Antimicrobial resistance in complicated urinary tract infections: A retrospective study from a Rehabilitation Center in a resource-limited setting

• High resistance to ciprofloxacin and ceftriaxone in uropathogens • Emerging carbapenem resistance in Pseudomonas aeruginosa and Klebsiella pneumoniae • Prior antibiotic use predicts for carbapenem resistance • Nitrofurantoin and fosfomycin remain effective for common uripathogens • Multidrug resistance associated with prolonged hospital stay Antimicrobial resistance (AMR) is a major challenge in complicated urinary tract infections (cUTIs), particularly among high-risk patients in resource-limited settings. This retrospective study (January 2019– December 2023) analyzes 622 urine culture–positive samples from cUTI patients at a rehabilitation center to investigate pathogen distribution, AMR patterns, and associations with clinical outcomes using descriptive statistics and regression models. Escherichia coli (46%) was the predominant isolate, followed by Klebsiella pneumoniae (16%). Although Enterococcus faecalis and Pseudomonas aeruginosa were less common, their prevalence increased over time. High resistance rates to ciprofloxacin and ceftriaxone were observed in E. coli (69.5%, 74.7%) and K. pneumoniae (60.2%, 58.1%). Carbapenem resistance emerged in P. aeruginosa (51.4%) and K. pneumoniae (37.5%), with prior antibiotic exposure identified as a significant predictor (OR: 2.15; 95% CI:1.33-3.47; p = 0.002). In contrast, E. coli and E. faecalis retained high susceptibility to nitrofurantoin and fosfomycin. Multidrug-resistant (MDR) infections were independently associated with prolonged hospital stay (β = 1.889; p = 0.045). The high prevalence of resistance to first-line agents and emergence of carbapenem resistance underscore the urgent need for antimicrobial stewardship (AMS) interventions. The study suggests specific hospital-setting AMS should be prioritized the judicious use of agents such as nitrofurantoin and fosfomycin, which retain clinical effectiveness. Addressing MDR is crucial as it represents a key modifiable determinant of length of hospital stay in patients with cUTI.