Bacterial Etiology and Antimicrobial Resistance Patterns of Urinary Tract Infections in Sana’a, Yemen

Abstract

Background: Urinary tract infections (UTIs) are among the most common bacterial infections worldwide, significantly impacting morbidity and contributing to antibiotic misuse. Objective: This study aimed to investigate the bacterial etiologies and antimicrobial resistance patterns of UTIs in Sana'a, Yemen, to inform effective empirical treatment strategies. Methods: This retrospective study was conducted using microbiological test records from four major medical laboratories and two tertiary hospitals in Sana'a between January 2022 and December 2023.A total of 3,829 urine samples from individuals with suspected UTIs were evaluated. Standard microbiological techniques were used to identify bacterial isolates, and antibiotic susceptibility testing was carried out using the Kirby-Bauer disc diffusion method in accordance with CLSI standards. Results: Among the 3,829 samples analyzed, 72.2% of the isolates were identified as Gram-negative. The most prevalent uropathogen was Escherichia coli, accounting for 65.7%, followed by Pseudomonas spp., Klebsiella pneumoniae, and Staphylococcus aureus. High resistance rates were observed to commonly used antibiotics, including amoxicillin (94.1%), ampicillin (85.9%), and ceftazidime (79.6%). Notably, resistance to carbapenems such as imipenem (11.8%) and meropenem (16.6%) remained relatively low. Multidrug resistance (MDR) was prevalent among both Gram-positive and Gram-negative isolates. Conclusion: The high prevalence of E. coli and significant levels of antimicrobial resistance underscore the urgent need for antimicrobial stewardship and updated local treatment guidelines. Stratified analysis revealed higher resistance in hospital-acquired infections, emphasizing the need for setting-specific guidelines. Methodological differences and the inclusion of potential duplicate isolates may have influenced resistance estimates. These findings underscore the urgent need for antimicrobial stewardship, carbapenem-sparing protocols, and national surveillance. Future studies should incorporate clinical outcomes and expand to other regions to inform national policy. Regular surveillance of uropathogens and their resistance profiles is crucial to combatting the rising trend of antibiotic resistance in Yemen.