Retrospective study on antibiotic resistance profiles of uropathogenic Escherichia coli with emphasis on β-lactamase production in a tertiary hospital in Saudi Arabia

Objective Urinary tract infections (UTIs) remain a major public health concern with increasing antimicrobial resistance worldwide. This study aimed to evaluate the demographic distribution, antimicrobial resistance patterns, and trends of multidrug-resistant Escherichia coli isolated from UTI cases over 5 years. Methods A retrospective analysis was conducted on UTI isolates collected between 2019 and 2023. Demographic data, clinical setting (inpatient vs. outpatient), and antimicrobial susceptibility profiles were analyzed. Phenotypic and molecular detection of major resistance mechanisms was performed for selected isolates. Results A total of UTI cases showed a higher prevalence in females (57.5%), with most infections occurring in the elderly age group (61–80 years). A notable shift in healthcare settings was observed, with inpatient cases decreasing over time and outpatient cases increasing, suggesting a rise in community-associated infections. An increasing trend in antimicrobial resistance was observed among E. coli isolates, particularly against fluoroquinolones, cephalosporins, and carbapenems, while nitrofurantoin retained comparatively lower resistance rates. A rising proportion of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains was detected over the study period, with ESBL-producing isolates being the most common resistant phenotype. Conclusion The study demonstrates a concerning increase in antimicrobial resistance among UTI pathogens, along with a growing burden of MDR/XDR E. coli . These findings highlight the need for continuous surveillance, strengthened antimicrobial stewardship, and effective infection control strategies to limit further spread of resistant uropathogens.