Antimicrobial Resistance Phenotypes and Clinical Predictors of Multidrug-Resistant Uropathogens among Patients with Urinary Tract Infection: A Cross-Sectional Study

Abstract

Background & objectives: Multidrug-resistant (MDR) uropathogens complicate empirical treatment of urinary tract infection (UTI), particularly in settings with frequent healthcare exposure. This study evaluated antimicrobial resistance phenotypes and clinical factors associated with MDR among adults with culture-confirmed UTI.
Methods: A hospital-based analytical cross-sectional study included 425 adults with culture-confirmed bacterial UTI at a tertiary-care teaching hospital in Moradabad, India, from January to August 2026. Uropathogen distribution, antimicrobial resistance patterns and relevant clinical exposures were recorded. Factors associated with MDR were assessed using univariable and multivariable logistic regression.
Results: MDR was identified in 252 (59.3%) isolates. Escherichia coli was the predominant uropathogen (64.9%), followed by Klebsiella pneumoniae (15.1%). Among E. coli, resistance to ciprofloxacin and ceftriaxone was 51.8% and 51.4%, respectively, whereas resistance to nitrofurantoin and fosfomycin was 14.9% and 6.9%. Recurrent UTI (aOR 1.77, 95% CI 1.07-2.93), hospitalisation within 90 days (aOR 2.94, 1.62-5.34) and urinary catheterisation (aOR 3.19, 1.44-7.06) were independently associated with MDR. Sensitivity analysis using non-susceptibility increased MDR prevalence to 67.5% but retained the same three independent clinical associations overall.
Interpretation & Conclusions: MDR was common in culture-confirmed UTI. Recent hospitalisation, recurrent UTI and urinary catheterisation may help identify patients at greater risk while awaiting susceptibility results.