Antimicrobial resistance trends during COVID-19 in male patients: a descriptive analysis

Urinary tract infections (UTIs) in male patients represent a distinct and underexplored clinical entity. The COVID-19 pandemic has further influenced infection patterns and antimicrobial use, potentially accelerating resistance trends. This study aimed to evaluate the prevalence of uropathogens and their resistance patterns in a large cohort of Romanian men during the full pandemic. A retrospective descriptive study was conducted at a tertiary academic urology center in Bucharest, Romania, including male patients evaluated during the COVID-19 pandemic (September 2021-February 2022). Male patients with positive urine cultures (≥10⁵ CFU/mL) and a single identified pathogen were included, while duplicate and polymicrobial samples were excluded. 733 male patients were included, with Gram-negative predominating (78.99%) over Gram-positive (21.01%). E. coli (32,74%) and Klebsiella (27.15%) were the most frequent isolates. UTIs were markedly more prevalent in patients >55 years. Gram-negative uropathogens showed high resistance to commonly used antibiotics, particularly Amoxicillin-Clavulanic acid (43.98%) and Levofloxacin (39.16%). E. coli demonstrated elevated resistance to Levofloxacin (36.52%) and Amoxicillin-Clavulanic acid (35.78%), while Klebsiella exhibited the most concerning profile, exceeding 50% resistance to Amoxicillin-Clavulanic acid (57.29%) and Nitrofurantoin (56.96%), with additional carbapenem resistance (Imipenem 13.59%, Meropenem 12.9%). Gram-positive isolates displayed relatively stable resistance patterns, with Enterococcus showing high resistance to Levofloxacin (56.7%) and lower resistance to Penicillin (19.67%). The male population showed higher resistance rates to several antibiotics, possibly due to the more complicated nature of their infections. These data highlight the need for tailored therapeutic approaches based on gender-specific resistance patterns.