Uropathogens' AMR in Male and Female Romanian Population-A Bi-Center Analysis over 1 Year

Background and Objectives: Urinary Tract Infections (UTIs) are a major concern worldwide due to increasing antimicrobial resistance. Even though sex-based differences in antimicrobial resistance are recognized worldwide, there is a lack of data in the literature. This study aims to evaluate differences in the distribution of uropathogens and antibiotic resistance across large groups of Romanian males and females. Materials and Methods: This retrospective descriptive analysis included 2567 positive urine cultures collected over a 1-year period from hospitalized and outpatient patients at two representative urology centers in Bucharest. Only urine tests with ≥10⁵ CFU/mL and monomicrobial growth were included. Results: The sex distribution showed a predominance of male patients (62.2%). Also, their age tended to be higher than that of females. Escherichia coli remained the most common pathogen, with a higher prevalence in females (54.08% vs. 32.54%), while Klebsiella and Pseudomonas were more frequently noted in males. The Gram-negative analysis revealed higher resistance rates in male patients, particularly for common antibiotics such as amoxicillin-clavulanic acid (50.37% vs. 35.77%), trimethoprim-sulfamethoxazole (46.69% vs. 34.64%), and levofloxacin (45.55% vs. 34.71%). Notably, carbapenem resistance in Klebsiella exceeded 30% in males, indicating major concerns about multidrug resistance in this case. In contrast, Gram-positive bacteria showed more stable resistance patterns among the studied groups. Preserved sensitivity was found to linezolid, vancomycin, fosfomycin, and nitrofurantoin. Conclusion: These findings demonstrate clinically relevant sex-based differences in both pathogen distribution and antimicrobial resistance, particularly among Gram-negative uropathogens. Also, it highlights the importance of developing sex-adapted antibiotic strategies in conjunction with the local epidemiological data.