Global trends in antibiotic prescription patterns and antimicrobial resistance in urinary tract infections: a scoping review

Background Urinary tract infections (UTIs) are infections affecting any part of the urinary system and are among the most common bacterial infections worldwide. Antimicrobial resistance (AMR) occurs when microorganisms no longer respond to medicines that previously treated them effectively. AMR among UTI-causing bacteria is a serious global health concern. Objective To map global evidence on antibiotic prescription patterns and reported antimicrobial resistance among urinary tract infections. Methods We conducted a scoping review and reported the review process in accordance with PRISMA-ScR. The review was guided by the Population–Concept–Context framework. A total of 2,051 records were identified; after removal of 1,033 duplicates, 1,018 records were screened, 321 full-text articles were assessed, 98 full-text articles were excluded, and 223 studies were included. Results The final review included 223 studies selected for analysis of antibiotic use and prescribing patterns. Among the final 223-study set, geographical region could be identified for 70 studies: Asia contributed 28.6%, the Middle East 24.3%, Europe 22.9%, Africa 15.7%, North America 7.1%, and South America 1.4%. Among the 223 studies reporting organism identification, the most frequently reported organisms were Escherichia coli (53.8%), Klebsiella pneumoniae (23.3%), and Pseudomonas aeruginosa (15.2%). Among the 223 studies reporting antibiotic-use information, ciprofloxacin was the most frequently reported antibiotic (29.1%), followed by nitrofurantoin (22.4%) and trimethoprim-sulfamethoxazole (20.2%). Reported resistance was highest for ofloxacin (78.7%), amoxicillin (72.1%), ampicillin (65.8%), and ciprofloxacin (56.7%). Lower reported resistance was observed for meropenem (2.9%), amikacin (7.5%), and fosfomycin (12.3%). Extended-spectrum beta-lactamase (ESBL) production was the most frequently reported resistance mechanism. Conclusions High levels of reported antimicrobial resistance were observed across multiple regions, particularly for several commonly used antibiotics. The findings support appropriate antibiotic prescribing, antimicrobial stewardship, continued surveillance, and consideration of a One Health approach.