Pattern of bacterial uropathogens and multidrug resistance in selected private laboratories, Ibb city, Yemen: a...

Urinary tract infections (UTIs) represent a significant global health burden, and rising antimicrobial resistance (AMR) threatens effective empirical treatment. Ibb City lacks contemporary, comprehensive resistance data from large cohorts that are essential to guide treatment decisions and antimicrobial stewardship. This analysis aimed to determine the spectrum of bacterial uropathogens and evaluate the prevalence of multidrug resistance (MDR).

A retrospective analysis was conducted on 905 non-duplicate, consecutive culture-confirmed UTI cases in Ibb between August 2024 and August 2025. Antimicrobial susceptibility testing was performed for 42 antibiotics across multiple classes using the Kirby-Bauer disk diffusion method. Statistical analyses included descriptive statistics, chi-square tests, Fisher's exact test, Cochran-Armitage trend test, and Monte Carlo simulation for contingency tables with low expected cell counts.

The majority of cases were recorded among females with 593 cases (65.5%) and young adults aged 19-35 years with 462 cases (51.0%). Escherichia coli was the most frequently isolated pathogen (387, 42.8%), followed by Staphylococcus saprophyticus (300, 33.1%), Staphylococcus aureus (131, 14.5%), Klebsiella spp. (30, 3.3%), Pseudomonas aeruginosa (21, 2.3%), Enterobacter spp. (21, 2.3%), Proteus spp. (12, 1.3%), and Acinetobacter spp. (3, 0.3%). The significant associations were observed between uropathogen distribution and demographic factors, including sex and age group (P < 0.001). The overall MDR prevalence was 27.8% (252/905). MDR prevalence showed a significant positive correlation with age (P < 0.001), increasing progressively from 12.7% in pediatric patients to 38.6% in elderly patients. Enterobacter spp. had the highest MDR rate (42.9%), followed by Proteus spp. (41.7%), E. coli (35.4%), P. aeruginosa (33.3%), S. aureus (19.8%), and S. saprophyticus (19.3%).

The finding revealed an increased burden of antimicrobial resistance in the study area, with an association between rising rates of MDR and advancing age. This necessitates a review of antimicrobial use protocols and the implementation of effective strategies to monitor the spread of antibiotic-resistant strains.

Not applicable.