Determinants of multidrug-resistant urinary tract infections: a retrospective cross-sectional study from a tertiary care hospital in southern Bangladesh

Multidrug resistance (MDR) poses significant public health concerns with global impacts, yet data on factors driving MDR in urinary tract infections (UTIs) within Bangladesh remains scarce. Therefore, this study aimed to identify factors associated with MDR in UTI patients. A retrospective cross-sectional study was conducted from January to December 2023 at a tertiary care hospital in Barishal, Bangladesh. Among 1,797 urine samples, 229 with significant bacterial growth were analyzed. Antimicrobial susceptibility testing (AST) was performed using the disk diffusion method. Univariate and multivariate logistic regression analyses were applied to determine significant predictors and risk factors. Multiple Correspondence Analysis (MCA) was used to prioritize categories of predictors and risk factors, highlighting primary and secondary contributors to MDR in UTI patients. Out of 229 samples assessed, 60 were MDR-positive. E. coli (55.9%) was the predominant uropathogen, followed by Pseudomonas spp. (20.5%), Klebsiella spp. (14.8%), and Acinetobacter spp. (8.7%). Samples from specialized units (SUs) had significantly higher odds of MDR (OR = 5.9; p = 0.002) compared to outpatient department (OPD). Additionally, male patients from private medical settings (PMSs) exhibited higher odds (OR = 21.8; p = 0.004). MCA identified MDR-positive status and SU sample sources as primary contributors, while Acinetobacter spp., and Pseudomonas spp. were linked to secondary dimensions. The findings highlight SU samples and male patients from PMSs as key predictors of MDR, underscoring the need for further research and the implementation of evidence-based antimicrobial stewardship (AMS) in resource-limited settings.