ABSTRACTBackground : The global escalation of antimicrobial resistance (AMR) is rapidly compromising the efficacy of empirical therapy for community-acquired urinary tract infections (CA-UTIs). As the distinction between community and nosocomial resistance profiles diminishes, local surveillance becomes essential to guide effective treatment. This study aimed to characterize the evolving microbial epidemiology and AMR patterns among Lebanese outpatients to inform evidence-based treatment strategies in Lebanon and similar resistance-endemic settings. Methods : A retrospective multicenter analysis was conducted on 2,188 culture-confirmed UTI cases collected between January 2019 and 2024 across Lebanese governorates. Pathogen distribution, antimicrobial susceptibility profiles, and temporal resistance trends were evaluated, with specific analysis of predictors for extended-spectrum beta-lactamase (ESBL) and multidrug-resistant (MDR) infections. Results : Escherichia coli was the leading pathogen (67.9%), followed by Klebsiella spp. (11.1%). The prevalence of ESBL-producing isolates reached 20.7%, while MDR organisms accounted for 11.15%. Alarming resistance rates were observed among Gram-negative bacteria to conventional β-lactams, including amoxicillin-clavulanate (61.7%), cefuroxime (53.2%), and cefixime (48.7%), as well as fluoroquinolones (36%), significantly exceeded the 10–20% clinical failure threshold. Longitudinal analysis demonstrated an upward trend in resistance to several β-lactams and aminoglycosides from 2019 to 2024. Conversely, nitrofurantoin and fosfomycin maintained the most favorable activity. Risk factors for resistant infections included male gender, advanced age, and specific geographic locations (pConclusions : The high prevalence of ESBL-producing pathogens and widespread β-lactam resistance suggest an emerging shift toward hospital-associated resistance patterns in community-acquired infections. These findings support the need to update the 2017 national treatment guidelines to reflect evolving local resistance trends. Strengthening antimicrobial stewardship efforts alongside continuous, structured surveillance is essential to optimize empirical therapy and limit further progression of AMR.
Hijazi et al. (Fri,) studied this question.