Int J Curr Pharm Res, Vol 18, Issue 1, 42-46Original Article

ANTIMICROBIAL RESISTANCE PATTERNS OF UROPATHOGENS CAUSING URINARY TRACT INFECTIONS AMONG THE ADULTS IN A TERTIARY CARE CENTRE-A DESCRIPTIVE STUDY

K. G. SATHEESH KUMAR1, UPPU BHARATHI1*, M. ASHA LATHA1, N. SRIVANI2

1Department of Pharmacology, SVMC, Tirupati--517507, Andhra Pradesh, India, 2Department of Microbiology, SVMC, Tirupati--517507, Andhra Pradesh, India. *Corresponding author: Uppu Bharathi; *Email: ubharathi1212@gmail.com

Received: 06 Oct 2025, Revised and Accepted: 26 Nov 2025

ABSTRACT

Objective: Urinary tract infections (UTIs) are among the most common bacterial infections worldwide, particularly affecting women. Rising antimicrobial resistance has made management increasingly challenging, especially in resource-limited settings. This study aimed to identify the predominant uropathogens causing UTIs in adults and evaluate their antimicrobial resistance patterns in a tertiary care hospital in Tirupati, Andhra Pradesh.

Methods: A descriptive study was conducted over three months (January–March 2025) in the Department of Microbiology. A total of 180 clean-catch midstream urine samples were collected from adults aged >18 years. Samples were cultured and isolates were identified by microbiological techniques. Antimicrobial susceptibility testing was performed using Kirby–Bauer disc diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results: Of the 180 patients, 71% were female, showing higher prevalence of UTIs in women. Infections were most frequent among individuals>60 years, followed by those in their 30s. Most samples were from the General Medicine department. Escherichia coli was the most common isolate, followed by Klebsiella pneumoniae. Both exhibited high resistance to amoxyclav and ciprofloxacin but were more susceptible to imipenem and nitrofurantoin. Pseudomonas aeruginosa and Proteus mirabilis also showed notable resistance. Among g-positive organisms, Enterococcus faecalis largely sensitive to linezolid and vancomycin.

Conclusion: The study highlights significant antimicrobial resistance among UTI pathogens. Routine surveillance and rational antibiotic prescribing based on local susceptibility data are essential to prevent resistance and improve outcomes.

Keywords: Urinary tract infection, Uropathogens, Antimicrobial resistance, Multi-drug resistance, Antibiotic stewardship, Kirby–bauer method

© 2026 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/)
DOI: https://dx.doi.org/10.22159/ijcpr.2026v18i1.8009 Journal homepage: https://innovareacademics.in/journals/index.php/ijcpr

INTRODUCTION

Urinary Tract Infections (UTIs) refer to infections that affect any part of the urinary system, including the kidneys, ureters, bladder, or urethra [1]. UTIs are one of the most common bacterial infections in humans, accounting for approximately 25% of all bacterial infections [2]. These infections contribute significantly to morbidity and are the second most common reason for hospital visits. Globally, around 150 million people are diagnosed with UTIs every year, leading to economic burdens exceeding 6 billion US dollars annually [3].

The risk of UTIs increases in males over the age of 60 due to prostate enlargement, which obstructs the flow of urine from the bladder [4]. However, the prevalence of UTIs is much higher among females, with about 50% of women experiencing at least one UTI in their lifetime, and 20% to 40% of these women experiencing recurrent infections. In comparison, men account for only about 20% of reported UTI cases [5]. Several factors contribute to the higher incidence of UTIs in adult females, including sexual activity and pregnancy [6].

UTIs are commonly caused by both g-negative and g-positive bacteria, along with certain fungi [7]. In most cases of uncomplicated UTIs, the infections are acquired in the community and are mainly attributed to uropathogenic Escherichia coli (UPEC) and Klebsiella species, which together are responsible for approximately 75–95% of all UTIs. Less frequently, other pathogens such as Proteus species, Enterobacter species, Pseudomonas species, Enterococcus faecalis, Staphylococcus saprophyticus, and Staphylococcus aureus can also cause UTIs [8].

The rise of antibiotic-resistant bacterial strains is a growing concern in the treatment and management of UTIs, especially in low-income countries, where the prevalence of infections is high, and irrational antibiotic use combined with inadequate infection prevention measures exacerbates the problem [9]. The patterns of antimicrobial resistance in uropathogens can change over time and vary across different geographical regions. Therefore, it is essential to regularly monitor antimicrobial susceptibility within each region to ensure current and accurate epidemiological data [10]. This study aims to investigate the antimicrobial resistance patterns of various uropathogens isolated from UTI patients, providing vital information for better management and treatment strategies.

MATERIALS AND METHODS

A total of 180 clean catch midstream urine samples from patients above 18 y of age were received from various departments and processed in the in the Department of Microbiology. The samples inoculated on Cystine Lactose Electrolyte Deficient (CLED) agar, and species-level identification done by biochemical tests according to standard guidelines. Antibiotic susceptibility testing was performed using the Kirby-Bauer disc diffusion method as per CLSI guidelines.

Study design

This Descriptive study was conducted in Dept. of Microbiology of a tertiary care hospital in Tirupati, Andhra Pradesh, from Jan 2025 to March 2025 after obtaining clearance from Institutional Ethics Committee. (Approval letter No.03/2025)

Study population

Received Urine Samples in the Microbiology laboratory, S. V. Medical College, Tirupati.

Inclusion criteria

All urine samples from patients aged 18 y or older, received from various departments with a diagnosis of UTI, were included in the study after confirmation of UTI by microscopic examination in the Department of Microbiology.

Isolation, identification, and characterization of organism

Samples were cultured aerobically on CLED agar, and strains having significant growth (>105cfu/ml) were further processed for identification using standard microbiological techniques [11].

The antibiotic susceptibility test was done by the Kirby-Bauer disc diffusion method by following standard procedures as per CLSI guidelines [12].

Data analysis

All data were maintained in Microsoft Office Excel and appropriate statistical tools were used wherever required.

RESULTS

Gender wise distribution of UTI cases

Table 1 illustrate the gender distribution of UTI cases. Among the 180 cases analyzed, 71.11% (128 cases) were females, while 28.89% (52 cases) were males, indicating a higher prevalence of UTI in females.

Table 1: Gender wise distribution of UTI cases

Gender Frequency (%) Total
Male 28.89% 52
Female 71.11% 128

Age-wise distribution of UTI cases

Table 2 presents the frequency distribution of UTI cases across different age groups. The highest prevalence was observed in individuals above 60 y (31.11%, 56 cases), followed by the 31-40 age group (21.66%, 39 cases). The lowest prevalence was noted in the 51-60 age group (11.66%, 21 cases).

Department-wise distribution of UTI cases

Table 3 depict the distribution of UTI cases across major hospital departments. General Medicine reported the highest number of cases (37.8%, 68 cases), followed by General Surgery (32.8%, 59 cases) and obstetrics and gynecology (OBG) (29.4%, 53 cases).

Table 2: Age-wise distribution of UTI cases

Age Frequency (%) Total
19-30 32 (17.77%) 36
31-40 39 (21.66%) 37
41-50 32 (17.77%) 32
51-60 21 (11.66%) 21
>60 56(31.11%) 54

Table 3: Total no of samples received from major departments

Department Frequency Total
General medicine 37.8% 68
General surgery 32.8% 59
OBG 29.4% 53
Total 100% 180

Table 4: Organisms

Gram negative Gram positive
E. coli Enterococcus faecalis
Klebsiella pneumoniae
Pseudomonas aeruginosa
Proteus mirabilis

Gram-negative urinary pathogens resistant (R) to antimicrobial agents

Table 5 shows that Escherichia coli was most resistant to both amoxyclav and ciprofloxacin, with 73.2% of isolates showing resistance. Norfloxacin resistance was also significant at 60.6%, while fewer strains were resistant to nitrofurantoin (16.9%) and imipenem (11.3%). Klebsiella pneumoniae had even higher resistance to amoxyclav (85.7%) and ciprofloxacin (74.6%), with a similarly high resistance to nitrofurantoin (74.6%) and norfloxacin (60.3%). Resistance to imipenem (34.9%) and piperacillin-tazobactam (49.2%) was moderate. Proteus mirabilis showed 83.3% resistance to nitrofurantoin and 66.7% to amoxyclav, while resistance to norfloxacin and ciprofloxacin was at 50% each. It had relatively lower resistance to piperacillin-tazobactam (33.3%) and imipenem (16.7%). Meanwhile, Pseudomonas aeruginosa exhibited 92% resistance to amoxyclav and 76% to norfloxacin, with 80% resistance to ciprofloxacin and 72% to nitrofurantoin. Resistance to imipenem (48%) and piperacillin-tazobactam (60%) was comparatively lower but still notable.

Table 5: Overall number (%) of g-negative urinary pathogens resistant (R) to antimicrobial agents

Antibiotics E. coli (71) Klebsiella pneumoniae (63) Proteus mirabilis (6) Pseudomonas aeruginosa (25)
Amoxyclav 52 (73.2%) 54 (85.7%) 4 (66.7%) 23(92%)
Ciprofloxacin 52 (73.2%) 47 (74.6%) 3 (50.0%) 20 (80.0%)
Imipenem 8 (11.3%) 22 (34.9%) 1 (16.7%) 12 (48.0%)
Nitrofurantoin 12 (16.9%) 47 (74.6%) 5 (83.3%) 18 (72.0%)
Piperacillin-Tazobactam 20 (28.2%) 31 (49.2%) 2 (33.3%) 15 (60.0%)
Norfloxacin 43 (60.6%) 38 (60.3%) 3 (50.0%) 19 (76%)

Gram-positive urinary pathogens resistant(R) to antimicrobial agents

Table 6 shows Enterococcus faecal is was most resistant to ciprofloxacin, with 46.7% of the samples not responding to it. The next highest resistance was to norfloxacin at 40%. About 27% of the samples were also resistant to tetracycline. Only a small number of samples (6.7%) were resistant to vancomycin and nitrofurantoin. All the samples were sensitive to linezolid.

Table 6: Overall number (%) of g-positive urinary pathogens resistant(R) to antimicrobial agents

Antibiotics Enterococcus faecalis (15)
Vancomycin 1 (6.7%)
Ciprofloxacin 7 (46.7%)
Linezolid 0 (0%)
Nitrofurantoin 1 (6.7%)
Tetracycline 4 (26.7%)
Norfloxacin 6 (40.0%)

DISCUSSION

Urinary tract infections (UTIs) are a common health problem seen in many people, both in hospitals and in daily life. They are caused by different germs, and the best medicine to treat them can change over time. That’s why it’s important to regularly check which antibiotics are working in a local area. This helps doctors choose the right treatment and take better care of patients.

Our finding that about 71% of UTI cases were in females lines up closely with what many other studies have reported. For example, Magliano et al. found that nearly 80% of UTI cases occurred in women [13], and Lo et al. observed a similar figure around 73% [14]. Harrington et al. noted that young, sexually active women are especially at risk, which helps explain why the numbers are so high [15]. Deltourbe et al. also emphasized that UTIs are generally much more common in women than men [16]. Even research focused on specific treatments, like the study by Bhat et al., showed that women made up 80% of UTI cases [17]. Altogether, these studies strongly support our observation that women are far more affected by UTIs than men, a trend seen consistently across different populations and healthcare settings.

Women are more likely to get UTIs than men, and there are some clear reasons behind it. Bono MJ et al. pointed out that women have a shorter urethra, which means bacteria don’t have to travel far to reach the bladder [18]. Hooton et al. added that the urethra is also closer to the anus, making it easier for bacteria to enter [19]. Scholes et al. found that being sexually active can raise the risk too, since it can push bacteria into the urinary tract [20]. And as Raz et al. explained, after menopause, falling estrogen levels can make the urinary tract more fragile and less protected [21]. Put all these factors together, and it’s easy to see why UTIs are more common in women.

In our study, we found that urinary tract infections (UTIs) were most common in people over 60 y old (31.11%), followed by those in the 31–40 age group (21.66%). Interestingly, the 51–60 age group had the lowest number of cases (11.66%). This trend is quite similar to what Janifer et al. observed—they also saw that older adults are more likely to be affected by UTIs [22]. However, Prakash D et al. found a different pattern, with more cases in women aged 26–36 and men aged 48 and above [23]. Sowjanya et al. also had different results, reporting the highest number of cases among women of reproductive age [24]. These differences might be explained by things like hormonal shifts, levels of sexual activity, or even the specific patient groups each study focused on.

In our study, we found that most urinary tract infection (UTI) cases were reported from the General Medicine department (37.8%), followed by General Surgery (32.8%) and Obstetrics and Gynecology (29.4%). This pattern closely matches the findings of Chandrasekhar D et al., who also observed more UTI cases in General Medicine—likely because patients in this department often have multiple underlying conditions that raise their risk [25]. Similarly, Kamat US et al. reported a higher number of UTI cases in both Medicine and Surgery departments, which could be due to factors like prolonged catheter use, surgical interventions, and frequent exposure to antibiotics that are common in these hospital settings [26].

Escherichia coli showed high resistance to amoxyclav and ciprofloxacin (73.2%), and Klebsiella pneumoniae displayed even higher resistance to amoxyclav (85.7%) and ciprofloxacin (74.6%), while nitrofurantoin and imipenem retained better efficacy. These findings are in line with Mortazavi-Tabatabaei SAR et al., who also reported high resistance in E. coli to amoxicillin/clavulanic acid and ciprofloxacin, but lower resistance to nitrofurantoin and imipenem [27]. In contrast, Caskurlu H et al. documented a lower resistance rate to ciprofloxacin (rising up to 43%) among E. coli strains, which is considerably below our finding of 73.2% [28]. Also, Yılmaz Net al. found resistance to nitrofurantoin in E. coli to be less than 1%, markedly different from our 16.9% [29]. Additionally, Abdullah FE et al., reported lower resistance rates for Klebsiella pneumoniae to ciprofloxacin, in contrast to the elevated levels seen in our study [30]. Pseudomonas aeruginosa showed high resistance to several commonly used antibiotics—amoxyclav (92%), ciprofloxacin (80%), norfloxacin (76%), and nitrofurantoin (72%). Resistance to imipenem (48%) and piperacillin-tazobactam (60%) was comparatively moderate. These results are in line with findings from Khan MA et al., who also reported high resistance to ciprofloxacin, nitrofurantoin, and β-lactam antibiotics in Pseudomonas strains isolated from UTI patients [31]. On the other hand, Marepalli et al. found much lower resistance rates to ciprofloxacin (20%) and nitrofurantoin (15%), suggesting that regional differences in antibiotic usage and microbial exposure might influence resistance patterns [32]. Similarly, Abdullah FE and colleagues observed lower resistance to piperacillin-tazobactam and imipenem, which could be attributed to stricter infection control practices or differing hospital policies during their study period [30] Enterococcus faecalis exhibited the highest resistance to ciprofloxacin (46.7%), followed by norfloxacin (40%) and tetracycline (26.7%). Linezolid resistance was observed in 13.3% of isolates, while vancomycin and nitrofurantoin were the most effective, with only 6.7% resistance each. These findings are in line with those of Lee G et al., who also observed a 47% resistance rate to ciprofloxacin and 58% to norfloxacin, closely mirroring our results [33]. Similarly, Balaei Gajan E et al. reported that E. faecalis isolates showing 44% resistance to ciprofloxacin, 44% to doxycycline (a tetracycline group antibiotic), and low resistance to linezolid (5.1%), vancomycin (3.6%), and nitrofurantoin (18.6%) in hospitalized patients with UTIs [34]. On the other hand, a study by Goel V et al. from North India reported much higher resistance rates-74.8% to ciprofloxacin and 66.1% to norfloxacin—suggesting that regional differences in antibiotic usage and local microbial patterns may significantly influence resistance trends [35].

Antibiotic resistance in urinary tract infections (UTIs) happens for several reasons. Gupta et al. pointed out that when antibiotics, especially broad-spectrum ones, are overused or misused, it creates the perfect conditions for resistant bacteria to thrive [36]. Ventola et al. added that not finishing a full course of antibiotics can leave behind some bacteria, which then adapt and become harder to kill next time. In some places, people can get antibiotics without a prescription, which often leads to self-medication and improper use [37]. On top of that, Donlan and Costerton explained that some bacteria, like Pseudomonas aeruginosa and Klebsiella pneumoniae, form biofilms,a kind of protective shield that help them survive even in the presence of antibiotics [38]. All these factors together explain why we’re seeing such strong resistance patterns in our study.

ACKNOWLEDGEMENT

Nil

FUNDING

Nil

AUTHORS CONTRIBUTIONS

All authors have contributed equally

CONFLICT OF INTERESTS

Declared none

REFERENCES

  1. Ms Mahale DG, Dr Chavan R. Evaluation of antibiotic resistance pattern of uropathogens in patients with urinary tract infection in a Tertiary Care Center, North Maharashtra. J Popul Ther Clin Pharmacol. 2023;30(10):567-71. doi: 10.53555/jptcp.v30i10.3585.

  2. Mehta A, Gupta HK, Tripathi K. Antimicrobial susceptibility pattern of uropathogens at a Tertiary Care Hospital in Central India during covid era. Int J Pharm Pharm Sci. 2023;15(5):28-33. doi: 10.22159/ijpps.2023v15i5.47533.

  3. Praseetha MJ, Shantala GB, Ambica R, Kusuma GR. Trends in antimicrobial resistance in commonly isolated uropathogens in a Tertiary Care Hospital before and during COVID‑19. RGUHS National Journal of Public Health. 2022;7(4):135–9. doi: 10.26463/rnjph.7_4_5.

  4. Debbarma M, Behera B, Rout B, Panigrahy R, Baral P. A glimpse into the resistant pattern of uropathogens: an overview. J Pure Appl Microbiol. 2022;16(4):2310-6. doi: 10.22207/JPAM.16.4.35.

  5. Mohanty JR, Pradhan A, Jena S, Padhi BK, Das P, Soren D. Antibiotic resistance pattern of uropathogens among non-pregnant women: a hospital-based cross-sectional study from Odisha. J Pure Appl Microbiol. 2022;16(1):296-304. doi: 10.22207/JPAM.16.1.18.

  6. Ahirwar N, Singha TK, Srivastava M, Pal M. Epidemiological study of the antimicrobial resistance pattern of a suspected urinary tract infection in a super surgical super specialty hospital in Northern India. Med Sci Forum. 2024;24(1):16. doi: 10.3390/ECA2023‑16468.

  7. Mendem S, Vinyas M, Faraz MA, Swamy MV, Shubham P. A retrospective study on the prevalence of urinary tract infections in a Tertiary Care Hospital in Sangareddy district of South India. Int J Reprod Contracept Obstet Gynecol. 2020 Jul 23;9(8):3422. doi: 10.18203/2320-1770.ijrcog20203335.

  8. Mohapatra S, Panigrahy R, Tak V, JS, KCS, Chaudhuri S. Prevalence and resistance pattern of uropathogens from community settings of different regions: an experience from India. Access Microbiol. 2022 Feb 9;4(2):000321. doi: 10.1099/acmi.0.000321, PMID 35355869.

  9. Kande S, Patro S, Panigrahi A, Khora PK, Pattnaik D. Prevalence of uropathogens and their antimicrobial resistance pattern among adult diabetic patients. Indian J Public Health. 2021 Jul-Sep;65(3):280-6. doi: 10.4103/ijph.IJPH_1413_20, PMID 34558491.

  10. Bhargava K, Nath G, Bhargava A, Kumari R, Aseri GK, Jain N. Bacterial profile and antibiotic susceptibility pattern of uropathogens causing urinary tract infection in the eastern part of Northern India. Front Microbiol. 2022;13:965053. doi: 10.3389/fmicb.2022.965053, PMID 36016776.

  11. Vadivelu N, Parmar RD, Shingala H, Mehta KD. Comparison of chromogenic and cysteine lactose electrolyte-deficient agar for identification of uropathogens in Gujarat, India. Afr J Lab Med. 2025 Feb 10;14(1):2551. doi: 10.4102/ajlm.v14i1.2551, PMID 40061864.

  12. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. 31st ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2021.

  13. Magliano E, Grazioli V, Deflorio L, Leuci AI, Mattina R, Romano P. Gender and age-dependent etiology of community-acquired urinary tract infections. Scientific World Journal. 2012;2012:349597. doi: 10.1100/2012/349597, PMID 22629135.

  14. Lo DS, Shieh HH, Ragazzi SL, Koch VH, Martinez MB, Gilio AE. Community-acquired urinary tract infection: age and gender-dependent etiology. J Bras Nefrol. 2013 Apr-Jun;35(2):93-8. doi: 10.5935/0101-2800.20130016, PMID 23812565.

  15. Harrington RD, Hooton TM. Urinary tract infection risk factors and gender. J Gend Specif Med. 2000 Nov-Dec;3(8):27-34. PMID 11253265.

  16. Deltourbe L, Lacerda Mariano L, Hreha TN, Hunstad DA, Ingersoll MA. The impact of biological sex on diseases of the urinary tract. Mucosal Immunol. 2022 May;15(5):857-66. doi: 10.1038/s41385-022-00549-0, PMID 35869147.

  17. Bhat MH, Baba MS, Alam ME, Bhat AH, Mir S, Dar BQ. Gender differences in the clinical profile of sodium-glucose cotransporter-2 inhibitor-related urinary tract infections. Cureus. 2024 Aug 23;16(8):e67590. doi: 10.7759/cureus.67590, PMID 39310616.

  18. Bono MJ, Leslie SW, Reygaert WC. Uncomplicated urinary tract infections. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023–2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470195/. [Last accessed on 21 Feb 2025].

  19. Minardi D, D’Anzeo G, Cantoro D, Conti A, Muzzonigro G. Urinary tract infections in women: etiology and treatment options. Int J Gen Med. 2011;4:333-43. doi: 10.2147/IJGM.S11767, PMID 21674026.

  20. Scholes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE. Risk factors for recurrent urinary tract infection in young women. J Infect Dis. 2000 Oct;182(4):1177-82. doi: 10.1086/315827, PMID 10979915.

  21. Raz R. Postmenopausal women with recurrent UTI. Int J Antimicrob Agents. 2001 Apr;17(4):269-71. doi: 10.1016/s0924-8579(00)00355-1, PMID 11295406.

  22. Janifer J, Geethalakshmi S, Satyavani K, Viswanathan V. Prevalence of lower urinary tract infection in south Indian type 2 diabetic subjects. Indian J Nephrol. 2009 Jul;19(3):107-11. doi: 10.4103/0971-4065.57107, PMID 20436730.

  23. Prakash D, Saxena RS. Distribution and antimicrobial susceptibility pattern of bacterial pathogens causing urinary tract infection in urban community of Meerut City, India. ISRN Microbiol. 2013 Oct 29;2013:749629. doi: 10.1155/2013/749629, PMID 24288649.

  24. Sowjanya M, Kumar AA, Prasad SV, Prasad K. A retrospective study on the prevalence of urinary tract infections in a Tertiary Care Hospital in Sangareddy district of South India. Int J Reprod Contracept Obstet Gynecol. 2020;9(8):3332-6.

  25. Chandrasekhar D, Dollychan A, Roy BM, Cholamughath S, Parambil JC. Prevalence and antibiotic utilization pattern of uropathogens causing community-acquired urinary tract infection in Kerala, India. J Basic Clin Physiol Pharmacol. 2018 Nov 27;29(6):671-7. doi: 10.1515/jbcpp-2018-0015, PMID 30063465.

  26. Kamat US, Fereirra A, Amonkar D, Motghare DD, Kulkarni MS. Epidemiology of hospital-acquired urinary tract infections in a medical college hospital in Goa. Indian J Urol. 2009 Jan;25(1):76-80. doi: 10.4103/0970-1591.45542, PMID 19468434.

  27. Mortazavi Tabatabaei SA, Ghaderkhani J, Nazari A, Sayehmiri K, Sayehmiri F, Pakzad I. Pattern of antibacterial resistance in urinary tract infections: a systematic review and meta-analysis. Int J Prev Med. 2019 Oct 9;10:169. doi: 10.4103/ijpvm.IJPVM_419_17, PMID 32133087.

  28. Caskurlu H, Culpan M, Erol B, Turan T, Vahaboglu H, Caskurlu T. Changes in antimicrobial resistance of urinary tract infections in adult patients over a 5-y period. Urol Int. 2020;104(3-4):287-92. doi: 10.1159/000504415, PMID 31940639.

  29. Yılmaz N, Agus N, Bayram A, Samlıoglu P, Sirin MC, Derici YK. Antimicrobial susceptibilities of Escherichia coli isolates as agents of community-acquired urinary tract infection (2008-2014). Turk J Urol. 2016 Mar;42(1):32-6. doi: 10.5152/tud.2016.90836, PMID 27011879.

  30. Abdullah FE, Mushtaq A, Irshad M, Rauf H, Afzal N, Rasheed A. Current efficacy of antibiotics against Klebsiella isolates from urine samples a multi-centric experience in Karachi. Pak J Pharm Sci. 2013 Jan;26(1):11-5. PMID 23261722.

  31. Khan MA, Rahman AU, Khan B, Al-Mijalli SH, Alswat AS, Amin A. Antibiotic resistance profiling and phylogenicity of uropathogenic bacteria isolated from patients with urinary tract infections. Antibiotics (Basel). 2023 Oct 3;12(10):1508. doi: 10.3390/antibiotics12101508, PMID 37887209.

  32. Marepalli NR, Nadipelli AR, Manohar Kumar Jain RJ, Parnam LS, Vashyani A. Patterns of antibiotic resistance in urinary tract infections: a retrospective observational study. Cureus. 2024 Jun 20;16(6):e62771. doi: 10.7759/cureus.62771, PMID 39036226.

  33. Lee G. Ciprofloxacin resistance in Enterococcus faecalis strains isolated from male patients with complicated urinary tract infection. Korean J Urol. 2013 Jun;54(6):388-93. doi: 10.4111/kju.2013.54.6.388, PMID 23789048.

  34. Balaei Gajan E, Shirmohammadi A, Aghazadeh M, Alizadeh M, Sighari Deljavan A, Ahmadpour F. Antibiotic resistance in Enterococcus faecalis isolated from hospitalized patients. J Dent Res Dent Clin Dent Prospects. 2013;7(2):102-4. doi: 10.5681/joddd.2013.018, PMID 23875089.

  35. Goel V, Kumar D, Kumar R, Mathur P, Singh S. Community-acquired enterococcal urinary tract infections and antibiotic resistance profile in North India. J Lab Physicians. 2016 Jan-Jun;8(1):50-4. doi: 10.4103/0974-2727.176237, PMID 27013814.

  36. Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011 Mar 1;52(5):e103-20. doi: 10.1093/cid/ciq257, PMID 21292654.

  37. Ventola CL. The antibiotic resistance crisis: part 1: Causes and threats. PT. 2015 Apr;40(4):277-83. PMID 25859123.

  38. Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev. 2002 Apr;15(2):167-93. doi: 10.1128/CMR.15.2.167-193.2002, PMID 11932229.