Alyaa M Ajabnoor,1,2 Abrar K Thabit,1 Ohood S Alharbi,3 Karem Ibrahem,4 Turki Asiri,5 Abdulrahman M Al-Ghamdi,3 Rakan F Felemban6 1Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; 2Division of Pharmacy 3Department of Microbiology and Parasitology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 4Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 5Department of Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia; 6Department of Laboratory and Blood Bank, Alnoor Specialist Hospital, Makkah, Saudi ArabiaCorrespondence: Alyaa M Ajabnoor, Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, P.O. BOX 80324, Jeddah, 21589, Saudi Arabia, Email ammajabnour@kau.edu.saBackground: Urinary tract infections (UTIs) are among the most prevalent bacterial infections worldwide, with notable variations in antimicrobial resistance (AMR) patterns influenced by age and sex. Local surveillance of resistance trends is essential for optimizing empirical treatment.Methods: This retrospective study analyzed urine culture data collected over a span of 7-year (2017â 2023) from a tertiary hospital in Saudi Arabia. The distribution of Pathogens and patterns of AMR were examined based on sex, age group, and year. Logistic regression was used to assess predictors of resistance.Results: The analysis included 3,201 urinary isolates from patients with culture-confirmed UTIs. E.coli was the predominant pathogen in most years, reaching up to 47.5%, but noted a decline in 2020 to 22.7% and further to 22% in 2023. In contrast, K. pneumoniae exhibited steady increase, peaking at 43.1% in 2023. The prevalence of antibiotic resistance to E coli was notably higher among older males (> 19 years), with exception of nitrofurantoin in younger males and ampicillin, ciprofloxacin, and sulfamethoxazole-trimethoprim in younger females (⤠18 years). In K. pneumoniae, younger males exhibited increased resistance to ampicillin, amoxicillin, and 3rd-generation cephalosporins, while females showed overall higher resistance levels, with the exception of ampicillin and nitrofurantoin, where younger females showed greater resistance. Male sex was significantly associated with resistance in E. coli to ampicillin (OR: 1.53, p=0.021), ciprofloxacin (OR: 1.47, p=0.026), imipenem (OR: 5.83, p=0.009), and in K. pneumoniae to gentamicin (OR: 1.85, p=0.001), ceftriaxone (OR: 2.44, p=0.008), ceftazidime (OR: 1.64, p=0.006), and imipenem (OR: 1.95, p=0.001). Age was inversely associated with imipenem resistance in E.coli (OR: 0.97, p=0.007).Conclusion: This study demonstrates significant variability in UTI pathogens and their resistance patterns based on sex and age. The findings support the need for targeted empirical treatment protocols and underscore the importance of ongoing monitoring of AMR.Plain Language Summary: Urinary tract infections (UTIs) are common and often treated with antibiotics. However, growing resistance to antibiotics makes treatment harder, especially when bacteria no longer respond to commonly used drugs. In this study, we analyzed 7 years of lab data from a large hospital in Saudi Arabia to understand which bacteria are causing UTIs and how resistant they are to antibiotics, especially among different age groups and between males and females.We found that E. coli and Klebsiella pneumoniae were the most common bacteria causing UTIs. Over time, Klebsiella infections increased and even became more common than E. coli in some years. Antibiotic resistance patterns were different depending on the patientâs age and sex. For example, older males had higher resistance to many antibiotics, while younger patients also showed resistance to certain drugs. We also found that male patients were more likely to have infections resistant to multiple antibiotics.These results show the importance of regularly monitoring local bacteria and their resistance to help doctors choose the right treatment. Understanding how resistance varies by age and sex can lead to more effective care and help reduce antibiotic misuse.Keywords: urine, resistance, E. coli, K. pneumoniae, antibiotics
Ajabnoor et al. (Wed,) studied this question.