45.1%). Proteus spp. demonstrated significant resistance to ampicillin (66.7%) and fosfomycin (34.6%). Multivariable analysis identified female sex (OR = 1.55, 95% CI: 1.25-1.89), age > 60 years (OR = 2.60, 95% CI: 2.08-2.99), and hospitalization (OR = 2.49, 95% CI: 1.95-2.95) as significant risk factors for UTIs.

High antimicrobial resistance rates were observed among uropathogens in Shanghai, particularly to commonly used antibiotics. These findings highlight the need for region-specific antibiotic stewardship programs and updated empirical treatment guidelines to combat rising resistance and improve clinical outcomes.