Evaluation of Urine Culture Results and Antibiotic Resistance Patterns in the Emergency Department Between 2020 and 2023

Objective: Urinary tract infections (UTIs) are one of the most common infectious diseases encountered in emergency departments (EDs), and increasing antimicrobial resistance has become a significant challenge in managing these infections. This study evaluated the antibiotic resistance patterns of pathogens isolated from urine cultures obtained from patients presenting to the ED between 2020 and 2023 and investigated the changes in resistance rates over time.
Material and Methods: This was a retrospective, single-center study. Urine culture and antibiogram results of patients aged 18 years who presented with a preliminary diagnosis of UTI between January 1, 2020, and December 31, 2023, were reviewed. Data were collected from electronic patient records, and pathogens isolated in cultures were analyzed according to antibiotic susceptibility.
Results: A total of 978 patients who had urine cultures requested were included in the study. Growth was detected in 258 (26.4%) patients. The median age of patients with positive cultures was 55.5 years (interquartile range: 35-74.25), and 69.8% were female. The most frequently isolated pathogen was Escherichia coli (61.6%), followed by Klebsiella pneumoniae (19%). Ampicillin (38%), ceftriaxone (32.9%), ciprofloxacin (28.3%), and trimethoprim-sulfamethoxazole (TMP/SMX) (24.4%) had the highest resistance rates. Resistance to antibiotics such as meropenem, amikacin, and gentamicin was also lower. An increase in resistance rates was observed for amoxicillin-clavulanate, ampicillin, and TMP/SMX between 2020 and 2023.
Conclusion: Our study shows that the UTI pathogens most commonly isolated from patients presenting to the ED exhibit increasing resistance rates to widely used antibiotics. These findings highlight the need for empirical antibiotic therapy to be guided by local resistance patterns and regularly updated. Continuous monitoring of local antibiogram data is crucial for reducing antibiotic resistance and improving patient outcomes.

Keywords: Urinary tract infections, emergency department, antibiotic resistance, Escherichia coli, Klebsiella pneumoniae, urine cultures