Background: Urinary tract infections (UTIs) represent a major public health concern, particularly in low- and middle-income countries, where they are highly prevalent and increasingly associated with antimicrobial resistance. In the Democratic Republic of Congo (DRC), data on the bacteriological profile and antibiotic susceptibility patterns of uropathogens remain scarce. This study aimed to describe the bacteriological profile, antibiotic resistance patterns, and factors associated with multidrug resistance (MDR) among uropathogens at the Hôpital Provincial Général de Référence de Bukavu (HPGRB). Methods: A retrospective descriptive and analytical study was conducted from July 1 to December 31, 2024, in the Microbiology Department of HPGRB. Urine cultures and Kirby–Bauer antibiograms (EUCAST and CLSI 2024 guidelines) from 380 positive samples were analyzed. Bivariate (χ 2 /Fisher) and multivariate logistic regression were used to identify factors associated with MDR. The production of extended-spectrum β-lactamases (ESBL) was detected and selected by the search for the champagne cork between clavulanic acid and ceftazidime alone or simply resistance to ceftazidime in the absence of the champagne cork. Results: Among 380 patients with positive urine cultures (55% female), children (40.4%) and elderly patients (41.6%) were the most affected. Escherichia coli (62%) and Klebsiella pneumoniae (21%) predominated, showing high resistance to third-generation cephalosporins and quinolones. Presumed ESBL phenotypes were observed in 76.2% of E. coli and 83.3% of K. pneumoniae , with MDR rates of 70% and 82%, respectively. Surgery department admission was the only independent predictor of MDR (adjusted OR 5.43; 95% CI 1.63– 18.09; p = 0.006). Conclusion: UTIs at HPGRB are dominated by Enterobacterales with high MDR and presumed ESBL rates, though last-line antibiotics remain effective. Continuous surveillance, confirmatory ESBL testing, and targeted antibiotic stewardship are urgently needed to preserve therapeutic options. Keywords: urinary tract infection, antibiotic resistance, MDR, ESBL, E. coli , K. pneumoniae , DR Congo
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