Antimicrobial Resistance and Clinical Outcomes of Uropathogenic Enterococcal Infections in Hospitalised Patients

Introduction Enterococcus faecalis and Enterococcus faecium are important opportunistic pathogens causing urinary tract infections (UTIs) and are increasingly associated with antimicrobial resistance (AMR). This study aimed to evaluate the AMR patterns and clinical outcomes of uropathogenic Enterococcus species in hospitalised patients and to correlate resistance profiles with demographic and clinical parameters. Methods This prospective observational study was conducted at a tertiary care hospital in Southwest Maharashtra from October 2023 to October 2025. Thirty Enterococcal urinary isolates from hospitalised patients were analysed using standard microbiological techniques in accordance with the Clinical and Laboratory Standards Institute (CLSI) M100 guidelines. Parameters such as the Antimicrobial Resistance Index (ARI), the Multiple Antibiotic Resistance Index (MARI), and resistance categories were assessed in relation to clinical factors. Results Enterococcus species isolates accounted for 30/490 (6.12%) of the inpatient culture-positive urine specimens, with 14 (46.7%) E. faecalis and 16 (53.3%) E. faecium. E. faecium showed 16 (100%) resistance to antimicrobials such as β-lactams, fluoroquinolones, fosfomycin, and high-level streptomycin (HLS), whereas E. faecalis showed comparatively lower resistance, including three (21.4%) to β-lactams. Both species were susceptible to vancomycin and linezolid. Multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) phenotypes were more common in E. faecium than in E. faecalis. XDR isolates had the longest hospital stays, whereas non-MDR E. faecalis had the shortest. Complicated UTIs (cUTIs) were the most common type. Overall, 23 (76.7%) patients showed improvement, 3 (10%) left against medical advice (LAMA), and 4 (13.3%) died due to renal disease and geriatric comorbidities in MDR/XDR infections. Conclusion E. faecium showed comparatively higher resistance than E. faecalis, necessitating species-specific antimicrobial treatment. Targeted vigilance is required, especially for high-risk groups with device-related infections, uropathy and obstetric conditions. Antimicrobial stewardship and surveillance are essential for improving patient outcomes.